Aims: The purpose of this study was to determine if Computed Tomography Arterial Portography (CTAP) has additional value to Contrast Enhanced helical CT (CE-CT) in selecting patients for hepatic surgery or Isolated Hepatic Perfusion/systemic chemotherapy.
Materials and methods: Forty-one patients were included. All CT's were performed in the normal pre-operative work-up of patients with liver metastases in our regular clinical setting and reviewed blinded by a radiologist. For CE-CT and CTAP the number, size (largest diameter) and location of all suspected malignant liver lesions were recorded. The favourable treatment option was determined based on the results of CE-CT and CTAP independently. The therapeutic decision based on CE-CT and CTAP was compared with the definite treatment. For all patients with recorded findings during surgery, consisting of intra-operative ultrasound, liver palpation and histology a standard of reference for lesion detection was available. For these patients detection rates and the fraction of false positive lesions were calculated.
Results: Twenty-seven patients were treated with hepatic resection and/or RFA. Fourteen patients were treated with chemotherapy, 4 with Isolated Hepatic Perfusion (IHP) and 10 with systemic therapy. Based on the findings on CE-CT 31 patients were classified as surgical candidates and 10 as non-surgical patients. Based on the findings on CTAP, surgery should be the treatment of choice in 29 patients and 12 patients were classified non-surgical. CE-CT and CTAP disagreed in two cases (4.9%). Seventy-four metastases were identified at surgery and pathologically proved. CE-CT and CTAP showed 53 (.72) and 66 (.89) metastases, respectively.
Conclusion: Despite a significantly higher detection rate for hepatic metastases, CTAP has no added value in the therapeutic stratification in candidates for resection of hepatic metastases of colorectal cancer.
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