La radiologia medica

, Volume 122, Issue 1, pp 1–15 | Cite as

Diagnostic performance of computed tomography and magnetic resonance imaging for detecting peritoneal metastases: systematic review and meta-analysis

  • Andrea LaghiEmail author
  • Davide Bellini
  • Marco Rengo
  • Fabio Accarpio
  • Damiano Caruso
  • Daniele Biacchi
  • Angelo Di Giorgio
  • Paolo Sammartino



Primary end point was to assess diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) in detecting peritoneal metastases (PM). Secondary end points were determining the diagnostic sensitivity and specificity of CT in detecting PM according to the peritoneal cancer index (PCI), investigating correlations between radiological and surgical PCI, and comparing diagnostic yield of CT versus positron emission tomography (PET)/CT.

Materials and methods

We searched MEDLINE, Cochrane Library, Embase and Web of Science databases. Analytic methods were based on PRISMA. Pooled estimates for sensitivity, specificity, positive and negative likelihood ratios were calculated using fixed and random effect models. I 2 was used to evaluate heterogeneity.


Of the 529 articles initially identified, 22 were selected for inclusion (934 patients). Cumulative data for per patient CT diagnostic accuracy were sensitivity 83 % (95 % CI 79–86 %), specificity 86 % (95 % CI 82–89 %), pooled positive LR 4.37 (2.58–7.41), and pooled negative LR 0.20 (0.11–0.35). On a per region basis CT performed best in epigastrium and pelvis. Correlation analysis showed a high correlation between CT-PCI and surgical-PCI scores, ranging from 0.49 to 0.96. MRI and PET/CT achieved similar per patient diagnostic accuracy.


CT should be the preferred diagnostic imaging modality for detecting peritoneal metastases because of the robustness of the data. MRI and PET/CT should be considered second choices, until more consistent information on their diagnostic yield in detecting PM are obtained.


Peritoneal carcinomatosis Computed tomography Magnetic resonance imaging Accuracy Peritoneal Cancer Index 



Computed tomography


Positron emission tomography/computed tomography


Magnetic resonance imaging


Peritoneal metastases


Peritoneal Cancer Index


Hyperthermic intraperitoneal chemotherapy



We have nothing to disclose.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

11547_2016_682_MOESM1_ESM.docx (84 kb)
Supplementary material 1 (DOCX 83 kb)


