J Korean Soc Radiol.  2017 Nov;77(5):286-297. 10.3348/jksr.2017.77.5.286.

Identifying CT-Based Risk Factors Associated with Synchronous Liver Metastases in Colorectal Cancer

• Seo CR
• Choi SJ
• Kim HS

• KMID: 2394042
• DOI: http://doi.org/10.3348/jksr.2017.77.5.286

Abstract

PURPOSE
The aim of this study was to determine the radiologic risk factors of colorectal cancer (CRC) with synchronous liver metastases.
MATERIALS AND METHODS
A total of 197 patients with CRC who had a visible tumor on contrast-enhanced abdominopelvic computed tomography and were treated between January 2012 and December 2012 were included. Longitudinal diameter, mural thickness, primary tumor attenuation, and other metastases were evaluated independently. Univariate analysis and multivariate logistic regression analysis were used to identify risk factors associated with the presence of liver metastases.
RESULTS
Cases were divided into two groups based on the presence or absence of liver metastases (n = 56 and 141, respectively). Primary tumors with enhancement of ≥ 90 Hounsfield units (HU) were found to have a higher risk of liver metastases than those with enhancement of < 90 HU [odds ratio (OR): 2.619, p = 0.034]. The presence of pulmonary metastases was associated with a higher risk of liver metastases (OR: 14.218, p = 0.025). The presence of lymph node metastases (N2 vs. N0) and carcinoembryonic antigen (CEA) level independently predicted the presence of liver metastases (OR: 8.766, p < 0.001; OR: 1.012, p = 0.048).
CONCLUSION
The identified risk factors of synchronous liver metastases in CRC were tumor mural enhancement, pulmonary metastases, lymph node metastases, and CEA level.

MeSH Terms

Carcinoembryonic Antigen
Colorectal Neoplasms*
Humans
Liver Neoplasms
Liver*
Logistic Models
Lymph Nodes
Neoplasm Metastasis*
Risk Factors*
Tomography, X-Ray Computed
Carcinoembryonic Antigen

Figure

• 

  Fig. 1. Flow chart of patient enrollment.

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  Fig. 2. Proximal sigmoid colon cancer in a 58-year-old woman. (A) Longitudinal tumor diameter, (B) tumor mural thickness, and (C) tumor en-hancement (region of interest) of the primary cancer were measured.

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  Fig. 3. Liver metastasis from recto-sigmoid colon cancer in a 67-year-old woman. (A) Transverse CT image shows a tiny indeterminate hypoat-tenuating lesion (arrow) in hepatic segment VI. (B) Transverse CT image shows a primary tumor (arrows). Tumor enhancement was 126 HU, sug-gestive of high risk. (C) The tiny lesion had increased in size as determined by follow-up CT 9 months later (arrow). (D) Gadoxetic acid-enhanced hepatobiliary phase image shows a hypointense lesion (arrow) in hepatic segment VI. (E) Diffusion weighted images (b = 1000 sec/mm2) and (F) T2-weighted images demonstrate a hyperintense lesion (arrows). This lesion was considered to be metastasis based on analyses of serial CT and magnetic resonance images. CT = computed tomography

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  Fig. 4. Liver metastasis from recto-sigmoid colon cancer in an 80-year-old man. (A) Transverse CT did not depict a definite abnormal lesion in hepatic segment V. (B) Coronal reconstruction image shows a primary tumor. Its enhancement was 92 Hounsfield units, suggestive of high risk. Magnetic resonance images were obtained 3 days after initial CT. (C) Gadoxetic acid-enhanced hepatobiliary phase image shows a hypointense lesion (arrow) in hepatic segment V. (D) Diffusion weighted images (b = 800 sec/mm2) and (E) T2-weighted images demonstrate a hyperintense lesion (arrows). This lesion was confirmed to be metastasis by tumorectomy. CT = computed tomography

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  Fig. 5. Receiver operating characteristic curve analysis results for fac-tors that were found to be positively associated with the presence of liver metastasis by logistic regression analysis. CEA = carcinoembryonic antigen

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