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The Effect of MRI in the Surgical Management of Hepatic Lesions After Initial CT Evaluation
Chukwuemeka Obiora*, Perry Shen, Melanie P. Caserta
Surgical Oncology, Wake Forest University Baptist Medical Center, Winston-Salem, NC
Objective:
MRI has been shown to be more accurate than CT in the diagnoses and characterization of hepatic lesions. However, it is unclear how MRI affects surgical decision making. The objective of this study is to identify the effect of MRI on clinical management of hepatic lesions after initial CT evaluation.
Methods:
A retrospective review of a prospective liver database between 2004 and 2013 was performed and a total of 102 cases in 101 patients were identified that underwent CT followed by MRI within 30 days to characterize hepatic lesions being evaluated for surgical treatment. The findings between CT and MRI were compared to identify differences in location, size, number and characterization of hepatic lesions. Diagnoses were confirmed by operative findings/pathology and follow up on imaging. The effect of MRI on management was classified into three categories: 1) No change from CT, 2) Diagnostic clarification leading to no surgery (A: unresectable, B: no indication for surgery, C: change in non-surgical treatment), and 3) Change in extent of surgical resection (A: larger resection, B: smaller resection)
Results:
In the 102 cases, the major tumor histology groups were as follows: benign [9 (9%)], colorectal metastases [47 (46%)], HCC/cholangiocarcinoma [26 (25%)], neuroendocrine metastases [12 (12%)], and other [8 (8%)]. Category 1 had 57 cases (56%), category 2 had 19 cases (19%), and category 3 had 26 cases (25%). Of the 19 category 2 cases, there were eight 2A, nine 2B and two 2C cases. Of the 26 category 3 cases, there were fifteen 3A cases and eleven 3B cases. The number of tumors on CT [Mean 1.6 (category 1) vs. 2.4 (categories 2 and 3), p=0.0034] was significantly associated with MRI imaging leading to a change in management. The maximum tumor size on CT [Mean 4.0 (category 1) vs. 2.7 (category 2 and 3), p=0.0714] suggested a trend towards MRI having an effect on surgical management. Factors such as age, gender, BMI, cirrhosis, prior chemotherapy, tumor histology, vascular invasion on CT, and tumor location on CT were not significantly associated with MRI category 2 or 3.
Conclusion:
The use of MRI in the surgical evaluation of hepatic lesions after initial CT scan changed management in 44% of cases. Multiple lesions and smaller lesions seen on CT may derive the most benefit from application of MRI imaging.
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