Recommendation ID
CG131/3
Question
The most effective sequence to perform magnetic resonance imaging (MRI and PET-CT in patients with colorectal cancer metastasised to the liver to determine whether the metastasis is resectable:- A prospective trial should be conducted to investigate the most clinically-effective and cost-effective sequence in which to perform MRI and PET-CT, after an initial CT scan, in patients with colorectal cancer that has metastasised to the liver, to determine whether the metastasis is resectable. The outcomes of interest are reduction in inappropriate laparotomies and improvement in overall survival.
Any explanatory notes
(if applicable)
Why this is important:- Nearly 7% of all patients with liver metastases from colorectal cancer are now being considered for liver resection with curative intent. These operations are costly and have their own inherent risks, including futile laparotomy, which can be psychologically devastating for patients and carers. After the initial diagnosis of suspected liver metastases on diagnostic or follow-up CT scan, it is clear that PET-CT (which is patient-specific to detect incurable extra-hepatic disease) and MRI (which is liver-specific to accurately characterise detected liver lesions) both play roles in the decision algorithm when considering surgery. Both of these investigations are expensive and can lead to delays in starting appropriate treatment. Research is needed to determine the correct sequence of these investigations to reduce the rate of futile laparotomy, improve cost effectiveness of treatment, and ultimately improve overall survival.

Source guidance details

Comes from guidance
Colorectal cancer: diagnosis and management
Number
CG131
Date issued
November 2011

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 06/01/2015