Manual Contouring Based Volumetric Evaluation for Colorectal Cancer with Liver Limited Metastases: A Comparison with RECIST

  • Fang, W.J. (First Affiliated Hospital, School of Medicine, Zhe Jiang University) ;
  • Lam, K.O. (Department of Clinical Oncology, Queen Mary Hospital, The University of Hong Kong) ;
  • Ng, S.C.Y. (Department of Clinical Oncology, Queen Mary Hospital, The University of Hong Kong) ;
  • Choi, C.W. (Department of Community Medicine and School of Public Health, The University of Hong Kong) ;
  • Kwong, D.L.W. (Department of Clinical Oncology, Queen Mary Hospital, The University of Hong Kong) ;
  • Zheng, S.S. (First Affiliated Hospital, School of Medicine, Zhe Jiang University) ;
  • Lee, V.H.F. (Department of Clinical Oncology, Queen Mary Hospital, The University of Hong Kong)
  • Published : 2013.07.30


Background: To compare response evaluation criteria in solid tumours (RECIST) and volumetric evaluation (VE) for colorectal cancer with liver-limited metastasis. Patients and Methods: VE of liver metastases was performed by manual contouring before and after chemotherapy on 45 pairs of computed tomography (CT) images in 36 patients who suffered from metastatic colorectal cancer (mCRC) with liver metastasis only. Cohen kappa was used to compare the agreement between VE and RECIST. Pearson correlation was performed for their comparison after cubic root transformation of the aggregate tumor volumes. Logistic regression was done to identify clinical and radiographic factors to account for the difference which may be predictive in overall response (OR). Results: There were 16 partial response (PR), 23 stable disease (SD) and 6 progressive disease (PD) cases with VE, and 14 PR, 23 SD and 8 PD with RECIST. VE demonstrated good agreement with RECIST (${\chi}$=0.779). Discordant objective responses were noted in 6 pairs of comparisons (13.3%). Pearson correlation also showed excellent correlation between VE and RECIST ($r^2$=0.966, p<0.001). Subgroup analysis showed that VE was in slightly better agreement with RECIST for enlarging lesions than for shrinking lesions ($r^2$=0.935 and $r^2$=0.780 respectively). No factor was found predictive of the difference in OR between VE and RECIST. Conclusions: VE exhibited good agreement with RECIST. It might be more useful than RECIST in evaluation shrinking lesions in cases of numerous and conglomerate liver metastases.


Manual contouring;volumetric evaluation;RECIST;liver metastases;colorectal cancer


