Performance of simulated abbreviated liver MRI combined with CT for liver metastasis screening in rectal cancer staging.

Abstract

Since non-enhanced pelvic MRI is routinely performed for staging rectal cancer, an additional scan of the liver during pelvic MRI could be easily acquired. This study aimed to evaluate the potential utility of routinely adding non-enhanced abbreviated MRI (NE-AMRI) for liver metastasis screening, in comparison to CT alone (the current guideline-recommended modality), and CT combined with AMRI using hepatobiliary phase imaging (HBP-AMRI) (another potential alternative). This retrospective study included patients diagnosed with rectal cancer between 2017 and 2022 at a tertiary institution. AMRI was simulated using full-protocol liver MRI. Two readers independently evaluated the presence of liver metastasis using (1) CT alone, (2) CT + NE-AMRI, and (3) CT + HBP-AMRI. Per-patient sensitivity and specificity for liver metastasis were compared using generalized estimating equations. The imaging cost of incorporating NE-AMRI was assessed using reimbursement data and the literature. A total of 476 patients (mean age 61.3 ± 11.9 years; 302 males) were included, 144 (30.3%) of whom had liver metastasis. CT + NE-AMRI had sensitivity higher than CT alone (96.5% [92.6-98.4%] vs 86.8% [81.0-91.1%]; p < 0.001), and similar to CT + HBP-AMRI (96.9% [93.8-98.5%]; p = 0.54). No significant difference was noted in specificity between the three protocols (p ≥ 0.24). The cost incurred by incorporating NE-AMRI was estimated as $126.81/₩197,409 per patient, in comparison to $131.92/₩199,156 using the current guideline. Based on a retrospective simulated image review, CT + NE-AMRI showed higher sensitivity for liver metastasis screening than CT alone, without a reduction in specificity. Integrating NE-AMRI of the liver into the routine pelvic MRI protocol in rectal cancer patients may improve tumor staging accuracy without added cost. Question Can NE-AMRI added to rectal cancer staging enhance the diagnosis of liver metastasis without increasing cost? Findings Compared to using the current guideline, incorporating NE-AMRI yielded a higher sensitivity (96.5% vs 86.8%; p < 0.001) without significant difference in specificity or increased cost (estimated as $126.81 vs $131.92 per patient). Clinical relevance Since non-enhanced pelvic MRI is routinely performed for rectal cancer, additional scanning of the liver can be easily acquired during pelvic MRI. Adding non-enhanced abbreviated liver MRI for rectal cancer staging may improve sensitivity in detecting metastasis without added cost.