Colorectal cancer affects over one million people worldwide annually, with the liver being the most common site of metastatic spread. Adequate resection of hepatic metastases is the only chance for a cure in a subset of patients, and five-year survival increases to 35% with complete resection. Traditionally, computed tomographic imaging (CT) was utilized for staging and to evaluate metastases in the liver. Recently, the introduction of hepatobiliary contrast-enhanced magnetic resonance imaging (MRI) agents including gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Eovist in the United States, Primovist in Europe, or Gd-EOB-DTPA) has proved to be a sensitive method for detection of hepatic metastases. Accurate detection of liver metastases is critical for staging of colorectal cancer as well as preoperative planning. 1. Introduction Colorectal cancer is one of the most common cancers worldwide with nearly one million people diagnosed each year. The liver is the most common site of distant metastases from colorectal cancer. Up to 70% of all patients with colorectal cancer will develop hepatic metastases at some point in their lifetime, and one-third of these will have metastases confined only to the liver [1, 2]. In metastases from colorectal adenocarcinoma, locoregional therapies are available including radiofrequency ablation and resection, which provide a survival benefit for patients with limited disease. Hepatectomy for liver metastases from colorectal cancer is the gold standard of treatment and provides the only chance for cure. Complete resection of all disease has been associated with a five-year survival ranging between 22% and 58% [3]. However, incomplete resection does not increase patient survival [4, 5]. Median survival for patients with untreated but potentially resectable metastases is 8 months, with a 5-year survival of less than 5% [2]. The paradigm for resection of colorectal metastases has changed from excluding patients with more than 3-4 liver metastases, periportal lymphadenopathy, or metastases within 1？cm of major vessels to only excluding those in which a margin-free resection cannot be achieved without preserving at least a 20% future liver remnant, or 30% if the patient has undergone chemotherapy [6–8]. Identification and resection of liver lesions often rely on high-quality cross-sectional imaging studies, and these images are an indispensable tool in the treatment planning process [9]. Historically, computed tomography (CT) has been used to stage and evaluate the liver in patients with colorectal adenocarcinoma.
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