Background: Thermal ablation of colorectal liver metastases (CRLM) may result in local progression, which\ngenerally appear within a year of treatment. As the timely diagnosis of this progression allows potentially curative\nlocal treatment, an optimal follow-up imaging strategy is essential. PET-MRI is a one potential imaging modality,\ncombining the advantages of PET and MRI. The aim of this study is evaluate fluorine-18 deoxyglucose positron\nemission tomography (FDG) PET-MRI as a modality for detection of local tumor progression during the first year\nfollowing thermal ablation, as compared to the current standard, FDG PET-CT. The ability of FDG PET-MRI to detect\nnew intrahepatic lesions, and the extent to which FDG PET-MRI alters clinical management, inter-observer variability\nand patient preference will also be included as secondary outcomes.\nMethods/Design: Twenty patients undergoing treatment with radiofrequency or microwave ablation for (recurrent)\nCRLM will be included in this prospective trial. During the first year of follow-up, patients will be scanned at the VU\nUniversity Medical Center at 3-monthly intervals using a 4-phase liver CT, FDG PET-CT and FDG PET-MRI. Patients\ntreated with chemotherapy <6 weeks prior to scanning or with a contra-indication for MRI will be excluded. MRI will\nbe performed using both whole body imaging (mDixon) and dedicated liver sequences, including diffusion-weighted\nimaging, T1 in-phase and opposed-phase, T2 and dynamic contrast-enhanced imaging. The results of all modalities\nwill be scored by 4 individual reviewers and inter-observer agreement will be determined. The reference standard\nwill be histology or clinical follow-up. A questionnaire regarding patients� experience with both modalities will also be\ncompleted at the end of the follow-up year.\nDiscussion: Improved treatment options for local site recurrences following CRLM ablation mean that accurate\npost-ablation staging is becoming increasingly important. The combination of the sensitivity of MRI as a detection\nmethod for small intrahepatic lesions with the ability of FDG PET to visualize enhanced metabolism at the ablation\nsite suggests that FDG PET-MRI could potentially improve the accuracy of (early) detection of progressive disease,\nand thus allow swifter and more effective decision-making regarding appropriate treatment.
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