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The role of imaging in diagnosis and management of malignant peritoneal mesothelioma: a systematic review

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Abstract

Purpose

Imaging of the peritoneum and related pathology is a challenge. Among peritoneal diseases, malignant peritoneal mesothelioma (MPeM) is an uncommon tumor with poor prognosis. To date, there are no specific guidelines or imaging protocols dedicated for the peritoneum and MPeM. The objective of this study was to analyze the literature describing imaging modalities used for MPeM to determine their relative clinical efficacy and review commonly reported imaging features of MPeM to promote standardized reporting.

Methods

We performed a systematic review of original research articles discussing imaging modalities in MPeM from 1999 to 2020. Effectiveness measures and common findings were compared across imaging modalities.

Results

Among 582 studies analyzed, the most-used imaging modality was CT (54.3%). In the differentiation of MPeM from peritoneal carcinomatosis, one study found CT had a diagnostic sensitivity of 53%, specificity of 100%, and accuracy of 68%. Two studies found fluorodeoxyglucose positron emission tomography (FDG-PET) had sensitivity of 86–92%, specificity of 83–89%, and accuracy of 87–89%. Another study found magnetic resonance imaging (MRI) was the best predictor of the peritoneal carcinomatosis index. Characteristics shown to best differentiate MPeM from other diseases included ascites, peritoneal thickening, mesenteric thickening, pleural plaques, maximum tumor dimension, and number of masses.

Conclusion

Most published MPeM imaging studies utilized CT. PET/CT or MRI appear promising, and future studies should compare effectiveness of these modalities. MPeM imaging reports should highlight ascites, number of and maximum tumor dimension, peritoneal/mesenteric thickening, and associated pleural plaques, allowing for better aggregation of MPeM imaging data across studies.

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Abbreviations

CRS/HIPEC:

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

CT:

Computed tomography

FDG:

18F-fluorodeoxyglucose

MPeM:

Malignant peritoneal mesothelioma

MRI:

Magnetic resonance imaging

PCI:

Peritoneal cancer index

PET:

Positron emission tomography

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

RECIST:

Response evaluation criteria in solid tumors

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Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Pritzker School of Medicine, University of Chicago, Chicago, IL, USA

    Bradley Carlson

  2. Department of Radiology, University of Chicago, Chicago, IL, USA

    Carla Harmath, Samuel G. Armato III & Christopher Straus

  3. Department of Surgery, University of Chicago, Chicago, IL, USA

    Kiran Turaga

  4. Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA

    Hedy L. Kindler

  5. Chicago, IL, USA

    Bradley Carlson

Authors
  1. Bradley Carlson
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  2. Carla Harmath
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  3. Kiran Turaga
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  4. Hedy L. Kindler
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  5. Samuel G. Armato III
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  6. Christopher Straus
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Contributions

All authors contributed to the study conception. The literature search was performed by BC and CS. The data analysis was performed by BC. The article was drafted by BC and CH. All authors critically revised the article.

Corresponding author

Correspondence to Bradley Carlson.

Ethics declarations

Hedy Kindler Consultant/advisory: AstraZeneca, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, Kyowa, Merck, Novocure, Paredox Therapeutics, Deciphera, Inhibrx, and Inventiva. Travel: AstraZeneca, Boehringer-Ingelheim, Merck, Paredox Therapeutics, and Inventiva.

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Appendices

Appendix A

PubMed Search Criteria:

(

(peritoneal mesothelioma) AND (MRI OR MR OR DW-MRI OR (magnetic resonance) OR PET OR FDG-PET OR (positron emission tomography) OR quantitative OR quantify OR measure OR measurement OR barium OR CT OR MDCT OR (computed tomography) OR ultrasound OR ultrasonography OR ultrasonogram OR sonogram OR sonography) AND ( ( "1999/01/01"[PDat]: "2020/12/31"[PDat])).

)

No MeSH terms were utilized.

Appendix B

From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. https://doi.org/10.1136/bmj.n71. For more information, visit: http://www.prisma-statement.org/

figure b

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Carlson, B., Harmath, C., Turaga, K. et al. The role of imaging in diagnosis and management of malignant peritoneal mesothelioma: a systematic review. Abdom Radiol 47, 1725–1740 (2022). https://doi.org/10.1007/s00261-022-03464-x

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  • DOI: https://doi.org/10.1007/s00261-022-03464-x

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