Learning objectives
The purposes of this educational exhibit are:
To make a pictorial review of computed tomography (CT) imaging and to remind the key signs in diffuse peritoneal involvement.
To specify sites that radiologists need to check for creating a precise cartography of peritoneal carcinomatosis .
To suggest a structural reportof peritoneal carcinomatosis extension
Background
Definition:
Peritoneal carcinomatosis is the intraperitoneal dissemination of any tumor that does not originate from the peritoneum itself.
It is the most common diffuse peritoneal disease.
The treatment is associated with very high morbidity and combines aggressive techniques ( cytoreduction surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) ).
The role of the radiologist consists in diagnosing peritoneal carcinomatosis at an early stage,
choosing the candidates who are likely to benefit from an extremely arduous surgery and excluding diffuse peritoneal disease that mimic carcinomatosis.
Pathophysiology of peritoneal...
Findings and procedure details
peritoneal carcinomatosis is the most common aetilogy of invasive peritoneal disease ,
originating often from primary tumours of the gastrointestinal tract,
ovary,
lung ,uterus,
breast and lung.
Structured reporting of key findings at CT is strongly recommended and peritoneal carcinomatosis should be evaluated qualitatively and quantitatively.
Key signs of peritoneal carcinomatosis :
Peritoneal carcinomatosis may be subtle and difficult to identify.
Abnormal peritoneal enhancement and thickening may be the first signs of peritoneal cacinomatosis.
Ascites ,
peritoneal nodules and implants ,
mesenteric thickening and distorsion...
Conclusion
A systematic approach should be taken to identify the important radiological CT findings and to highlight unresectable sites of disease within the abdomen and pelvis,
which may alter or preclude surgery.
Some sites of disease and complications should be included as part of the radiological report as these may require additional surgical expertise or influence treatment selection.
The volume of disease estimated by the PCI has a reliable prognostic value.
All these findings,
detailed in a structured presentation,
offer a clear roadmap for the therapeutic...
References
Diop AD,
et al.
CT imaging of peritoneal carcinomatosis and its mimics.
Diagnostic and Interventional Imaging (2014).
Meyers MA.
Distribution of intra-abdominal malignant seeding: dependency on dynamics of flow of ascitic fluid.
Am Roentgenol Radium Ther Nucl Med 1973; 119:198–206.
Nougaret S,
Addley H,
Colombo PE,
Fujii S,
Al Sharif S,
Tirumani SH,
et al.Ovarian Carcinomatosis: How the Radiologist Can Help Plan the Surgical Approach.
RadioGraphics 2012; 32:1775–1800.
Pannu HK,
Bristow RE,
Montz FJ,
Fishman EK.
Multidetector CT of Peritoneal Carcinomatosis from Ovarian Cancer.
RadioGraphics...