Chapter 3 - Pre-operative imaging, response evaluation, and surgical planning – CT, PET, radiomics, and FLR measurement
Elizabeth Y. Liu BA, Azarakhsh Baghdadi MD, MAS, Timothy M. Pawlik MD, MPH, MTS, PhD, R.Kamel MD, PhD
Colorectal cancer (CRC) is one of the most common malignancies and a leading cause of cancer morbidity and mortality worldwide1. Many factors can impact survival including the presence of metastases. The most common site of colorectal cancer metastases is the liver, as almost 20 percent of patients with CRC have liver metastasis at presentation2. Among patients without liver metastases at presentation, about 25 percent will develop metachronous liver metastasis at some point in their disease course3. Different treatment options are available for patients with CRC and colorectal liver metastases (CRLM) including locoregional and systemic therapies3. Surgical resection remains, however, the best chance at long-term survival and cure4,5. In this chapter, we aim to describe the different imaging modalities used to evaluate and stage patients with CRLM. We describe the role that each imaging modality plays and discuss the elements of hepatic imaging related to evaluation of response to preoperative therapy, as well as surgical planning.
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