Preoperative Detection of Hepatic Metastases from the colorectal Cancers: Comparison of Dual-phase CT scan, Mn-DPDP enhanced MRI, and combination of CT and MRI

대장암의 간 전이 진단: 이중시기 CT, Mn-DPDP 조영증강 MRI, 그리고 CT-MRI 종합 판독의 비교

  • Shin, Kyung-Min (Department of Radiology, School of Medicine, Kyungpook National University) ;
  • Kim, Jong-Yeol (Department of Radiology, School of Medicine, Kyungpook National University) ;
  • Choi, Gyu-Seok (Department of Surgery, School of Medicine, Kyungpook National University) ;
  • Kim, Hye-Jeong (Department of Radiology, School of Medicine, Kyungpook National University) ;
  • Lee, Jong-Min (Department of Radiology, School of Medicine, Kyungpook National University) ;
  • Chang, Yong-Min (Department of Radiology, School of Medicine, Kyungpook National University) ;
  • Kim, Yong-Seon (Department of Radiology, School of Medicine, Kyungpook National University) ;
  • Kang, Duk-Sik (Department of Radiology, School of Medicine, Kyungpook National University) ;
  • Ryeom, Hun-Kyu (Department of Radiology, School of Medicine, Kyungpook National University)
  • 신경민 (경북대학교 의과대학 진단방사선과학교실) ;
  • 김종열 (경북대학교 의과대학 진단방사선과학교실) ;
  • 최규석 (경북대학교 의과대학 외과학교실) ;
  • 김혜정 (경북대학교 의과대학 진단방사선과학교실) ;
  • 이종민 (경북대학교 의과대학 진단방사선과학교실) ;
  • 장용민 (경북대학교 의과대학 진단방사선과학교실) ;
  • 김용선 (경북대학교 의과대학 진단방사선과학교실) ;
  • 강덕식 (경북대학교 의과대학 진단방사선과학교실) ;
  • 염헌규 (경북대학교 의과대학 진단방사선과학교실)
  • Published : 2005.12.01

Abstract

Purpose : To determine the usefulness of additional Mn-DPDP MRI for preoperative evaluation of the patients with colorectal cancers by comparison of dual-phase CT scan, Mn-DPDP enhanced MRI and combination of CT and MRI. Materials and Methods : Fifty-three colorectal cancer patients with 92 metastatic nodules underwent dualphase (arterial and portal) helical CT scan and Mn-DPDP MRI prior to surgery. The indication of MRI was presence or suspected of having metastatic lesions at CT scan and/or increased serum carcinoembryonic antigen (CEA) levels (10 ng/mL or more). The diagnosis was established by the combination of findings at surgery, intraoperative ultrasonography, and histopathologic examination. Two radiologists interpreted CT, MRI, and combination of CT-MRI at discrete sessions and evaluated each lesion for location, size, and intrinsic characteristics. The lesions were divided into three groups according to their diameter; 1cm<, 1-2 cm, and >2 cm. Diagnostic accuracy was evaluated using the alternative-free response receiver operating characteristic method. Detection and false positive rate were also evaluated. Results : In the lesions smaller than 1 cm, detection rate of combined CT-MRI was superior to CT or MRI alone (82%, p=0.036). The mean accuracy (Az values) of combined CT and MRI was significantly higher than that of CT in the lesions smaller than 2 cm (1 cm<, p=0.034; 1-2 cm, p=0.045). However, there was no significant difference between MRI and combined CT-MRI. The false positive rate of CT was higher than those of combined CT-MR in the lesions smaller than 1 cm (28%, p=0.023). Conclusion : Additional MRI using Mn-DPDP besides routine CT scan was helpful in differentiating the hepatic lesions (<2 cm) and could improve detection of the small hepatic metastases (<1 cm) from colorectal carcinoma.