Hepatic metastases: diagnosis and staging

Liver metastases are much more common than primary hepatic malignancies and may occur in up to 80% of patients with extrahepatic malignancies. To opti mize the patient's management, precise detection or exclusion of liver meta stases, as well as assessment of their number and extent, is indispensable. For imaging of liver metastases, ultrasound, computed tomography (CT), mag netic resonance imaging (MRI), scintigraphy, and angiography can be utilize d. All these methods have been technically improved with benefits for diagn ostic utility. Biphasic contrast-enhanced spiral CT (SCT) and MRI with mode rn pulse sequences and tissue-specific contrast agents are superior to othe r imaging modalities in terms of diagnostic efficacy and reproducibility of results. With SCT and MRI sensitivities and specificities in the diagnosis of focal hepatic disease are in the range of 80-95%. Moreover, their non-i nvasiveness is a strong advantage. The diagnostic strategy in the assessmen t of liver metastases has to take into account both the strengths and limit ations of the respective method. Additionally, the clinical situation of a particular patient has to be considered, and conclusive diagnostic results have to be achieved in a short time in order to ensure a favourable cost-ef fectiveness relation.