Late gadolinium MRI enhancement of colorectal liver metastases is associated with overall survival among nonsurgical patients

Eur Radiol. 2019 Jul;29(7):3901-3907. doi: 10.1007/s00330-019-06177-w. Epub 2019 Apr 1.

Abstract

Purpose: To determine if late gadolinium MRI enhancement of colorectal liver metastases (CRCLM) is associated with overall survival among nonsurgical patients.

Materials and methods: This retrospective study was approved by the institutional research ethics board. Late gadolinium enhancement was measured using target tumour enhancement (TTE) in all nonsurgical patients with CRCLM who received a 10-min delayed phase gadobutrol-enhanced liver MRI between March 1, 2006, and August 31, 2014. A total of 122 patients met inclusion/exclusion criteria. Patients were dichotomized into strong and weak TTE. Kaplan-Meier and Cox regression statistics were used to determine whether TTE was associated with overall survival. Noncontributory potential confounding variables (age, sex, number and size of metastases, carcinoembryonic (CEA) level, and presence of extrahepatic disease) were excluded from the final Cox regression model using the backward Wald elimination. Subgroup Kaplan-Meier survival analyses were performed on patients who were chemotherapy-naïve and chemotherapy-treated at the time of MRI.

Results: Strong TTE had increased survival compared with those with weak TTE on Kaplan-Meier analysis (2-year survival: 69.8% vs. 43.5%, p = 0.002). Among 96 patients where data was available for multivariable analysis, weak TTE was associated with death (adjusted hazard ratio 0.25, 95% CI 0.11-0.59, p = 0.002), after adjusting for CEA level. Other potential confounders were noncontributory. Subgroup analyses demonstrated that strong TTE had increased survival compared with those with weak TTE in both the chemotherapy-naïve (p = 0.047) and chemotherapy-treated (p = 0.008) groups.

Conclusion: Strong late gadolinium MRI enhancement of CRCLM is associated with overall survival among nonsurgical patients.

Key points: • MRI enhancement of colorectal liver metastases is associated with overall survival in nonsurgical patients. • MRI enhancement of colorectal liver metastases is associated with overall survival in both chemotherapy-naïve and chemotherapy-treated subgroups.

Keywords: Biomarkers, tumour; Colorectal neoplasms; Contrast media; Magnetic resonance imaging; Neoplasm metastasis.

MeSH terms

  • Adult
  • Aged
  • Carcinoembryonic Antigen / blood
  • Colorectal Neoplasms / pathology*
  • Female
  • Gadolinium
  • Humans
  • Kaplan-Meier Estimate
  • Liver Neoplasms / diagnostic imaging*
  • Liver Neoplasms / mortality
  • Liver Neoplasms / pathology
  • Liver Neoplasms / secondary
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Retrospective Studies

Substances

  • Carcinoembryonic Antigen
  • Gadolinium