Comparative Evaluation of Non-contrast MRI Versus Gadoxetic Acid-enhanced Abbreviated Protocols in Detecting Colorectal Liver Metastases

Overview

Journal Insights Imaging

Publisher Springer

Specialty Radiology

Date 2025 Jan 3

PMID 39747788

Authors

Haoran Dai

Cheng Yan

Xi Jia

Yuyao Xiao

Xinyue Liang

Chun Yang

Kai Liu

Mengsu Zeng

Affiliations

Soon will be listed here.

Abstract

Purpose: This study compares the diagnostic efficacy of non-contrast abbreviated MRI protocols with Gadoxetic acid-enhanced abbreviated MRI for detecting colorectal liver metastasis (CRLM), focusing on lesion characterization and surveillance.

Methods: Ninety-four patients, including 55 with pathologically verified CRLM, were enrolled, totaling 422 lesions (287 metastatic, 135 benign). Two independent readers assessed three MRI protocols per patient: Protocol 1 included non-contrast sequences (T2-weighted turbo spin-echo, T1-weighted Dixon, diffusion-weighted imaging (DWI), and ADC mapping). Protocol 2 included gadoxetic acid enhancement with hepatobiliary phase imaging, T2 TSE, DWI, and ADC maps. Protocol 3 utilized the standard Gadoxetic Acid-enhanced MRI sequence, which included pre-contrast T1-weighted imaging, T1-weighted Dixon sequences, post-contrast T1-weighted imaging (including arterial, portal venous, transitional and hepatobiliary phases), and additional T2-weighted and DWI sequences. Diagnoses were scored on a 5-point scale (benign = 1; malignant = 5), with scores ≥ 3 indicating CRLM. ROC curves analyzed diagnostic accuracy, comparing area under the curve (AUC) values across protocols.

Results: No significant difference in AUCs was observed between Protocol 1 (0.899-0.909) and Protocol 2 (0.906-0.931) versus Protocol 3 (0.935-0.939) (p = 0.091-0.195). For lesions ≤ 10 mm, Protocol 1 was slightly inferior to Protocol 3 (p = 0.002-0.032), while Protocol 2 remained comparably effective (p = 0.096-0.179). These findings held when using a threshold of ≥ 4 to define CRLM.

Conclusion: The non-enhanced abbreviated MRI protocol is as effective as the gadoxetic acid-enhanced protocol in identifying CRLM. The proposed Ab-MRI approach may be a viable alternative for CRLM surveillance.

Critical Relevance Statement: The non-enhanced abbreviated MRI (Ab-MRI) protocol is as effective as the gadoxetic acid-enhanced protocol in identifying colorectal liver metastasis (CRLM). The proposed Ab-MRI approach may be a viable alternative for CRLM surveillance.

Key Points: Two abbreviated protocols are proposed for colorectal liver metastasis (CRLM) surveillance. The non-enhanced protocol showed equivalent efficacy and was more cost-effective. The non-enhanced protocol may be a viable alternative for CRLM surveillance.

References

Czauderna C, Luley K, von Bubnoff N, Marquardt J . Tailored Systemic Therapy for Colorectal Cancer Liver Metastases. Int J Mol Sci. 2021; 22(21). PMC: 8584068. DOI: 10.3390/ijms222111780. View

Ozaki K, Ishida S, Higuchi S, Sakai T, Kitano A, Takata K . Diagnostic performance of abbreviated gadoxetic acid-enhanced magnetic resonance protocols with contrast-enhanced computed tomography for detection of colorectal liver metastases. World J Radiol. 2022; 14(10):352-366. PMC: 9630987. DOI: 10.4329/wjr.v14.i10.352. View

Whang S, Choi M, Choi J, Youn S, Kim D, Eun Rha S . Comparison of diagnostic performance of non-contrast MRI and abbreviated MRI using gadoxetic acid in initially diagnosed hepatocellular carcinoma patients: a simulation study of surveillance for hepatocellular carcinomas. Eur Radiol. 2020; 30(8):4150-4163. DOI: 10.1007/s00330-020-06754-4. View

Barat M, Soyer P, Dautry R, Pocard M, Lo-Dico R, Najah H . Preoperative detection of malignant liver tumors: Comparison of 3D-T2-weighted sequences with T2-weighted turbo spin-echo and single shot T2 at 1.5 T. Eur J Radiol. 2018; 100:7-13. DOI: 10.1016/j.ejrad.2018.01.007. View

