Newly Appearing Hepatic Lesion After Curative Surgery For Colorectal Cancer: Single-phase CT Findings Implying Metastasis

Background: In patients treated with curative surgery for colorectal cancer, the single-phase (portal phase) abdomen-pelvic computed tomography (CT) follow-up is routinely performed to detect any recurrent lesions.

Objective: The objective of this study is to evaluate CT features implying metastasis in newly appearing hepatic lesions on single-phase CT after colorectal cancer surgery.

Methods: Of 1,227 patients who underwent curative colorectal surgery between 2011 and 2014, 267 patients with new hepatic lesions on follow-up single-phase CT (metastasis, n=192; benign, n=75) were included. The CT features of the hepatic lesions were analyzed by two radiologists retrospectively, and clinical information, including carcinoembryonic antigen (CEA) level was also reviewed. The risk factors for hepatic metastasis were evaluated by multivariable logistic regression.

Results: In this study, independent CT features associated with metastasis were spherical shape (p < 0.001), circumscribed margin (p = 0.021), heterogeneous attenuation (p = 0.024) and bulging appearance (p = 0.007). Among the clinical factors, increased CEA level (p = 0.013), higher preoperative stage (p = 0.014) and lymphovascular invasion (p = 0.003) were associated with metastasis. However, on multivariable analysis, spherical shape was the only significant predictive factor for hepatic metastasis. The diagnostic performance of 'spherical shape' for detection of hepatic metastasis showed an accuracy of 84.6%, sensitivity of 83.9%, and specificity of 86.7%.

Conclusion: Specific single-phase CT features could be useful in distinguishing hepatic metastasis from benign, resulting in continuing routine CT follow-up without liver magnetic resonance imaging (MRI) when metastasis is unlikely.