Usefulness of EOB-MRI for diagnosis of rectal cancer and metachronous hepatic metastases
Ehime University School of Medicine
Dr. Kei Ishimaru, Donated Dept. of Regional Minimally Invasive Gastroenterology
DATE : 2021
Introduction
Patient’s background
Female; 70s; body weight: 50 kg; diagnosis of rectal cancer and metachronous hepatic metastases
Assessment objectives
The patient arrived at the author’s hospital with the primary complaint of bloody stools. No hepatic metastases were found by contrast computed tomography (CT) at resection of the primary lesion, but contrast CT 6 months after surgery showed two metastases in the right lobe of the liver (S7 and S8), and one metastasis in the left lobe lateral segment (S3). mFOLFOX6 + P-mab chemotherapy was initiated due to recurrence of hepatic metastasis 6 months after surgery, but contrast CT and EOB-MRI were performed again after completion of four cycles.
Contrast agent used
Gadoxetate disodium(Gd-EOB-DTPA) injection, 0.1 mL/kg
Case explanation
The patient arrived at the author’s hospital with the primary complaint of bloody stools. No hepatic metastases were found by contrast CT at resection of the primary lesion, but contrast CT 6 months after surgery showed two metastases in the right lobe of the liver (S7 and S8), and one metastasis in the left lobe lateral segment (S3). mFOLFOX6 + P-mab chemotherapy was initiated due to recurrence of hepatic metastasis 6 months after surgery, but contrast CT and EOB-MRI were performed again after completion of four cycles. No new lesions were found, and resection was judged to be feasible, so laparoscopic partial hepatectomy was performed.
Imaging findings
A nodule showing contrast enhancement was found in S7 of the liver left lobe.
Fig. 1. Contrast CT in December of Year 202X
A nodule showing contrast enhancement was found in S8 of the liver left lobe.
Fig. 2. Contrast CT in December of Year 202X
A nodule showing contrast enhancement was found in S3 of the liver left lobe.
Fig. 3. Contrast CT in December of Year 202X
The nodule showing contrast enhancement in S7 of the liver left lobe could be seen more distinctly.
Fig. 4. EOB-MRI in January of Year 202X + 1
The nodule showing contrast enhancement in S8 of the liver left lobe could be seen more distinctly, and was found to be at some distance from the hepatic vein.
Fig. 5. EOB-MRI in January of Year 202X + 1
The nodule showing contrast enhancement in S3 of the liver left lobe could be seen more distinctly.
Fig. 6. EOB-MRI in January of Year 202X + 1
Usefulness of Gadoxetate disodium(Gd-EOB-DTPA) contrast MRI with this patient
All this patient’s lesions were very difficult to interpret with CT, but were distinctly delineated by EOB-MRI. In addition, especially in Fig. 5, there can be seen to be a significant distance between the hepatic vein and the tumor. This could not be observed at all by CT.
A three-dimensional structure and volume evaluation by CT is considered to be essential for planning surgery. However, it may be possible to ascertain lesion borders more distinctly with EOB-MRI. In addition, the distance from neighboring blood vessels and the degree of invasion can be determined by EOB-MRI, and are considered to be useful. EOB-MRI is used to determine whether or not to perform combined resection, with a vessel included.
Precautions relating to administration
9. Precautions relating to patients with specific background factors (taken from the Package Insert)
9.8 Elderly patients
Administration must be performed with care, and with sufficient monitoring of the patient’s condition.
Elderly patients generally have depressed physiological function.
- *The case introduced is just one clinical case, so the results are not the same as for all cases.
- *Please refer to the Package Insert for the effects and indications, dosage and administration method, and warnings, contraindications, and other precautions with use.