  1. Armato SG, 3rd, Oxnard GR, MacMahon H, et al (2004). Measurement of mesothelioma on thoracic CT scans: a comparison of manual and computer-assisted techniques. Med Phys, 31, 1105-15.
  2. Benjamin RS, Choi H, Macapinlac HA, et al (2007). We should desist using RECIST, at least in GIST. J Clin Oncol, 25, 1760-4.
  3. Bokemeyer C, Bondarenko I, Makhson A, et al (2009). Fluorouracil, leucovorin, and oxaliplatin with and without cetuximab in the first-line treatment of metastatic colorectal cancer. J Clin Oncol, 27, 663-71.
  4. Cassidy J, Clarke S, Diaz-Rubio E, et al (2008). Randomized phase III study of capecitabine plus oxaliplatin compared with fluorouracil/folinic acid plus oxaliplatin as first-line therapy for metastatic colorectal cancer. J Clin Oncol, 26, 2006-12.
  5. De Gramont A, Figer A, Seymour M, et al (2000). Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol, 18, 2938-47.
  6. Eisenhauer EA, Therasse P, Bogaerts J, et al (2009). New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer, 45, 228-47.
  7. Frauenfelder T, Tutic M, Weder W, et al (2011). Volumetry: an alternative to assess therapy response for malignant pleural mesothelioma? Eur Respir J, 38, 162-8.
  8. Gavrielides MA, Kinnard LM, Myers KJ and Petrick N(2009). Noncalcified lung nodules: volumetric assessment with thoracic CT. Radiology, 251, 26-37.
  9. Galizia MS, Tore HG, Chalian H and Yaghmai V(2011). Evaluation of hepatocellular carcinoma size using two-dimensional and volumetric analysis: effect on liver transplantation eligibility. Acad Radiol, 18, 1555-60.
  10. Heussel CP, Meier S, Wittelsberger S, et al (2007). Follow-up CT measurement of liver malignoma according to RECIST and WHO vs. volumetry. RoFo, 179, 958-64.
  11. Kundel HL and Polansky M(2003). Measurement of observer agreement. Radiology, 228, 303-8.
  12. Lemke AJ, Brinkmann MJ, Schott T, et al (2006). Living donor right liver lobes: preoperative CT volumetric measurement for calculation of intraoperative weight and volume. Radiology, 240, 736-42.
  13. Laghi A(2007). Multidetector CT (64 Slices) of the liver: examination techniques. Eur Radiol, 17, 675-83.
  14. Mantatzis M, Kakolyris S, Amarantidis K, Karayiannakis A and Prassopoulos P (2009). Treatment response classification of liver metastatic disease evaluated on imaging. Are RECIST unidimensional measurements accurate? Eur Radiol, 19, 1809-16.
  15. Maughan TS, Adams RA, Smith CG, et al (2011). Addition of cetuximab to oxaliplatin-based first-line combination chemotherapy for treatment of advanced colorectal cancer: results of the randomised phase 3 MRC COIN trial. Lancet, 377, 2103-14.
  16. Oxnard GR, Armato SG, 3rd and Kindler HL(2006). Modeling of mesothelioma growth demonstrates weaknesses of current response criteria. Lung Cancer, 52, 141-8.
  17. Prasad SR, Jhaveri KS, Saini S, et al (2002). CT tumor measurement for therapeutic response assessment: comparison of unidimensional, bidimensional, and volumetric techniques initial observations. Radiology, 225, 416-9.
  18. Plathow C, Klopp M, Thieke C, et al (2008). Therapy response in malignant pleural mesothelioma-role of MRI using RECIST, modified RECIST and volumetric approaches in comparison with CT. Eur Radiol, 18, 1635-43.
  19. Reeves AP, Biancardi AM, Apanasovich TV, et al (2007). The Lung Image Database Consortium (LIDC): a comparison of different size metrics for pulmonary nodule measurements. Acad Radiol, 14, 1475-85.
  20. Reiner CS, Karlo C, Petrowsky H, et al (2009). Preoperative liver volumetry: how does the slice thickness influence the multidetector computed tomography- and magnetic resonance-liver volume measurements? J Comput Assist Tomogr, 33, 390-7.
  21. Sohaib SA, Turner B, Hanson JA, et al (2000). CT assessment of tumour response to treatment: comparison of linear, cross-sectional and volumetric measures of tumour size. Br J Radiol, 73, 1178-84.
  22. Shin SJ, Ahn JB, Choi JS, et al (2012). Implications of clinical risk score to predict outcomes of liver-confined metastasis of colorectal cancer. Surg Oncol, 21, e125-30.
  23. Therasse P, Arbuck SG, Eisenhauer EA, et al (2000). New guidelines to evaluate the response to treatment in solid tumors. J Natl Cancer Inst, 92, 205-16.
  24. Tran LN, Brown MS, Goldin JG, et al (2004). Comparison of treatment response classifications between unidimensional, bidimensional, and volumetric measurements of metastatic lung lesions on chest computed tomography. Acad Radiol, 11, 1355-60.
  25. Vogl TJ, Naguib NN, Eichler K, et al (2008). Volumetric evaluation of liver metastases after thermal ablation: long-term results following MR-guided laser-induced thermotherapy. Radiology, 249, 865-71.
  26. Van Cutsem E, Kohne CH, Hitre E, et al (2009). Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer. N Engl J Med, 360, 1408-17.
  27. Winer-Muram HT, Jennings SG, Meyer CA, et al(2003). Effect of varying CT section width on volumetric measurement of lung tumors and application of compensatory equations. Radiology, 229, 184-94.
  28. William WN, Jr., Pataer A, Kalhor N, et al (2013). Computed tomography RECIST assessment of histopathologic response and prediction of survival in patients with resectable non-small-cell lung cancer after neoadjuvant chemotherapy. J Thorac Oncol, 8, 222-8,
  29. Yankelevitz DF, Reeves AP, Kostis WJ, Zhao B and Henschke CI (2000). Small pulmonary nodules: volumetrically determined growth rates based on CT evaluation. Radiology, 217, 251-6.

Cited by

  1. Therapeutic response assessment using 3D ultrasound for hepatic metastasis from colorectal cancer: Application of a personalized, 3D-printed tumor model using CT images vol.12, pp.8, 2017,