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Abstract
Introduction. Colorectal cancer ranks third in global cancer incidence. Liver metastases are present in 25 % of patients at initial diagnosis and develop in 50 % of patients following resection of the primary tumor.
Aim. To develop and evaluate a CT arteriography protocol for diagnosing colorectal cancer liver metastases following chemotherapy.
Materials and Methods. Seven patients with colorectal cancer and liver metastases after neoadjuvant chemotherapy were included. All patients underwent CT arteriography with intra-arterial administration of 40 ml iodinated contrast medium (300-320 mg iodine/ml) at 2 ml/s. Scanning was performed in two phases: arterial (22 seconds post-injection; n = 7) and portal venous (33-38 seconds; n = 6). Imaging assessment included capillary phase enhancement, metastasis visualization, peripheral rim enhancement, and severity of transient hepatic attenuation differences (THAD).
Results. Nineteen liver metastases were identified. Capillary phase enhancement was achieved in 4/7 patients (57 %) at 22 seconds and all 6 patients (100 %) at 33-38 seconds. Hypervascular rim enhancement was visualized in 15 non-calcified metastases (100 %) during both phases with consistent intensity. THAD was observed in all patients at 22 seconds, with reduced severity at 33-38 seconds.
Conclusion. The proposed CT arteriography technique provides 100 % visualization of peripheral rim enhancement in non-calcified colorectal liver metastases after chemotherapy. The 33-38 second scan timing is preferred due to consistent capillary phase achievement and reduced perfusion artifacts while maintaining diagnostic rim enhancement quality.
References
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