Added Value of Liver MRI in Patients Eligible for Surgical Resection or Ablation of Colorectal Liver Metastases Based on CT: A Systematic Review and Meta-Analysis

Abdominal computed tomography (CT) is the standard for detecting and staging colorectal liver metastases (CRLM), but liver magnetic resonance imaging (MRI) is superior in identifying small lesions. Current guidelines do not clearly state the added value of liver MRI in surgical planning for CRLM. This systematic review and meta-analysis evaluated the clinical benefit of liver MRI in patients eligible for CRLM resection or ablation based on CT findings.

A comprehensive search of PubMed, Embase, and Cochrane Library databases was conducted up to June 23, 2023. Eleven studies with 1,440 patients were included, with 468 patients (32.5%) evaluated for changes in treatment plans. The pooled data indicated a 24.12% change in local treatment plans based on MRI findings following CT (95% CI, 15.58%–32.65%) (Figure. 1). The local treatment plan changes primarily involved resecting additional liver segments (11.1%, n = 52). In 8 patients (1.7%), segmental resections were reduced. Twelve patients (2.6%) initially planned for local treatment based on CT were deemed unresectable due to extensive metastatic disease seen on liver MRI. In 9 patients (1.9%), local therapy was withheld as lesions suspected to be malignant on CT were assessed as benign on liver MRI (Figure. 2). The review concludes that liver MRI alters the pre-interventional treatment plan in approximately one-fifth of patients eligible for CRLM surgery or ablation based on CT.