[Diagnostic possibilities and strategy in the detection of liver metastases]

The value of laboratory tests, scintigraphy, angiography, ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MR) in the detection of hepatic metastases is evaluated through a review of the literature. The diagnostic value, advantages, disadvantages and limitations of each test are discussed separately. The discussion also includes, economic aspects such as costs, time consumption and examination capacity as well as invasiveness, side-effects, use of contrast medium and patient tolerance. Based on an over-all evaluation, high-quality US combined with US-guided needle biopsy is recommended as the first-choice examination in the detection of liver metastases. In cases of doubt, CT with intravenous contrast and CT-guided biopsy are advisable as a supplement to US. For assessing the effect of treatment, CT is the most suited modality because of its reproducibility. In planning a resection of the liver, detailed information about the localization, size and extent of each lesion is required. Under these circumstances a combination of angiography, CT (or MR) and intraoperative US is to be preferred.