Optimization of imaging and treatment of patients with focal liver lesions

The incidence of focal liver lesions (either benign or malignant) has increased drastically the last decades. Treatment possibilities have extended significantly due to improved chemotherapeutic agents, extended eligibility criteria for partial liver resection, the introduction of radiofrequency ablation (RFA) and the development of yttrium radio-embolization. Patients with focal liver lesions often require a different individual treatment strategy, which should be chosen accurately in order to improve patient outcome. To accurately determine the treatment strategy, correct lesion detection and characterization is crucial. This thesis presents research that was performed in order to optimize imaging, selection and treatment of patients with focal liver lesions. This thesis focuses on imaging, evaluation and treatment of focal liver lesions and is subdivided into four parts. Part 1 evaluates the optimal imaging modality for assessment of colorectal liver metastases in patients receiving chemotherapy. Also, novel measurement techniques for response evaluation following chemotherapy are addressed. Part 2 concentrates on the optimization of pre-operative evaluation and the surgical management of colorectal liver metastases. Part 3 assesses Primovist-enhanced MR imaging for evaluation of focal liver lesions. Part 4 summarizes and discusses the results from this thesis and addresses future perspectives.