Dynamic Contrast‐Enhanced MRI for Assessing Histopathological Growth Patterns and Prognosis in Colorectal Liver Metastases

ABSTRACT Background The desmoplastic histopathological growth pattern (dHGP) of colorectal liver metastases (CRLM) is associated with prolonged survival and favorable anti‐angiogenic chemotherapy response. However, reliable preoperative identification of dHGP using MRI remains challenging. Purpose To develop a dynamic contrast‐enhanced MRI (DCE‐MRI)‐based model for assessing dHGP probability, facilitating candidate selection for anti‐angiogenic neoadjuvant chemotherapy, and prognostic evaluation. Study Type Retrospective, dual‐center study. Subjects 286 patients (114 female; 133 with dHGP) with pathologically confirmed CRLM (≥ 10 mm). Field Strength/Sequence 3.0 T, T1‐weighted imaging using 3D gradient sequence (precontrast, arterial, portal venous and delayed phases). Assessment Three abdominal radiologists independently reviewed DCE‐MRI features, including peritumoral rim enhancement at different phases for dHGP assessment. Disease‐free survival (DFS), overall survival (OS), and treatment response to bevacizumab were also assessed. Statistical Tests Univariable and multivariable logistic regression, area under the receiver operating characteristic curve (AUC), DeLong test, Kaplan–Meier analysis, and log‐rank test. Results Peritumoral rim enhancement on arterial (odds ratio [OR] = 4.65, [95% CI: 2.20–9.84]), portal venous (OR = 7.46, [95% CI: 3.12–17.84]), and delayed phases (OR = 3.55, [95% CI: 1.84–6.88]) was significantly and independently associated with dHGP. A peritumoral rim enhancement‐based probability model achieved AUCs of 0.86 (95% CI: 0.81–0.90) and 0.82 (95% CI: 0.70–0.91) for diagnosing dHGP in development and external validation cohorts, respectively. Peritumoral rim enhancement was independently associated with longer survival (DFS: adjusted hazard ratio [HR] = 0.34, [95% CI: 0.25–0.47]; OS: HR = 0.46, [95% CI: 0.34–0.63]) in all patients. Among patients receiving bevacizumab‐containing neoadjuvant chemotherapy ( n = 90), peritumoral rim enhancement was significantly associated with longer DFS (HR = 0.24, [95% CI: 0.12–0.49]) and OS (HR = 0.24, [95% CI: 0.11–0.50]). Data Conclusion Peritumoral rim enhancement on DCE‐MRI shows a strong association with dHGP, indicates favorable survival, and may identify candidates for anti‐angiogenic chemotherapy. Evidence Level 3. Technical Efficacy Stage 2.