Imaging Pearls ❯ Liver ❯ Colon cancer
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- Colorectal Cancer: Facts
- Approximately 60% of patients with colorectal carcinoma eventually develop lymph node or distant metastases
- The liver is the initial site of metastases in 30% of cases
- Classic chemotherapy is cytotoxic (5-FU, leucovorin, irinotecan or oxaliplatin) and new chemotherapy is recombinant human monoclonal antibody against vascular endothelial growth factor (bevacizumab or Avastin)
- Avastin has improved survival of stage IV colon cancer but the agent inhibits tumor growth rather than shrinkage - “ Our retrospective study compared RECIST version 1.1 with modified CT criteria to determine their respective utilities as a prognostic indicator. Using both sets of criteria, we compared treatment responses of patients with colorectal liver metastases treated with bevacizumab-containing chemotherapy with those of patients treated with chemotherapy alone.”
Response Evaluation in Patients With Colorectal Liver Metastases: RECIST Version 1.1 Versus Modified CT Criteria
Chung WS et al.
AJR 2012; 199:809-815 - “Evaluating treatment response with tumor size and density changes on CT was a better predictor of time to tumor progression than changes in tumor size alone in both groups.”
Response Evaluation in Patients With Colorectal Liver Metastases: RECIST Version 1.1 Versus Modified CT Criteria
Chung WS et al.
AJR 2012; 199:809-815 - “In conclusion, response evaluation using changes in tumor size and density on CT better predicted time to tumor progression than changes in tumor size only in patients with colorectal liver metastases treated with bevacizumab containing chemotherapy or chemotherapy alone.”
Response Evaluation in Patients With Colorectal Liver Metastases: RECIST Version 1.1 Versus Modified CT Criteria
Chung WS et al.
AJR 2012; 199:809-815 - “On the basis of our results, we suggest adding tumor density changes to new criteria for evaluating treatment response of the anticancer treatment agents or tumor type. These new criteria should be tested further in large scale studies of other tumors treated with various therapies.”
Response Evaluation in Patients With Colorectal Liver Metastases: RECIST Version 1.1 Versus Modified CT Criteria
Chung WS et al.
AJR 2012; 199:809-815 - Measuring Changes in Tumor Attenuation
- Venous phase images (60-70 seconds)
- 2 ml/kg IV dose of Ultravist 300
- Key was drop in attenuation by 15% of the target lesion
- Note: scan protocols must be the same between studies - Response Evaluation in Patients With Colorectal Liver Metastases: RECIST Version 1.1 Versus Modified CT Criteria
Chung WS et al.
AJR 2012; 199:809-815 - “Perfusion CT measurements may measure vascularity of colorectal tumors, however, correlation with MVD (microvessel density), which is a morphologic measure, appears inappropriate.”
Perfusion CT Vascular Parameters Do Not Correlate with Immunohistochemically Derived Microvessel Density Count in Colorectal Tumors
Dighe S et al.
Radiology 2013; 268:400-410 - “Perfusion CT calculated vascular parameters do not correlate with microvessel density count obtained by means of immunohistochemical staining, which is the measure of angiogenesis in colorectal tumors.”
Perfusion CT Vascular Parameters Do Not Correlate with Immunohistochemically Derived Microvessel Density Count in Colorectal Tumors
Dighe S et al.
Radiology 2013; 268:400-410 - “ Therefore we believe that perfusion CT measurements may still be able to provide a measure of vascularity of the tumor, however, its correlation with MVD appears to be inappropriate. Its role in assessment of the treatment response to antiangiogenic agents needs to be evaluated in further studies.”
Perfusion CT Vascular Parameters Do Not Correlate with Immunohistochemically Derived Microvessel Density Count in Colorectal Tumors
Dighe S et al.
Radiology 2013; 268:400-410 - “ For diagnosing 1 to 2cm HCC detected on surveillance ultrasound, arterial phase and delayed phase are two essential phases, providing higher sensitivity than the combination of arterial phase and PVP, and equal performance with triphasic and quadriphasic combinations. The biphasic combination of arterial phase and delayed phase may replace quadriphasic CT recommended by AASLD.”
Characterization of 1- to 2-cm Liver Nodules Detected on HCC Surveillance Ultrasound According to the Criteria of the American Association for the Study of Liver Disease: Is Quadriphasic CT Necessary-
Jang HJ et al.
AJR 2013; 201:314-321 - “ Using these two essential phases only may reduce the radiation dose for these patients who are likely to undergo multiple follow-up imaging studies.”
Characterization of 1- to 2-cm Liver Nodules Detected on HCC Surveillance Ultrasound According to the Criteria of the American Association for the Study of Liver Disease: Is Quadriphasic CT Necessary-
Jang HJ et al.
AJR 2013; 201:314-321 - Scan Protocol (2006-2008)
- 64 MDCT
- 5 mm thick sections reconstructed at 2.5 mm intervals
- Visipaque 320 injected at 5 ml/sec and volume was 2 ml/kg with a maximum volume of 180 ml
- Study triggered at abdominal aorta at 100 HU, with four phases; unenhanced, arterial phase (20 seconds after the trigger), PVP (60 seconds after the trigger), and delayed phase (180 seconds after start of IV injection)
- Characterization of 1- to 2-cm Liver Nodules Detected on HCC Surveillance Ultrasound According to the Criteria of the American Association for the Study of Liver Disease: Is Quadriphasic CT Necessary-
Jang HJ et al.
AJR 2013; 201:314-321