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Abdominal Imaging

, Volume 35, Issue 6, pp 701–707 | Cite as

Peritoneal carcinomatosis from ovarian cancer: the role of CT and [18F]FDG-PET/CT

  • L. Funicelli
  • L. L. Travaini
  • F. Landoni
  • G. Trifirò
  • L. Bonello
  • M. Bellomi
Article

Abstract

Purpose

The diagnosis of peritoneal carcinomatosis secondary to ovarian cancer is a real challenge in the cancer imaging field. In this retrospective study, we evaluate the accuracy of Single Detector Computed Tomography (SDCT), Multi Detector Computed Tomography (MDCT), and Positron Emission Tomography–Computed Tomography with F18-fluorodeoxyglucose ([18F]FDG-PET/CT) in the diagnosis of peritoneal seeding and we evaluate the possible applications of MDCT to predict the complete surgical removal of the peritoneal deposits.

Methods and materials

A total of 228 scans (91 SDCT, 89 MDCT, and 48 [18F]FDG-PET/CT) of patients with peritoneal carcinomatosis secondary to ovarian cancer proved at laparoscopy and confirmed by histopathology were retrospectively reviewed by two independent groups of Radiologists and Nuclear Medicine Physicians for the evaluation of ascites, peritoneal nodules, and omental cake signs.

Results

MDCT showed 81% of true positives, SDCT 72.5%, and [18F]FDG-PET/CT 77%. False negatives were 19% for MDCT, 27.5% for SDCT, and 23% for [18F]FDG-PET/CT.

Conclusion

From our results, we concluded that MDCT is the technique of choice in the diagnosis of peritoneal seeding, while [18F]FDG-PET/CT, though showing similar accuracy, remains the most accurate technique for monitoring therapeutic response and disease recurrence. MDCT could play an important role due to its ability to predict the possibility of complete surgical removal of disease thus influencing the treatment plan aimed to improve quality of life.

Keywords

Ovarian cancer Peritoneal carcinomatosis Multi Detector CT Positron emission tomography Mesenteric root implant Single Detector CT 

