Skip to main content

Advertisement

SpringerLink
Log in

Preoperative assessment of peritoneal carcinomatosis: intraindividual comparison of 18F-FDG PET/CT and MRI

  • Published:
Abdominal Imaging Aims and scope Submit manuscript

Abstract

Objective

Exact determination of localization and extent of peritoneal carcinomatosis (PC) before peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC) is crucial for the clinical outcome. Our study compares dynamic contrast enhanced 3D MRI (T1wDCE) and 18F-FDG PET/CT regarding diagnostic accuracy in correlation with surgical exploration (SE) and histological (HI) results.

Materials and methods

15 patients with PC were examined on a 1.5T MRI and 16 slice PET/CT. MRI: coronal T1wDCE covering the complete abdomen (0.15 mmol Gd-chelate/kg BW, 2000 mL mannitol solution p.o., 40 mg buscopan i.v.). PET-CT: contrast enhanced 16slice CT (120 mL ultravist 370 i.v., 1000 mL mannitol solution p.o., 40 mg buscopan i.v.), PET: 350 MBq 18-FDG i.v., 3 min acquisition time/bed, 60 min after tracer injektion). Assessment by two independent, experienced observers in correlation with results of SE and HI for each abdominal segment based on the peritoneal cancer index (PCI) proposed by Sugarbaker and co-authors.

Results

MRI and PET/CT provided reliable detection of PC. One patient had to be excluded from statistical analysis. In summary, 182 segments were assessed (13/patient, 14 patients, one patient excluded from statistical analysis). PC was found in 118 by MRI, 124 by PET/CT. 4 segments were classified false positive for MRI, 2 for PET/CT. False negative segments (MRI: 17, PET/CT: 9) did not result in irresectability. Positive predictive value for PC/segment was 97/98%, negative predictive value 73/84%, sensitivity 87/93%, specificity 92/96%, and diagnostic accuracy 88/94% (MRI/PET/CT).

Conclusion

With high diagnostic accuracy for PC of both, MRI and PET/CT, PET/CT provides better diagnostic accuracy and especially better NPV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Sadeghi B, Arvieux C, Glehen O, et al. (2000) Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer 88:358–363

    Article  PubMed  CAS  Google Scholar 

  2. Pyrhoenen S, Kuitunen T, Nyandoto P, Kouri M (1995) Randomized comparison of fluorouracil, epidoxorubicin and methotrexate (FEMTX) plus supportive care with supportive care alone in patients with non-resectable gastric cancer. Br J Cancer 71:587–591

    Article  Google Scholar 

  3. Hamilton T, Lanuke K, Mack LA, Temple WJ (2011) Long-term follow-up in the treatment of peritoneal carcinomatosis. Am J Surg 201(5):650–654

    Article  PubMed  Google Scholar 

  4. Raue W, Tsilimparis N, Langelotz C, et al. (2011) Initial results after implementation of multimodal treatment for peritoneal malignancies. Acta Chir Belg 111(2):68–72

    PubMed  CAS  Google Scholar 

  5. Gill RS, Al-Adra DP, Nagendran J, et al. (2011) Treatment of gastric cancer with peritoneal carcinomatosis by cytoreductive surgery and HIPEC: a systematic review of survival, mortality, and morbidity. J Surg Oncol 104:692–698

    Article  PubMed  Google Scholar 

  6. Esquivel J, Elias D, Baratti D (2008) Consensus statement on the loco regional treatment of colorectal cancer with peritoneal dissemination. J Surg Oncol 98:263–267

    Article  PubMed  Google Scholar 

  7. Testa A, Ludovisi M, Mascilini F, et al. (2011) Ultrasound evaluation of intra-abdominal sites of disease to predict the likelihood of suboptimal cytoreduction in advanced ovarian cancer: a prospective study. Ultrasound Obstet Gynecol 39:99–105

    Article  Google Scholar 

  8. Forstner R (2007) Radiological staging of ovarian cancer: imaging findings and contribution of CT and MRI. Eur Radiol 17:3223–3246

    Article  PubMed  Google Scholar 

  9. Pfannenberg C, Koenigsrainer I, Aschoff P, et al. (2009) (18)F-FDG-PET/CT to select patients with peritoneal carcinomatosis for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol 16:1295–1303

    Article  PubMed  Google Scholar 

  10. Low RN, Barone RM, Lacey C, et al. (1997) Peritoneal tumor: MR imaging with dilute oral barium and intravenous gadolinium containing contrast agents compared with unenhanced MR imaging and CT. Radiology 204:513–520

    PubMed  CAS  Google Scholar 

  11. Low RN (2007) MR imaging of the peritoneal spread of malignancy. Abdom Imaging 32:267–283

    Article  PubMed  Google Scholar 

  12. Low RN, Sigeti JS (1994) MR imaging of peritoneal disease: comparison of contrast enhanced fast multiplanar spoiled gradient recalled and spin echo imaging. Am J Roentgenol 163:1131–1140

    CAS  Google Scholar 

  13. Glaspy JA, Hawkins R, Hoh CK, Phelps ME (1993) Use of positron emission tomography in oncology. Oncology 7:41–55

    PubMed  CAS  Google Scholar 

  14. Kole AC, Nieweq OE, Pruim J, et al. (1998) Detection of unknown occult primary tumors using positron emission tomography. Cancer 82:1160–1166

    Article  PubMed  CAS  Google Scholar 

  15. Chopra S, Laurie LR, Chintapalli KN, Valente PT, Dodd GD 3rd (2000) Primary papillary serous carcinoma of the peritoneum: CT-pathologic correlation. J Comput Assist Tomogr 24:395–399

