Liver Imaging for Colorectal Cancer Metastases

Purpose of Review: The prognosis of colorectal carcinoma with liver metastases (CRLM) is driven largely by the resectability of hepatic metastatic disease. An increasing number of systemic and hepatic-directed therapies are being applied in the neoadjuvant setting to downstage patients for surgical eligibility. The goal of this review is to describe the use of imaging techniques in the management of CRLM with an emphasis on staging, pretreatment planning, and response assessment. Recent Findings: While CT has an established role in screening for hepatic metastatic disease, MRI with hepatobiliary contrast has emerged as the workhorse technique in patients with CRLM in whom surgical intervention is being considered. Multiphasic CT and/or contrast-enhanced ultrasound are useful adjunctive tools, particularly when MRI is contraindicated. PET/CT provides added value in candidates for surgical resection or hepatic-directed therapy, primarily in its ability to exclude extra-hepatic metastatic disease. Summary: Accurate staging and detailed presurgical anatomic assessment including volumetry, guide management in patients with CRLM, particularly in selecting for resection and hepatic-directed therapies.