References

  1. 1.
    American Cancer Society (2009) Cancer Facts and Figs 2009. Atlanta, GA: American Cancer SocietyGoogle Scholar
  2. 2.
    Johns Hopkins ovarian cancer website. http://ovariancancer.jhmi.edu/menu_understanding.cfm. Accessed 11 September 2009
  3. 3.
    Ozols RF (2005) Treatment goals in ovarian cancer. Int J Gynecol Cancer 5(suppl 1):3–11CrossRefGoogle Scholar
  4. 4.
    Meyers MA (1973) Distribution of intra-abdominal malignant seeding: dependency on dynamics of flow of ascitic fluid. Am J Roentgenol Radium Ther Nucl Med 119:198–206PubMedGoogle Scholar
  5. 5.
    Schwartz PE (2008) Cytoreductive surgery in the management of ovarian cancer. Oncology (Williston Park) 22(9):1025–1033 (discussion 1033–8, 1041,1045)Google Scholar
  6. 6.
    Bristow RE, Tomacruz RS, Armstrong DK, et al. (2002) Survival effects of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta analysis. J Clin Oncol 20:1248–1259CrossRefPubMedGoogle Scholar
  7. 7.
    Van der Burg ME (2001) Advanced ovarian cancer. Curr Treat Options Oncol 2:109–118CrossRefPubMedGoogle Scholar
  8. 8.
    Kurtz AB, Tsimikas JV, Tempany CM, et al. (1999) Diagnosis and staging of ovarian cancer: comparative values of Doppler and conventional US, CT, and MR imaging correlated with surgery and histopathologic analysis—Report of the Radiology Diagnostic Oncology Group. Radiology 212:19–27PubMedGoogle Scholar
  9. 9.
    Nelson BE, Rosenfield AT, Schwartz PE (1993) Preoperative abdominopelvic computed tomographic prediction of optimal cytoreduction in epithelial ovarian carcinoma. J Clin Oncol 11(1):166–172PubMedGoogle Scholar
  10. 10.
    William MR. Introduction to gynaecologic oncology. www.gyncancer.com/ovarian-cancer.html. Accessed 11 September 2009
  11. 11.
    Edmonson JH, McCormack GW, Fleming TR, et al. (1985) Comparison of cyclophosphamide plus cisplatin versus hexamethylmelamine, cyclophosphamide, doxorubicin, and cisplatin in combination as initial chemotherapy for stage III and IV ovarian carcinomas. Cancer Treat Rep 69:1243–1248PubMedGoogle Scholar
  12. 12.
    Omura GA, Brady MF, Homesley HD, et al. (1991) Long follow-up and prognostic factor analysis in advanced ovarian carcinoma: the Gynecologic Oncology Group experience. J Clin Oncol 9:1138–1150PubMedGoogle Scholar
  13. 13.
    Griffiths C (1975) Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. Natl Cancer Inst Monogr 42:101–104PubMedGoogle Scholar
  14. 14.
    Boente MP, Chi DS, Hoskins WJ (1998) The role of surgery in the management of ovarian cancer: primary and interval cytoreductive surgery. Semin Oncol 25:326–334PubMedGoogle Scholar
  15. 15.
    Prokopf M, Galanski M (2003) Peritoneal Carcinomatosis and Metastases. Spiral and Multislice Computed Tomography of the Body, vol 16, pp 609–610Google Scholar
  16. 16.
    Forstner R (2007) Radiological staging of ovarian cancer: imaging findings and contribution of CT and MRI. Eur Radiol 17(12):3223–3235 (Epub 2007 Aug)CrossRefPubMedGoogle Scholar
  17. 17.
    Delbeke D, Martin WH (2001) Positron emission tomography imaging in oncology. Radiol Clin North Am 39(5):883–917CrossRefPubMedGoogle Scholar
  18. 18.
    Hamacher K, Coenen HH, Stocklin G (1988) Efficient stereospecific synthesis of no-carried-added 2-[18F]-fluoro-2-d-glucose using aminopolyether supported nucleophilic substitution. J Nucl Med 29:241–247Google Scholar
  19. 19.
    Holschneider CH, Berek JS (2000) Ovarian cancer: epidemiology, biology, and prognostic factors. Semin Surg Oncol 19:3–10CrossRefPubMedGoogle Scholar
  20. 20.
    Wimberger P, Lehmann N, Kimmig R, et al. (2007) Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group Prognostic factors for complete debulking in advanced ovarian cancer and its impact on survival. An exploratory analysis of a prospectively randomized phase III study of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group (AGO-OVAR). Gynecol Oncol 106(1):69–74CrossRefPubMedGoogle Scholar
  21. 21.
    Turlakow A, Yeung HW, Salmon AS, Macapinlac HA, Larson SM (2003) Peritoneal carcinomatosis: role of (18)F-FDG PET. J Nucl Med 44(9):1407–1412PubMedGoogle Scholar
  22. 22.
    Dromain C, Leboulleux S, Auperin A, et al. (2008) Staging of peritoneal carcinomatosis: enhanced CT vs. PET/CT. Abdom Imaging 33:87–93CrossRefPubMedGoogle Scholar
  23. 23.
    Tempany CM, Zou KH, Silverman SG, et al. (2000) Staging of advanced ovarian cancer: comparison of imaging modalities—report from the Radiology Oncology Group. Radiology 215:761–767PubMedGoogle Scholar
  24. 24.
    Coakley FV, Choi PH, Cougoutas CA, et al. (2002) Peritoneal metastases: detection with spiral CT in patients with ovarian cancer. Radiology 223:495–499CrossRefPubMedGoogle Scholar
  25. 25.
    Low RN, Chen SC, Barone R (2003) Distinguishing benign from malignant bowel obstruction in patients with malignancy: findings at MR imaging. Radiology 228(1):157–165CrossRefPubMedGoogle Scholar
  26. 26.
    Fujii S, Matsusue E, Kanasaki Y, et al. (2008) Detection of peritoneal dissemination in gynecological malignancy: evaluation by diffusion-weighted MR imaging. Eur Radiol 18(1):18–23 (Epub 2007 Aug 14)CrossRefPubMedGoogle Scholar
  27. 27.
    Pannu HK, Bristow RE, Cohade C, Fishman EK, Wahl RL (2004) PET-CT in recurrent ovarian cancer: initial observations. Radiographics 24(1):209–223CrossRefPubMedGoogle Scholar
  28. 28.
    Gadducci A, Cosio S (2009) Surveillance of patients after initial treatment of ovarian cancer. Crit Rev Oncol Hematol [Epub ahead of print]Google Scholar
  29. 29.
    Nakamoto Y, Saga T, Ishimori T, et al. (2001) Clinical value of positron emission tomography with FDG for recurrent ovarian cancer. Am J Roentgenol 176:1449–1454Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • L. Funicelli
    • 1
  • L. L. Travaini
    • 2
  • F. Landoni
    • 3
  • G. Trifirò
    • 2
  • L. Bonello
    • 1
  • M. Bellomi
    • 1
    • 4
  1. 1.Department of RadiologyEuropean Institute of OncologyMilanItaly
  2. 2.Department of Nuclear MedicineEuropean Institute of OncologyMilanItaly
  3. 3.Department of GynaecologyEuropean Institute of OncologyMilanItaly
  4. 4.School of RadiologyUniversity of MilanMilanItaly

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