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September 2012 Liver Newsletter >>
Novel MRI for Detection of Liver Metastases: A Study of Radiographic-Pathologic Correlation
Detection of Liver Metastases with Gadoexetic Acid-enhanced Magnetic Resonance Imaging (MRI): A Study of Radiographic-pathologic Correlation
PI: Emily Winslow, MD
The Department of Surgery Clinical Research Program provides faculty and staff with comprehensive support to conduct clinical research studies at the University of Wisconsin.
The primary goal of this study is to define the histologic correlates of radiographic “lesions” for patients with hepatic metastatic colorectal cancer.
Patients with hepatic metastatic colorectal cancer derive a significant survival benefit from resection but accurate detection of all metastatic lesions is essential. Current imaging identifies most lesions but smaller lesions may not be consistently identified. Because some patients present with hepatic “recurrence” quickly postoperatively, it is likely that some lesions present preoperatively are not identified and therefore are not resected. Gadoexetic acid has been demonstrated to be safe and well-tolerated with improved hepatic lesion identification.
However, it is unclear how to apply this to patients, as these radiographic “lesions” have not definitively been demonstrated to represent metastases. Assuming this without verification could lead to patients being unnecessarily denied the only potentially curative therapy. Conversely, should gadoexetic acid-enhanced MRI more accurately identify metastases than our current standard, we could be subjecting patients unnecessarily to the risks of hepatic resection or performing suboptimal resections. Put simply, it is essential to establish if these small MRI-detected lesions are histologically malignant.
Three dimensional model with volume rendering and surface shading
Our project’s primary goal is therefore to define the histologic correlates of these radiographic “lesions.” In order to accomplish this, we must first be able to reliably identify small lesions seen on imaging in the liver pathologically. To date, we have been working to construct an MRI-compatible sectioning device that will allow very precise identification of small hepatic lesions so that they can then be specifically examined histologically (see Figure). This process should help circumvent the pathologic dilemma of how to process a large hepatic specimen in hopes of finding a subcentimeter lesion. It will allow the pathologist to examine in more detail small pieces of liver with the highest likelihood of harboring malignancy. Using this technique to image resected hepatic specimens ex vivo should then allow us to determine definitively the precise pathologic correlates to lesions seen with gadoexetic acid-enhanced MRI.
Although this could improve the cure rates for patients undergoing resection of hepatic colorectal metastases, it also has the potential to have an impact on patients with any resectable solid organ malignancy by establishing a method for precise identification of lesions found only by preoperative imaging studies. Although radiologists, surgeons, and pathologists each singularly make important contributions to patient care, the most rapid path toward improving clinical outcomes in surgical oncology is a research effort which merges previously distinct episodes of clinical care – preoperative radiographic findings, operative therapy, and postoperative pathologic diagnosis.
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