Follow the CoNoR Study on Twitter for updates @CoNoR_Study


The CoNoR Study:

Colorectal Liver Metastases: Novel Assessment Tools for Resectability

The CoNoR Study is a Delphi of international Hepatobiliary experts aiming to establish the potential added benefit of two novel technologies in assessing colorectal liver metastases resectability prior to surgery:

  1. Humedics LiMAx Test to assess liver function (LiMAx)
  2. Perspectum Diagnostics Advanced pre-operative MR Imaging Tool (HepaT1ca)


To assess the added benefit of these two novel tools in determining the technical resectability of colorectal liver metastases (CLM).



Surgery offers a chance of cure for selected patients with CLM, dependent upon a thorough pre-operative assessment of the liver. There is currently wide variation in patient selection, with a role for novel liver assessment tools to aid decision-making.


LiMAx test:

This novel breath test provides highly sensitive information on liver function. It directly determines the metabolism of 13C-methacetin to 13CO2 by a hepatocyte-specific enzyme system, and has been used in Europe to aid decision-making in liver surgery. The first use of the LiMAx test in the UK is for these two sister studies – CLiFF and CoNoR. For more information on the LiMAx test, please visit:

Perspectum Diagnostics Pre-operative Imaging Tool (HepaT1ca):

Perspectum Diagnostics have recently developed a comprehensive advanced Magnetic Resonance imaging liver assessment to aid pre-operative planning, developed during the HepaT1ca study. Perspectum will further refine this custom-made tool for the optimal assessment of CLM resectability, designed specifically to assess factors identified as relevant from the current literature and feedback from the hepatobiliary (HPB) community. For more information on the HepaT1ca study, please visit:



The potential added benefit of the LiMAx test and HepaT1ca in HPB Multi-Disciplinary Team decision-making on resectability in CLM will be assessed using the following four workstreams:


Expected Duration:

Workstreams 1 and 2 will begin in 2019; Workstreams 3-4 will take place in 2020-2021. The worksteam 3 survey launched on 6th February 2020 with a presentation at the ALPS (Alpine Liver and Pancreatic Surgery) annual international conference. The survey was then paused due to the COVID-19 pandemic, and subsequently re-opened in September 2020. The closing date for this workstream 3 questionnaire is Friday 15th January 2021.


Study Team:

The CoNoR Study is being carried out as part of a University of Manchester PhD Thesis (K Parmar) with the following supervisory team: