[...]... [4, 5] Evaluation of tumor resectability includes assessment of vascular structures for tumor invasion and vascular anomalies The evolution of imaging over the S Cirillo ( ) Radiology Unit, Mauriziano “Umberto I” Hospital, Turin, Italy Surgical Treatment of Colorectal Liver Metastases Lorenzo Capussotti (Ed.) © Springer-Verlag Italia 2011 7 8 2 Surgical Treatment of Colorectal Liver Metastases past several... 1 Surgical Treatment of Colorectal Liver Metastases of Western Europe Nonetheless, colorectal cancer still represents the second leading cause of cancer-related deaths In fact, even though 85% of patients with a largebowel primary have tumors amenable to curative resection at the time of diagnosis, the disease recurs in more than half of the patients, with the liver involved in up to two-thirds of. .. regardless of the arterial phase pattern (Fig 2.2) [6] During the portal-venous phase, liver metastases typically enhance less than the liver, whereas benign lesions are more enhanced Fig 2.1 A liver metastasis hypoechoic with surrounding liver parenchyma a b Fig.2.2 Liver with metastases seen at conventional US (a) and after contrast media administration (b) 10 2 Surgical Treatment of Colorectal Liver Metastases. .. primary tumor stage Recurrences after resection of stage I or II cancer occurred significantly later than after resection of more advanced tumors 4 1 Surgical Treatment of Colorectal Liver Metastases 1.3 Natural History and Disease Therapy The natural history of untreated metastatic colorectal cancer is the standard against which the effectiveness of any treatment should be measured However, since in... (1997) Natural history of liver metastases from colo-rectal carcinoma J Gastrointest Surg 1:398–407 Stangl R, Altendorf-Hofmann A, Charnley RM et al (1994) Factors influencing the natural history of colorectal liver metastases Lancet 343:1405–1410 Wagner JS, Adson MA, Adson MH et al (1984) The natural history of hepatic metastases from colorectal cancer A comparison with resective treatment Ann Surg 199:502–507... 2.3.2 Imaging Findings The majority of colorectal liver metastases are solid hypovascular lesions In the portal-venous phase, metastases become more conspicuous as lesions that are hypodense compared to normal liver Late arterial phase imaging has been reported to improve lesion characterization of colorectal liver metastases, particularly lesions < 1 cm in diameter Liver metastases may have a peripheral,... T2-weighted imaging Surgical Treatment of Colorectal Liver Metastases 16 2 a c b d Fig 2 9 Liver metastases (red arrows) detected after injection of gadoxate (Primovist), an extracellular and hepatobiliary contrast agent: (a) arterial phase, (b) portal-venous phase, (c) late venous phase, and (d) hepatobiliary phase Lesion-to -liver contrast is improved in the last phase DWI, colorectal hepatic metastases show... surgical resection of liver metastases, by detecting small lesions not shown at CT scan In 2004, Bartolozzi et al [30] presented the results of a prospective, multi-institutional trial whose primary end-point was to compare the sensitivity of unenhanced and mangafodipir enhanced MRI with that of spiral CT in the detection of liver metastases from colorectal cancer The authors used as the standard of. .. site of the primary tumor: 14.8% for colon cancers and 13.9% for rectal cancer Compared to patients who developed secondary liver tumors after the treatment of their primary tumor, patients with synchronous metastases exhibited a higher number of liver deposits and a more frequent bilobar distribution Rather disappointingly, analysis of temporal trends showed that the incidence of synchronous liver metastases. .. Volumetric measurement of tumor size and normal liver is Fig.2.3 A reformatted coronal CT image demonstrating portal invasion by a liver metastasis (red arrow) Fig.2.4 Vascular reconstruction demonstrates that the right hepatic artery arises from the superior mesenteric artery 12 Surgical Treatment of Colorectal Liver Metastases 2 Fig.2.5 Area measurement of tumor size and normal liver on a CT image is . multidisciplinary approach. Surgical Treatment of Colorectal Liver Metastases addresses the contemporary multidiscipli- nary management of liver metastases. It logically. than half of the patients, with the liver involved in up to two-thirds of the cases. In most of the surgical literature on colorectal liver metastases,