How to Best Image Colorectal Liver Metastases

Purpose of Review Colorectal liver metastases affect about half of the patients with colorectal cancer and have an impact on prognosis. Resection of liver metastases, even after downstaging with chemotherapy, improves patient survival. Several imaging modalities are available for initial detection and follow-up of liver metastases. Our purpose is to review the advantages and disadvantages of each modality and to determine which is the optimal way to evaluate colorectal liver metastases in each phase of the patient's journey. Recent Findings The available evidence derives mostly from comparative studies and meta-analysis, with only few available randomized trials. MRI with DWI sequences and liver-specific contrast agents appears to be the most accurate modality for the detection of liver metastases. Different imaging modalities can be used successfully for the detection and follow-up of colorectal liver metastases, depending on the stage of the disease and patient characteristics. A stepwise approach is recommended, instead of using all modalities in each patient.