  1. 1.
    Cotte E, Passot G, Gilly FN, Glehen O (2010) Selection of patients and staging of peritoneal surface malignancies. World J Gastrointest Oncol 2(1):31–35. doi: 10.4251/wjgo.v2.i1.31 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Jacquet P, Sugarbaker PH (1996) Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. In: Sugarbaker PH (ed) Peritoneal carcinomatosis: principles of management. Kluwer Academic Publishers, Boston, USA, pp 359–374CrossRefGoogle Scholar
  3. 3.
    Pomel C, Appleyard TL, Gouy S, Rouzier R, Elias D (2005) The role of laparoscopy to evaluate candidates for complete cytoreduction of peritoneal carcinomatosis and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 31(5):540–543. doi: 10.1016/j.ejso.2005.01.009 Google Scholar
  4. 4.
    Gonzalez-Moreno S, Gonzalez-Bayon L, Ortega-Perez G, Gonzalez-Hernando C (2009) Imaging of peritoneal carcinomatosis. Cancer J 15(3):184–189. doi: 10.1097/PPO.0b013e3181a58ec3 CrossRefPubMedGoogle Scholar
  5. 5.
    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 151(4):W65–W94CrossRefPubMedGoogle Scholar
  6. 6.
    Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MM, Sterne JA, Bossuyt PM, Group Q- (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Annals of internal medicine 155(8):529–536. doi: 10.7326/0003-4819-155-8-201110180-00009 CrossRefPubMedGoogle Scholar
  7. 7.
    Mazzei MA, Khader L, Cirigliano A, Cioffi Squitieri N, Guerrini S, Forzoni B, Marrelli D, Roviello F, Mazzei FG, Volterrani L (2013) Accuracy of MDCT in the preoperative definition of Peritoneal Cancer Index (PCI) in patients with advanced ovarian cancer who underwent peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC). Abdom Imaging 38(6):1422–1430. doi: 10.1007/s00261-013-0013-9 CrossRefPubMedGoogle Scholar
  8. 8.
    Franiel T, Diederichs G, Engelken F, Elgeti T, Rost J, Rogalla P (2009) Multi-detector CT in peritoneal carcinomatosis: diagnostic role of thin slices and multiplanar reconstructions. Abdom Imaging 34(1):49–54. doi: 10.1007/s00261-008-9372-z CrossRefPubMedGoogle Scholar
  9. 9.
    Coakley FV, Choi PH, Gougoutas CA, Pothuri B, Venkatraman E, Chi D, Bergman A, Hricak H (2002) Peritoneal metastases: detection with spiral CT in patients with ovarian cancer. Radiology 223(2):495–499. doi: 10.1148/radiol.2232011081 CrossRefPubMedGoogle Scholar
  10. 10.
    Rubini G, Altini C, Notaristefano A, Merenda N, Rubini D, Ianora AA, Asabella AN (2014) Role of 18F-FDG PET/CT in diagnosing peritoneal carcinomatosis in the restaging of patient with ovarian cancer as compared to contrast enhanced CT and tumor marker Ca-125. Revista espanola de medicina nuclear e imagen molecular 33(1):22–27. doi: 10.1016/j.remn.2013.06.008 PubMedGoogle Scholar
  11. 11.
    Kim HW, Won KS, Zeon SK, Ahn BC, Gayed IW (2013) Peritoneal carcinomatosis in patients with ovarian cancer: enhanced CT versus 18F-FDG PET/CT. Clin Nucl Med 38(2):93–97. doi: 10.1097/RLU.0b013e31826390ec CrossRefPubMedGoogle Scholar
  12. 12.
    Dirisamer A, Schima W, Heinisch M, Weber M, Lehner HP, Haller J, Langsteger W (2009) Detection of histologically proven peritoneal carcinomatosis with fused 18F-FDG-PET/MDCT. Eur J Radiol 69(3):536–541. doi: 10.1016/j.ejrad.2007.11.032 CrossRefPubMedGoogle Scholar
  13. 13.
    Suzuki A, Kawano T, Takahashi N, Lee J, Nakagami Y, Miyagi E, Hirahara F, Togo S, Shimada H, Inoue T (2004) Value of 18F-FDG PET in the detection of peritoneal carcinomatosis. Eur J Nucl Med Mol Imaging 31(10):1413–1420. doi: 10.1007/s00259-004-1577-y CrossRefPubMedGoogle Scholar
  14. 14.
    Turlakow A, Yeung HW, Salmon AS, Macapinlac HA, Larson SM (2003) Peritoneal carcinomatosis: role of (18)F-FDG PET. J Nucl Med Off Publ Soc Nucl Med 44(9):1407–1412Google Scholar
  15. 15.
    Esquivel J, Chua TC, Stojadinovic A, Melero JT, Levine EA, Gutman M, Howard R, Piso P, Nissan A, Gomez-Portilla A, Gonzalez-Bayon L, Gonzalez-Moreno S, Shen P, Stewart JH, Sugarbaker PH, Barone RM, Hoefer R, Morris DL, Sardi A, Sticca RP (2010) Accuracy and clinical relevance of computed tomography scan interpretation of peritoneal cancer index in colorectal cancer peritoneal carcinomatosis: a multi-institutional study. J Surg Oncol 102(6):565–570. doi: 10.1002/jso.21601 CrossRefPubMedGoogle Scholar
  16. 16.
    Duhr CD, Kenn W, Kickuth R, Kerscher AG, Germer CT, Hahn D, Pelz JO (2011) Optimizing of preoperative computed tomography for diagnosis in patients with peritoneal carcinomatosis. World J Surg Oncol 9:171. doi: 10.1186/1477-7819-9-171 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Koh JL, Yan TD, Glenn D, Morris DL (2009) Evaluation of preoperative computed tomography in estimating peritoneal cancer index in colorectal peritoneal carcinomatosis. Ann Surg Oncol 16(2):327–333. doi: 10.1245/s10434-008-0234-2 CrossRefPubMedGoogle Scholar
