Type:
Educational Exhibit
Keywords:
Abdominal Viscera, Abdomen, Peritoneum, CT, MR, Ultrasound, Biopsy, Metastases, Neoplasia, Not applicable
Authors:
K. Kuriyama1, T. Koyama1, S. Nakashita2, K. Nakatani2, Y. Ishizaka1, K. Notohara2; 1Kurashiki/JP, 2Kurashiki, Okayama/JP
DOI:
10.26044/ecr2020/C-11398
Background
Omental cake is the condition in which implanted neoplastic cells diffusely involve the omentum, and can result from a variety of conditions, mainly results from dissemination of malignancy.
In most of cases, CT or US is a usually initial modality to detect omental cake. On CT, omental cake is demonstrated as areas of soft tissue attenuation or diffuse or reticular appearance in the thickened omentum, which is enhanced on postcontrast images (Fig.1). Occasionally coarse nodule may be present in the thickend omentum (Fig.2). US typically shows thickened omentum of heterogeneously decreased echogenicity (Fig.1,2). At MRI, omental cake is demonstrated as areas of decreased signal on both T1- and T2 weighted images and restricted diffusion on diffusion weighted images (DWI) (Fig.3).
When the primary site was unknown, radiologists confront differentiation of a variety of etiologies for omental cake. In majority of cases, the tissue sampling is inevitable, since the establishment of the final diagnosis rely on pathologic diagnosis. For the purpose of tissues sampling, exploratory laparotomy or laparoscopic biopsy commonly performed. However, image guided biopsy is by far less invasive method for establishing the pathologic diagnosis.