The Role of Imaging in Metastatic Colorectal Cancer Management

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[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: 1.25
Patient Care: 0.25
Patient Interactions and Management: 0.25
Procedures: 1.00
Body: 1.00

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

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. understand the barriers to performing contrast-enhanced US for the assessment of CRC liver metastases
4. describe the sensitivity of intraoperative US in the evaluation of colorectal cancer
5. identify the most commonly used imaging modality in the workup of patients with metastatic colorectal cancer
6. understand the timing of the phases of enhancement following administration of intravenous CT contrast material
7. describe the appearance of hepatic metastases on T1- and T2-weighted MR imaging
8. list the conditions that may produce false-negative PET/CT results during imaging of mCRC
9. identify the only definitive treatment for metastatic colorectal cancer
10. understand the goal of conversion chemotherapy
11. list the major determinants of liver metastasis resectability
12. describe the liver-directed therapy capable of achieving a selective high-dose delivery of chemotherapeutic drugs
13. recognize the most widely used local ablative procedure for colorectal cancer
14. list the imaging modalities used to guide liver-directed therapies
15. list the CRC MTTs that bind to vascular endothelial growth factor (VEGF) receptors
16. list the mCRC treatments that are associated with cholecystitis
17. identify the most widely used imaging modality in the assessment of mCRC treatment response
18. describe the imaging findings associated with a good or optimal morphologic response to treatment in liver metastases
19. list the imaging modalities that are recommended for assessment of treatment response
20. describe the major complications associated with percutaneous ablation