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Article Abstract
Background: The desmoplastic histopathological growth pattern (dHGP) of colorectal liver metastases (CRLM) is associated with prolonged survival and favorable anti-angiogenic chemotherapy response. However, reliable preoperative identification of dHGP using MRI remains challenging.
Purpose: To develop a dynamic contrast-enhanced MRI (DCE-MRI)-based model for assessing dHGP probability, facilitating candidate selection for anti-angiogenic neoadjuvant chemotherapy, and prognostic evaluation.
Study Type: Retrospective, dual-center study.
Subjects: 286 patients (114 female; 133 with dHGP) with pathologically confirmed CRLM (≥ 10 mm).
Field Strength/sequence: 3.0 T, T1-weighted imaging using 3D gradient sequence (precontrast, arterial, portal venous and delayed phases).
Assessment: Three abdominal radiologists independently reviewed DCE-MRI features, including peritumoral rim enhancement at different phases for dHGP assessment. Disease-free survival (DFS), overall survival (OS), and treatment response to bevacizumab were also assessed.
Statistical Tests: Univariable and multivariable logistic regression, area under the receiver operating characteristic curve (AUC), DeLong test, Kaplan-Meier analysis, and log-rank test.
Results: Peritumoral rim enhancement on arterial (odds ratio [OR] = 4.65, [95% CI: 2.20-9.84]), portal venous (OR = 7.46, [95% CI: 3.12-17.84]), and delayed phases (OR = 3.55, [95% CI: 1.84-6.88]) was significantly and independently associated with dHGP. A peritumoral rim enhancement-based probability model achieved AUCs of 0.86 (95% CI: 0.81-0.90) and 0.82 (95% CI: 0.70-0.91) for diagnosing dHGP in development and external validation cohorts, respectively. Peritumoral rim enhancement was independently associated with longer survival (DFS: adjusted hazard ratio [HR] = 0.34, [95% CI: 0.25-0.47]; OS: HR = 0.46, [95% CI: 0.34-0.63]) in all patients. Among patients receiving bevacizumab-containing neoadjuvant chemotherapy (n = 90), peritumoral rim enhancement was significantly associated with longer DFS (HR = 0.24, [95% CI: 0.12-0.49]) and OS (HR = 0.24, [95% CI: 0.11-0.50]).
Data Conclusion: Peritumoral rim enhancement on DCE-MRI shows a strong association with dHGP, indicates favorable survival, and may identify candidates for anti-angiogenic chemotherapy.
Evidence Level: 3.
Technical Efficacy: Stage 2.
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