Attiyeh M, Malhotra G, Li D, Manoukian S, Motarjem P, Singh G . Defining MRI Superiority over CT for Colorectal and Neuroendocrine Liver Metastases. Cancers (Basel). 2023; 15(20). PMC: 10605771. DOI: 10.3390/cancers15205109. View

Ivey G, Johnston F, Azad N, Christenson E, Lafaro K, Shubert C . Current Surgical Management Strategies for Colorectal Cancer Liver Metastases. Cancers (Basel). 2022; 14(4). PMC: 8870224. DOI: 10.3390/cancers14041063. View

Patel R, Rahman S, Schwantes I, Bartlett A, Eil R, Farsad K . Updated Management of Colorectal Cancer Liver Metastases: Scientific Advances Driving Modern Therapeutic Innovations. Cell Mol Gastroenterol Hepatol. 2023; 16(6):881-894. PMC: 10598050. DOI: 10.1016/j.jcmgh.2023.08.012. View

Granata V, Fusco R, Avallone A, Cassata A, Palaia R, Delrio P . Abbreviated MRI protocol for colorectal liver metastases: How the radiologist could work in pre surgical setting. PLoS One. 2020; 15(11):e0241431. PMC: 7676687. DOI: 10.1371/journal.pone.0241431. View

Besa C, Lewis S, Pandharipande P, Chhatwal J, Kamath A, Cooper N . Hepatocellular carcinoma detection: diagnostic performance of a simulated abbreviated MRI protocol combining diffusion-weighted and T1-weighted imaging at the delayed phase post gadoxetic acid. Abdom Radiol (NY). 2016; 42(1):179-190. DOI: 10.1007/s00261-016-0841-5. View

10.

Yang J, Heimbach J . New advances in the diagnosis and management of hepatocellular carcinoma. BMJ. 2020; 371:m3544. DOI: 10.1136/bmj.m3544. View

11.

Yu M, Kim J, Yoon J, Kim H, Chung J, Han J . Small (≤1-cm) hepatocellular carcinoma: diagnostic performance and imaging features at gadoxetic acid-enhanced MR imaging. Radiology. 2014; 271(3):748-60. DOI: 10.1148/radiol.14131996. View

12.

Wald L, McDaniel P, Witzel T, Stockmann J, Cooley C . Low-cost and portable MRI. J Magn Reson Imaging. 2019; 52(3):686-696. PMC: 10644353. DOI: 10.1002/jmri.26942. View

13.

Ronot M, Nahon P, Rimola J . Screening of liver cancer with abbreviated MRI. Hepatology. 2023; 78(2):670-686. DOI: 10.1097/HEP.0000000000000339. View

14.

Taouli B, Koh D . Diffusion-weighted MR imaging of the liver. Radiology. 2009; 254(1):47-66. DOI: 10.1148/radiol.09090021. View

15.

Eng C, Yoshino T, Ruiz-Garcia E, Mostafa N, Cann C, OBrian B . Colorectal cancer. Lancet. 2024; 404(10449):294-310. DOI: 10.1016/S0140-6736(24)00360-X. View

16.

Kuhl C . Abbreviated Breast MRI: State of the Art. Radiology. 2024; 310(3):e221822. DOI: 10.1148/radiol.221822. View

17.

Park J, Lee J, Kim T, Yoon J . Imaging diagnosis of hepatocellular carcinoma: Future directions with special emphasis on hepatobiliary magnetic resonance imaging and contrast-enhanced ultrasound. Clin Mol Hepatol. 2021; 28(3):362-379. PMC: 9293611. DOI: 10.3350/cmh.2021.0361. View

18.

Raphael M, Karanicolas P . Regional Therapy for Colorectal Cancer Liver Metastases: Which Modality and When?. J Clin Oncol. 2022; 40(24):2806-2817. DOI: 10.1200/JCO.21.02505. View

19.

Canellas R, Patel M, Agarwal S, Sahani D . Lesion detection performance of an abbreviated gadoxetic acid-enhanced MRI protocol for colorectal liver metastasis surveillance. Eur Radiol. 2019; 29(11):5852-5860. DOI: 10.1007/s00330-019-06113-y. View

20.

COUINAUD C . Liver anatomy: portal (and suprahepatic) or biliary segmentation. Dig Surg. 2000; 16(6):459-67. DOI: 10.1159/000018770. View