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Hepatic Metastases from Colorectal Cancer: Preoperative Detection and Assessment of Resectability with Helical CT¹

¹ From the Institute of Diagnostic Imaging, Hospital Duran i Reynals, Ciutat Sanitària i Universitària de Bellvitge, Autovia de Castelldefels km 2,7, L’Hospitalet de Llobregat, 08907 Barcelona, Spain (C.V., E.A., A.S.); and the Departments of Radiology (A.G.), Surgery (J.F., J.T.), and Pathology (T.S.), Hospital Princeps d’Espanya, Barcelona, Spain. From the 1999 RSNA scientific assembly. Received November 29, 1999; revision requested January 18, 2000; revision received March 7; accepted April 5. Address correspondence to C.V. (e-mail: carlosvalls@csub.scs.es).

PURPOSE: To prospectively evaluate helical computed tomography (CT) in the preoperative detection of hepatic metastases and assessment of resectability with surgical, intraoperative ultrasonographic (US), and histopathologic correlation.

MATERIALS AND METHODS: Between October 1995 and December 1998, preoperative staging with helical CT (5-mm collimation; reconstruction interval, 5 mm) was performed in 157 patients with hepatic metastases. Iodinated contrast material was injected intravenously (160–170 mL; rate, 2.5–3.0 mL/sec); acquisition began at 60–70 seconds. Four radiologists prospectively assessed the metastatic involvement of the liver by indicating the number and location of the lesions; resection was indicated in 113 patients (119 instances). Helical CT findings were correlated with pathologic and surgical findings on a lesion-by-lesion basis.

RESULTS: Intraoperative US, palpation, and histopathologic examination revealed 290 liver metastases; helical CT correctly depicted 247. Helical CT results were the following: overall detection rate, 85.1% (95% CI: 80.8%, 89.3%); positive predictive value, 96.1% (95% CI: 92.9%, 98.1%); and false-positive rate, 3.9% (10 of 257 findings; 95% CI: 1.9%, 7.1%). False-positive findings were related to hemangioendothelioma, hemangioma, hepatic peliosis, biliary adenoma, centrilobar hemorrhage, biliary hamartoma, periportal fibrosis, and normal liver parenchyma. Curative resection was performed in 112 instances with a resectability rate of 94.1%. Four-year patient survival rate was 58.6%.

CONCLUSION: Helical CT is a noninvasive, reliable, and accurate technique for imaging the liver and should be considered as the standard preoperative work-up of hepatic metastases from colorectal cancer.

Index terms: Computed tomography (CT), comparative studies, 761.12112, 761.12114, 761.12115, 761.1267, 761.12982 • Computed tomography (CT), contrast enhancement, 761.12112 • Computed tomography (CT), helical, 761.12115 • Liver neoplasms, CT, 761.12112, 761.12114, 761.12115 • Liver neoplasms, metastases, 761.3397 • Ultrasound (US), intraoperative, 761.12982

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