  18. 18.
    Courcoutsakis N, Tentes AA, Astrinakis E, Zezos P, Prassopoulos P (2013) CT-Enteroclysis in the preoperative assessment of the small-bowel involvement in patients with peritoneal carcinomatosis, candidates for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Abdom Imaging 38(1):56–63. doi: 10.1007/s00261-012-9869-3 CrossRefPubMedGoogle Scholar
  19. 19.
    Chandrashekhara SH, Thulkar S, Srivastava DN, Kumar L, Hariprasad R, Kumar S, Sharma MC (2011) Pre-operative evaluation of peritoneal deposits using multidetector computed tomography in ovarian cancer. Br J Radiol 84(997):38–43. doi: 10.1259/bjr/87415692 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Chang-Yun L, Yonemura Y, Ishibashi H, Sako S, Tsukiyama G, Kitai T, Matsuki N (2011) Evaluation of preoperative computed tomography in estimating peritoneal cancer index in peritoneal carcinomatosis. Gan to kagaku ryoho Cancer Chemother 38(12):2060–2064Google Scholar
  21. 21.
    Jacquet P, Jelinek JS, Steves MA, Sugarbaker PH (1993) Evaluation of computed tomography in patients with peritoneal carcinomatosis. Cancer 72(5):1631–1636CrossRefPubMedGoogle Scholar
  22. 22.
    Satoh Y, Ichikawa T, Motosugi U, Kimura K, Sou H, Sano K, Araki T (2011) Diagnosis of peritoneal dissemination: comparison of 18F-FDG PET/CT, diffusion-weighted MRI, and contrast-enhanced MDCT. AJR Am J Roentgenol 196(2):447–453. doi: 10.2214/AJR.10.4687 CrossRefPubMedGoogle Scholar
  23. 23.
    Pfannenberg C, Konigsrainer I, Aschoff P, Oksuz MO, Zieker D, Beckert S, Symons S, Nieselt K, Glatzle J, Weyhern CV, Brucher BL, Claussen CD, Konigsrainer A (2009) (18)F-FDG-PET/CT to select patients with peritoneal carcinomatosis for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol 16(5):1295–1303. doi: 10.1245/s10434-009-0387-7 CrossRefPubMedGoogle Scholar
  24. 24.
    Low RN, Barone RM, Lucero J (2014) Comparison of MRI and CT for predicting the peritoneal cancer Index (PCI) preoperatively in patients being considered for cytoreductive surgical procedures. Ann Surg Oncol. doi: 10.1245/s10434-014-4041-7 Google Scholar
  25. 25.
    Fujii S, Matsusue E, Kanasaki Y, Kanamori Y, Nakanishi J, Sugihara S, Kigawa J, Terakawa N, Ogawa T (2008) Detection of peritoneal dissemination in gynecological malignancy: evaluation by diffusion-weighted MR imaging. Eur Radiol 18(1):18–23. doi: 10.1007/s00330-007-0732-9 CrossRefPubMedGoogle Scholar
  26. 26.
    Soussan M, Des Guetz G, Barrau V, Aflalo-Hazan V, Pop G, Mehanna Z, Rust E, Aparicio T, Douard R, Benamouzig R, Wind P, Eder V (2012) Comparison of FDG-PET/CT and MR with diffusion-weighted imaging for assessing peritoneal carcinomatosis from gastrointestinal malignancy. Eur Radiol 22(7):1479–1487. doi: 10.1007/s00330-012-2397-2 CrossRefPubMedGoogle Scholar
  27. 27.
    Bamba Y, Itabashi M, Kameoka S (2012) Clinical use of PET/CT in peritoneal carcinomatosis from colorectal cancer. Hepatogastroenterology 59(117):1408–1411. doi: 10.5754/hge11640 PubMedGoogle Scholar
  28. 28.
    Dromain C, Leboulleux S, Auperin A, Goere D, Malka D, Lumbroso J, Schumberger M, Sigal R, Elias D (2008) Staging of peritoneal carcinomatosis: enhanced CT vs. PET/CT. Abdom Imaging 33(1):87–93. doi: 10.1007/s00261-007-9211-7 CrossRefPubMedGoogle Scholar
  29. 29.
    Chang MC, Chen JH, Liang JA, Huang WS, Cheng KY, Kao CH (2013) PET or PET/CT for detection of peritoneal carcinomatosis: a meta-analysis. Clin Nucl Med 38(8):623–629. doi: 10.1097/RLU.0b013e318299609f CrossRefPubMedGoogle Scholar
  30. 30.
    Davey J, Turner RM, Clarke MJ, Higgins JP (2011) Characteristics of meta-analyses and their component studies in the Cochrane Database of Systematic Reviews: a cross-sectional, descriptive analysis. BMC Med Res Methodol 11:160. doi: 10.1186/1471-2288-11-160 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Italian Society of Medical Radiology 2016

Authors and Affiliations

  • Andrea Laghi
    • 1
    Email author
  • Davide Bellini
    • 1
  • Marco Rengo
    • 1
  • Fabio Accarpio
    • 2
  • Damiano Caruso
    • 1
  • Daniele Biacchi
    • 2
  • Angelo Di Giorgio
    • 2
  • Paolo Sammartino
    • 2
  1. 1.Department of Radiological Sciences, Oncology and Pathology“SAPIENZA” University of Rome, I.C.O.T. HospitalLatinaItaly
  2. 2.Department of Surgery “P. Valdoni”“SAPIENZA” University of RomeRomeItaly

Personalised recommendations