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Purpose <p>Development of fibrosis in treated colorectal liver metastases (CRLM) could be supposedly used for the estimation of both treatment response and prognosis. This study aimed to investigate the association between post-chemotherapy, fibrosis-related progressive gadolinium enhancement of CRLM on MRI and overall survival.</p> Material and methods <p>A retrospective study of 97 CRLM patients (68&#xa0;M, mean age 62.3 ± 10.71&#xa0;years) who underwent between 2017 and 2022 preoperative gadobenate dimeglumine (Gd-BOPTA) – enhanced MRI after chemotherapy. Tumor and liver enhancement were quantified using Signal Intensity Change Percentages (SICP) across 5-min and 60-min delay phases, along with the Tumor-to-Liver Enhancement Index (TLEI) to estimate fibrosis within CRLM. A subset of 18 patients was evaluated for radiologic-pathologic correlation. Cox regression, Kaplan–Meier analysis, and multivariate models were used to assess overall survival (OS).</p> Results <p>High SICP (≥ 90.3%) in the 60-min delayed phase was associated with significantly lower OS (median: 37 vs. 66&#xa0;months; <i>p</i> = 0.023). TLEI was significantly elevated in non-survivors (1.25 vs. 1.10; <i>p</i> = 0.007). Histopathologic correlation, available in 18 patients, confirmed fibrosis in lesions with elevated SICP, though limited sample size precluded statistical validation. In multivariate analysis, both high TLEI and elevated SICP were independent predictors of reduced OS (HR 1.38 [1.05–1.82], <i>p</i> = 0.023; HR 1.01 [1.00–1.01], <i>p</i> = 0.043, respectively). Notably, aflibercept- and FOLFOX-4-treated patients showed higher fibrosis-associated enhancement.</p> Conclusion <p>Gd-BOPTA-enhanced MRI, specifically SICP and TLEI in the delayed phase, may serve as non-invasive imaging biomarkers of fibrosis in CRLM. Contrary to prior assumptions, increased fibrosis was associated with worse prognosis, suggesting fibrosis-mediated tumor microenvironment alterations. Prospective studies with robust radiologic-pathologic validation are needed to clarify the mechanistic and prognostic implications.</p>

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Mapping fibrosis in colorectal liver metastases (CRLM) with gadobenate dimeglumine-enhanced MRI: prognostic implications and imaging biomarkers

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月19日

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  • Irmina Morawska,
  • Katarzyna Pasicz,
  • Andrzej Cieszanowski

摘要

Purpose

Development of fibrosis in treated colorectal liver metastases (CRLM) could be supposedly used for the estimation of both treatment response and prognosis. This study aimed to investigate the association between post-chemotherapy, fibrosis-related progressive gadolinium enhancement of CRLM on MRI and overall survival.

Material and methods

A retrospective study of 97 CRLM patients (68 M, mean age 62.3 ± 10.71 years) who underwent between 2017 and 2022 preoperative gadobenate dimeglumine (Gd-BOPTA) – enhanced MRI after chemotherapy. Tumor and liver enhancement were quantified using Signal Intensity Change Percentages (SICP) across 5-min and 60-min delay phases, along with the Tumor-to-Liver Enhancement Index (TLEI) to estimate fibrosis within CRLM. A subset of 18 patients was evaluated for radiologic-pathologic correlation. Cox regression, Kaplan–Meier analysis, and multivariate models were used to assess overall survival (OS).

Results

High SICP (≥ 90.3%) in the 60-min delayed phase was associated with significantly lower OS (median: 37 vs. 66 months; p = 0.023). TLEI was significantly elevated in non-survivors (1.25 vs. 1.10; p = 0.007). Histopathologic correlation, available in 18 patients, confirmed fibrosis in lesions with elevated SICP, though limited sample size precluded statistical validation. In multivariate analysis, both high TLEI and elevated SICP were independent predictors of reduced OS (HR 1.38 [1.05–1.82], p = 0.023; HR 1.01 [1.00–1.01], p = 0.043, respectively). Notably, aflibercept- and FOLFOX-4-treated patients showed higher fibrosis-associated enhancement.

Conclusion

Gd-BOPTA-enhanced MRI, specifically SICP and TLEI in the delayed phase, may serve as non-invasive imaging biomarkers of fibrosis in CRLM. Contrary to prior assumptions, increased fibrosis was associated with worse prognosis, suggesting fibrosis-mediated tumor microenvironment alterations. Prospective studies with robust radiologic-pathologic validation are needed to clarify the mechanistic and prognostic implications.