Current guidelines lack clarity on whether contrast-enhanced magnetic resonance imaging (MRI) should be added routinely to computed tomography (CT) in the examination of patients with colorectal liver metastases. This study reveals that the addition of contrast-enhanced MRI resulted in treatment plan changes for approximately one-third of patients, emphasising the potential clinical impact of integrating this technique into the evaluation process.
Current guidelines provide no clear recommendation on whether contrast-enhanced MRI (using gadoxetic acid and diffusion-weighted imaging) should be added routinely to computed tomography (CT) in the examination of patients with colorectal liver metastases. Despite reports indicating that contrast-enhanced MRI is superior at detecting and characterising colorectal liver metastases compared to CT scans, its impact on patient management remains unknown. This study aimed to evaluate how adding liver contrast-enhanced MRI would affect the treatment plans (based on contrast-enhanced CT ) of patients with colorectal liver metastases.
This incremental diagnostic accuracy trial was conducted in 14 liver surgery centres in the Netherlands, Belgium, Norway, and Italy. Eligible participants were adults (≥18 years) with histological proof of colorectal cancer, a WHO performance status score of 0-4, and primary or recurrent colorectal liver metastases, who were scheduled for local therapy based on contrast-enhanced CT. All patients underwent both contrast-enhanced CT and liver contrast-enhanced MRI with diffusion-weighted imaging and gadoxetic acid as a contrast agent before undergoing local therapy. The primary outcome was to evaluate whether liver contrast-enhanced MRI findings changed the local clinical treatment plan previously determined by the respective clinic. A 10% change in the treatment plan was considered a significant difference.
In total, 298 patients were enrolled and included in the intention-to-treat population, including 177 males (59%) and 121 females (41%) with planned local therapy based on contrast-enhanced CT. Notably, liver contrast-enhanced MRI prompted changes in the local treatment plans for 92 (31%) of these patients. Specifically, changes were made for 40 patients (13%) requiring more extensive local therapy, 11 patients (4%) requiring less extensive local therapy, and 34 patients (11%) for whom the indication for curative-intent local therapy was revoked. The latter included 26 patients (9%) with too extensive disease and eight patients (3%) with benign lesions on liver contrast-enhanced MRI.
These findings suggest that incorporating liver contrast-enhanced MRI into the assessment of patients scheduled for local treatment of colorectal liver metastases, based on contrast-enhanced CT imaging, should be always considered.
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