Late gadolinium enhancement of colorectal liver metastases post-chemotherapy is associated with tumour fibrosis and overall survival post-hepatectomy

Eur Radiol. 2018 Aug;28(8):3505-3512. doi: 10.1007/s00330-018-5331-4. Epub 2018 Feb 23.


Purpose: To determine whether late gadolinium MRI enhancement of colorectal liver metastases (CRCLM) post-chemotherapy is associated with tumour fibrosis and survival post-hepatectomy.

Materials and methods: The institutional review board approved this retrospective cohort study and waived the requirement for informed consent. A cohort of 121 surgical patients who received preoperative MRI after chemotherapy between 2006-2012 was included in this study. Target tumour enhancement (TTE), defined as the mean contrast-to-noise ratio of up to two target lesions on late-phase gadobutrol-enhanced MRI, was determined by two independent raters. The average TTE was correlated with tumour fibrosis on post-hepatectomy specimens using Spearman correlation and with survival post-hepatectomy using Kaplan-Meier and Cox regression. Inter-rater reliability was determined using relative intra-class correlation coefficients.

Results: In the surgical cohort (mean age: 63.0 years; male: 58%), TTE was associated with tumour fibrosis (r = 0.43, p < 0.001). Strong TTE was associated with improved survival compared to weak TTE (3-year survival: 88.4% vs. 58.8%, p = 0.003) with a hazard ratio of 0.32 (95% CI: 0.14-0.75, p = 0.008), after taking into account known prognostic variables. Inter-rater reliability was very good with a relative intraclass correlation of 0.84 (95% CI: 0.77-0.89).

Conclusion: Late gadolinium MRI enhancement of CRCLM post-chemotherapy is associated with tumour fibrosis and survival.

Key points: • MRI enhancement of colorectal liver metastases is associated with survival post-hepatectomy • MRI enhancement of chemotherapy-treated colorectal liver metastases correlates with tumour fibrosis • Measuring late MRI enhancement using target tumour enhancement is reliable.

Keywords: Colorectal cancer; Fibrosis; Gadolinium; Neoplasm metastases; Survival.

MeSH terms

  • Aged
  • Colorectal Neoplasms / pathology*
  • Contrast Media / pharmacokinetics
  • Female
  • Fibrosis
  • Hepatectomy*
  • Humans
  • Image Enhancement / methods*
  • Liver / diagnostic imaging
  • Liver / pathology
  • Liver / surgery
  • Liver Neoplasms / drug therapy
  • Liver Neoplasms / secondary
  • Liver Neoplasms / surgery*
  • Magnetic Resonance Imaging / methods*
  • Male
  • Organometallic Compounds / pharmacokinetics*
  • Proportional Hazards Models
  • Reproducibility of Results
  • Retrospective Studies
  • Survival Analysis


  • Contrast Media
  • Organometallic Compounds
  • gadobutrol