Evaluation of the Liver for Metastatic Disease

Erik K. Paulson, MD1, 1Department of Radiology, Duke University Medical Center, Durham, North Carolina.

Semin Liver Dis. 2001;21(2) 

In This Article

Abstract and Introduction


Metastatic disease of the liver accounts for the vast majority of detected liver masses. In patients with suspected metastatic disease, cross-sectional imaging with ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI) is critical. In the group of patients undergoing evaluation for hepatic surgery, it is even more important to optimize techniques to detect and localize metastatic disease. With improvements in technology and contrast agents, there are several approaches to imaging the liver for metastatic disease. The approach will vary by institution. This article will attempt to provide an overview of the general issues relevant to imaging metastatic disease, highlight the advantages and disadvantages of one modality compared to another, and illustrate the appearance of metastases using US, CT, and MRI.

Objectives: Upon completion of this article, the practicing hepatologist or gastroenterologist will be able to (1) understand general issues relevant to imaging hepatic metastatic disease, (2) understand basic advantages and disadvantages of one imaging modality compared to another relative to imaging metastatic disease, and (3) gain further expertise in the various imaging appearances of metastases to the liver.


In most institutions metastatic disease accounts for the vast majority of liver masses, far outnumbering primary liver tumors. The true prevalence of hepatic metastatic disease is unknown.[1] Published reports are biased and reflect sampling time relative to the course of the disease. Furthermore, prevalence estimates based on cross-sectional imaging are biased by limitations in detection.[2] However, autopsy series of patients with primary tumors indicate that at the time of death, approximately 50% of patients have metastatic disease of the liver.[3]

The liver is the most common site for metastatic spread of colorectal cancer, which accounts for well over 50,000 deaths per year in the United States alone.[4] The presence of metastatic disease to the liver is a prime determinate of survival. Prognosis is inversely proportional to not only the presence of metastases but also the number and volume of metastases.[5] For example, in patients with metastatic colon cancer, Wagner et al[6] found a 3-year survival rate of 21% in patients with solitary lesions, 6% in those with multiple lesions affecting only one lobe, and 4% in those patients with widespread disease.

Over the last decade, there have been tremendous advances in the treatment of metastatic disease of the liver.[7] Liver resection or liver-directed therapy is justified for select patients when extrahepatic malignancy is not present and the patient can tolerate therapy. With improvements in surgical therapy, most institutions are encountering an increasing number of referrals for liver-directed therapy.

In patients with suspected metastatic disease, cross-sectional imaging is critical. Specific approaches will vary among institutions. This article will provide an overview of cross-sectional imaging of metastatic disease.