    Article  PubMed  CAS  Google Scholar 

  16. Hideo M, Aoki J, Taketomi A, Sato N, Endo K (2004) Serous surface papillary carcinoma of the peritoneum: clinical, radiologic and pathologic findings in 11 patients. Am J Roentgenol 183:923–928

    Google Scholar 

  17. Furukawa T, Ueda J, Takahashi S, et al. (1999) Peritoneal serous papillary carcinoma: radiological appearance. Abdom Imaging 24:78–81

    Article  PubMed  CAS  Google Scholar 

  18. Stafford-Johmson DB, Bree RL, Francis IR, Korobkin M (1998) CT appearance of primary serous carcinoma of the peritoneum. Am J Roentgenol 171:687–689

    Google Scholar 

  19. Zissin R, Hertz M, Shapiro-Feinberg M, et al. (2001) Primary serous papillary carcinoma of the peritoneum: CT findings. Clin Radiol 56:740–745

    Article  PubMed  CAS  Google Scholar 

  20. Brown G, Kirkham A, Williams GT, et al. (2004) High-resolution MRI of the anatomy important in total mesorectal excision of the rectum. Am J Roentgenol 182:431–439

    Google Scholar 

  21. De laco P, Musto A, Orazi L, et al. (2010) FDG-PET/CT in advanced ovarian cancer staging: Value and pitfalls in detecting lesions in different abdominal and pelvic quadrants compared with laparoscopy. Eur J Radiol 80:e98–e103

    Google Scholar 

  22. Berthelot C, Morel O, Girault S, et al. (2011) Use of FDG-PET/CT for peritoneal carcinomatosis before hyperthermic intraperitoneal chemotherapy. Nucl Med Commun 32:23–29

    Article  PubMed  Google Scholar 

  23. Jacquet P, Jelinek JS, Steves MA, Sugarbaker PH (1993) Evaluation of computed tomography in patients with peritoneal carcinomatosis. Cancer 72:1631–1636

    Article  PubMed  CAS  Google Scholar 

  24. Sala E, Kataoka M, Pandit-Taskar N, et al. (2010) Recurrent ovarian cancer: use of contrast-enhanced CT and PET/CT to accurately localize tumor recurrence and to predict patients’ survival. Radiology 257:125–134

    Article  PubMed  Google Scholar 

  25. Rakheja R, Makis W, Hickeson M (2011) Extraovarian primary peritoneal carcinoma: staging with 18F-FDG PET/CT. Abdom Imaging. doi:10.1007/s00261-011-9722-0

  26. Funicelli L, Travaini LL, Landoni F, et al. (2010) Peritoneal carcinomatosis from ovarian cancer: the role of CT and [18F]FDG-PET/CT. Abdom Imaging 35:701–707

    Article  PubMed  CAS  Google Scholar 

  27. Marin D, Catalano C, Baski M, et al. (2010) 64-Section multi-detector row CT in the preoperative diagnosis of peritoneal carcinomatosis: correlation with histopathological findings. Abdom Imaging 35:694–700

    Article  PubMed  Google Scholar 

  28. Iafrate F, Ciolina M, Sammartino P, et al. (2011) Peritoneal carcinomatosis: imaging with 64-MDCT and 3T MRI with diffusion-weighted imaging. Abdom Imaging [Epub]

  29. Dromain C, Leboulleux S, Auperin A, et al. (2008) Staging of peritoneal carcinomatosis: enhanced CT vs. PET/CT. Abdom Imaging 33:87–93

    Article  PubMed  Google Scholar 

  30. Low RN, Semelka RC, Worawattanakul S, Alzate GD, Sigeti JS (1999) Extrahepatic abdominal imaging in patients with malignancy: comparison of MR imaging and helical CT with subsequent surgical correlation. Radiology 210:625–632

    PubMed  CAS  Google Scholar 

  31. Priest AN, Gill AB, Kataoka M, et al. (2010) Dynamic contrast-enhanced MRI in ovarian cancer: initial experience at 3 tesla in primary and metastatic disease. Magn Reson Med 63:1044–1049

    Article  PubMed  Google Scholar 

  32. Satoh Y, Ichikawa T, Motosugi U, et al. (2011) Diagnosis of peritoneal dissemination: comparison of 18F-FDG PET/CT diffusion-weighted MRI and contrast-enhanced MDCT. Am J Roentgenol 196:447–453

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany

    Bernhard Daniel Klumpp, Nina Schwenzer, Ulrich Kramer, Claus D. Claussen & Christina Pfannenberg

  2. Diakonie Klinikum Stuttgart, Südwestdeutsches PET-Zentrum, Seidenstr. 47, 70174, Stuttgart, Germany

    Philip Aschoff

  3. Department for General, Visceral and Transplantation Surgery, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany

    Bjoern Bruecher & Alfred Koenigsrainer

  4. Radiologiepraxis Dr. Aicher, Dr. Kölbel, Prof. Dr. Miller, Uhlandstr. 8, 72072, Tübingen, Germany

    Stephan Miller

Authors
  1. Bernhard Daniel Klumpp
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nina Schwenzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Philip Aschoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephan Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ulrich Kramer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Claus D. Claussen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bjoern Bruecher
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alfred Koenigsrainer
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Christina Pfannenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bernhard Daniel Klumpp.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Klumpp, B.D., Schwenzer, N., Aschoff, P. et al. Preoperative assessment of peritoneal carcinomatosis: intraindividual comparison of 18F-FDG PET/CT and MRI. Abdom Imaging 38, 64–71 (2013). https://doi.org/10.1007/s00261-012-9881-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-012-9881-7

Keywords

Search

Navigation