The Role of Imaging in Metastatic Colorectal Cancer Management

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after May 9, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 1.00
Procedures: 1.00
Abdomen and Pelvis: 1.00

Magnetic Resonance Imaging: 1.00
Procedures: 1.00
Body: 1.00

Nuclear Medicine Technology: 1.00
Procedures: 1.00
Endocrine and Oncology Procedures: 1.00

Registered Radiologist Assistant: 2.75
Procedures: 2.75
Abdominal Section: 2.75

Sonography: 1.00
Procedures: 1.00
Abdomen: 1.00

Radiation Therapy: 2.75
Patient Care: 2.75
Patient and Medical Record Management: 2.75

Outline

1. Introduction
2. Imaging of Metastases in CRC
   1. Ultrasonography
   2. Multidetector CT
   3. MR Imaging
   4. PET/CT
3. Management of mCRC
4. Surgery in mCRC
5. Role of Imaging in Surgical Planning for mCRC
6. Liver-directed Therapies in mCRC
7. Role of Imaging in Liver-directed Therapies for mCRC
8. Systemic Chemotherapy in mCRC
   1. Chemotherapeutic Regimens
   2. Novel MTTs
9. Role of Imaging in Systemic Chemotherapy
10. Complications and Toxicities Associated with Treatment of mCRC
11. Complications Associated with Liver-directed Therapies
12. Conclusion

Objectives

Upon completion of this course, students will:

1. list the compounds in the FOLFOX and FOLFIRI chemotherapeutic regimens
2. identify the most common site of CRC metastasis
3. recognize the imaging modalities that have supplanted US in the evaluation of colorectal cancer
4. understand the barriers to performing contrast-enhanced US for the assessment of CRC liver metastases
5. describe the sensitivity of intraoperative US in the evaluation of colorectal cancer
6. identify the most commonly used imaging modality in the workup of patients with metastatic colorectal cancer
7. understand the timing of the phases of enhancement following administration of intravenous CT contrast material
8. describe the CT imaging findings of pseudomyxoma peritonei
9. describe the appearance of hepatic metastases on T1- and T2-weighted MR imaging
10. list the potential routes of excretion of intravenous MR contrast agents
11. describe the enhancement pattern of hepatocyte-specific intravenous MR contrast agents
12. describe the appearance of metastatic lesions on diffusion-weighted MR imaging
13. list the conditions that may produce false-negative PET/CT results during imaging of mCRC
14. identify the only definitive treatment for metastatic colorectal cancer
15. understand the goal of conversion chemotherapy
16. list the major determinants of liver metastasis resectability
17. recognize the imaging modalities capable of performing volumetry that is used to estimate the volume of liver remnants following resection
18. understand the timeframe associated with preoperative portal vein embolization
19. describe the liver-directed therapy capable of achieving a selective high-dose delivery of chemotherapeutic drugs
20. describe the liver-directed therapy that involves the administration of yttrium-90 microspheres
21. recognize the most widely used local ablative procedure for colorectal cancer
22. list the imaging modalities used to guide liver-directed therapies
23. describe the imaging findings of periablational hyperemia
24. list the CRC MTTs that have an antiangiogenesis effect
25. describe the percentage of CRC cases that demonstrate mutations in the KRAS intracellular signaling protein
26. list the CRC MTTs that bind to vascular endothelial growth factor (VEGF) receptors
27. identify the mCRC treatments that can result in wound dehiscence
28. list the mCRC treatments that are associated with cholecystitis
29. identify the most widely used imaging modality in the assessment of mCRC treatment response
30. describe the imaging findings associated with a good or optimal morphologic response to treatment in liver metastases
31. identify the main limitation of dynamic contrast-enhanced CT for assessment of treatment response
32. identify the MR imaging technique that can help predict treatment response by measuring the volume transfer constant K-trans and rate constant K-ep
33. list the imaging modalities that are recommended for assessment of treatment response
34. recognize the complications associated with cetuximab administration
35. describe the major complications associated with percutaneous ablation