Learning objectives
to set out essential information about peritoneal metastases,
to provide general knowledge about diagnostic imaging of peritoneal lesions,
to indicate several scoring systems that are used in determining the extent of peritoneal carcinomatosis,
to point out basic facts about various therapeutic options,
to present a concept of a standardized radiology report.
Background
Peritoneal cavity
a potential space confined by the parietal and the visceral peritoneum
contains serosal fluid - 50-100ml
the pathways of circulation of the peritoneal fluid explain the propensity of metastases for occupying certain compartments
The fluid accumulates in the most dependent recesses,
which are:
the pouch of Douglas in women,
the rectovesical recess in men,
the right paracolic gutter,
the right subhepatic recess (the Morison's pouch),
the upper part of the sigmoid mesocolon and the caecum.
[1,
2]
Peritoneal metastases – most common places...
Findings and procedure details
The role of diagnostic imaging
to differentiate a group of patients with extensive carcinomatosis or with unfavorable lesion sites,
who are not amenable to CRS from patients,
in whose case surgical procedures are feasible,
to guide sampling of suspicious sites
to assess the response to chemotherapy
to detect a relapse [5,
11]
Imaging modalities
Ultrasound
an auxiliary modality
poor sensitivity in the visualization of peritoneal,
nodal and parenchymal metastases (69%,
32%,
and 57%,
respectively) [4]
a guiding modality for biopsies [4,
6,
8]
Computed tomography...
Conclusion
The awareness of the clinical implications of radiology reports in patients with peritoneal metastases may lead to a substantial improvement in report quality.
Each diagnostic imaging study should be meticulously searched for signs of involvement of the surgically critical areas,
that potentially might be a cause of unresectability,
and the overall tumor burden should be estimated.
This might prevent unnecessary surgical interventions and might enable choosing a group of patients that would potentially benefit from neoadjuvant chemotherapy or should be treated with palliative chemotherapy.
References
1.
Tirkes T1,
Sandrasegaran K,
Patel AA,
Hollar MA,
Tejada JG,
Tann M,
Akisik FM,
Lappas JC.
Peritoneal and retroperitoneal anatomy and its relevance for cross-sectional imaging.
Radiographics.
2012 Mar-Apr;32(2):437-51.
2.
Patel CM1,
Sahdev A,
Reznek RH.
CT,
MRI and PET imaging in peritoneal malignancy. Cancer Imaging.
2011 Aug 24;11:123-39.
3.
Diop AD1,
Fontarensky M1,
Montoriol PF1,
Da Ines D2.
CT imaging of peritoneal carcinomatosis and its mimics.
Diagn Interv Imaging.
2014 Sep;95(9):861-72.
4.
Kyriazi S,
Kaye SB,
deSouza NM.
Imaging ovarian cancer and peritoneal...