Evaluation of the peritoneal carcinomatosis index with CT and MRI

Dohan, Anthony; Hoeffel, Christine; Soyer, Philippe; Jannot, Anne‐Sophie; Valette, Pierre-Jean; Thivolet, Charles; Passot, Guillaume; Gléhen, Olivier; Rousset, Pascal

doi:10.1002/bjs.10527

Cited by 103 publications

(55 citation statements)

References 19 publications

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“…Improving patient selection is therefore reliant on the ability to predict accurately the extent of peritoneal metastasis and the ability to resect it completely. Specialist radiologists have demonstrated good concordance between radiological and surgical PCI estimations, particularly when combining modalities; however, these tend to be most accurate in patients with high PCI scores 57,58 . In some centres this is used in combination with diagnostic laparoscopy before CRS + HIPEC.…”

Section: Discussionmentioning

confidence: 99%

Meta‐analysis of prognostic factors for patients with colorectal peritoneal metastasis undergoing cytoreductive surgery and heated intraperitoneal chemotherapy

et al. 2019

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Background: Up to 15 per cent of colorectal cancers present with peritoneal metastases (CPM). Cytoreductive surgery and heated intraperitoneal chemotherapy (CRS + HIPEC) aims to achieve macroscopic tumour resection combined with HIPEC to destroy microscopic disease. CRS + HIPEC is a major operation with significant morbidity and effects on quality of life (QoL). Improving patient selection is crucial to maximize patient outcomes while minimizing morbidity and mortality. The aim of this study was to identify prognostic factors for patients with CPM undergoing CRS + HIPEC. Methods: A systematic search of MEDLINE, Embase and Cochrane Library electronic databases was performed using terms for colorectal cancer, peritoneal metastasis and CRS + HIPEC. Included studies focused on the impact of prognostic factors on overall survival following CRS + HIPEC in patients with CPM. Results: Twenty-four studies described 3128 patients. Obstruction or perforation of the primary tumour (hazard ratio (HR) 2⋅91, 95 per cent c.i. 1⋅5 to 5⋅65), extent of peritoneal metastasis as described by the Peritoneal Carcinomatosis Index (PCI) (per increase of 1 PCI point: HR 1⋅07, 1⋅02 to 1⋅12) and the completeness of cytoreduction (CC score above zero: HR 1⋅75, 1⋅18 to 2⋅59) were associated with reduced overall survival after CRS + HIPEC. Conclusion: Primary tumour obstruction or perforation, PCI score and CC score are valuable prognostic factors in the selection of patients with CPM for CRS + HIPEC.

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Section: Discussionmentioning

confidence: 99%

Meta‐analysis of prognostic factors for patients with colorectal peritoneal metastasis undergoing cytoreductive surgery and heated intraperitoneal chemotherapy

et al. 2019

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“…The present results are comparable with those of smaller pilot studies on the assessment of PM with DW‐MRI. In a population of patients with appendiceal and ovarian cancer, Low and co‐workers reported that, compared with S‐PCI, DW‐MRI correctly categorized tumour volume in 91 per cent of patients as opposed to only 50 per cent with CT. Interestingly, a recent meta‐analysis proposed CT as the preferred imaging modality for detection of PM. This conclusion, however, was based on the robustness of CT data, given the minority of available MRI studies (19 versus 3).…”

Section: Discussionmentioning

confidence: 99%

“…Despite a well known high understaging rate of the PCI assessed by CT, this remains the imaging method of choice in most centres. The combination of contrast‐enhanced MRI with diffusion‐weighted (DW) imaging has shown promising results for assessing the PCI. The latter studies, however, were retrospective and either small or heterogeneous, including patients with PM originating from other malignancies.…”

Section: Introductionmentioning

confidence: 99%

Diffusion-weighted MRI assessment of the peritoneal cancer index before cytoreductive surgery

Sant

Eden

Engbersen

et al. 2019

Journal of British Surgery

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Background: Patients with limited peritoneal metastases from colorectal cancer may be candidates for an aggressive surgical approach including cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). Selection is based on surgical inspection during laparoscopy or laparotomy. The aim of this study was to investigate whether diffusion-weighted MRI (DW-MRI) can be used to select patients for CRS-HIPEC.Methods: This was a prospective study at a tertiary referral centre. Patients with confirmed or suspected colorectal peritoneal metastases scheduled for exploratory laparotomy or laparoscopy were eligible. Two radiologists assessed the peritoneal cancer index (PCI) on CT (CT-PCI) and DW-MRI (MRI-PCI). The reference standard was PCI at surgery. Radiologists were blinded to the surgical PCI and to each other's findings. The main outcome was the accuracy of DW-MRI in predicting whether patients had resectable disease (PCI less than 21) or not.Results: Fifty-six patients were included in the study, of whom 49 could be evaluated. The mean(s.d.) PCI at surgery was 11⋅27(7⋅53). The mean MRI-PCI was 10⋅18(7⋅07) for reader 1 and 8⋅59(7⋅08) for reader 2. Readers 1 and 2 correctly staged 47 of 49 and 44 of 49 patients respectively (accuracy 96 and 90 per cent). Both readers detected all patients with resectable disease with a PCI below 21 at surgery (sensitivity 100 per cent). No patient was overstaged. The intraclass correlation (ICC) between readers was excellent (ICC 0⋅91, 95 per cent c.i. 0⋅77 to 0⋅96). MRI-PCI had a stronger correlation with surgical PCI (ICC 0⋅83-0⋅88) than did CT-PCI (ICC 0⋅39-0⋅44).Conclusion: DW-MRI is a promising non-invasive tool to guide treatment selection in patients with peritoneal metastases from colorectal cancer.

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“…21–23 Unfortunately, each technique has some intrinsic limitations, such as low contrast resolution for CT and low spatial resolution for MRI and positron emission tomography-CT, resulting in a consistent underestimation of the PM spread mostly because of false-negatives of thin or small lesions less than 1 cm. 24–28 In addition, none of these 3 techniques allows spectral capabilities such as differentiation of 2 contrast agents.…”

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confidence: 99%

Improved Peritoneal Cavity and Abdominal Organ Imaging Using a Biphasic Contrast Agent Protocol and Spectral Photon Counting Computed Tomography K-Edge Imaging

Si‐Mohamed¹,

Thivolet²,

Bonnot³

et al. 2018

Invest Radiol

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Evaluation of the peritoneal carcinomatosis index with CT and MRI

Abstract: The combination of CT and MRI improved the preoperative estimation of PCI compared with CT alone.

Cited by 103 publications

References 19 publications

Meta‐analysis of prognostic factors for patients with colorectal peritoneal metastasis undergoing cytoreductive surgery and heated intraperitoneal chemotherapy

Meta‐analysis of prognostic factors for patients with colorectal peritoneal metastasis undergoing cytoreductive surgery and heated intraperitoneal chemotherapy

Diffusion-weighted MRI assessment of the peritoneal cancer index before cytoreductive surgery

Improved Peritoneal Cavity and Abdominal Organ Imaging Using a Biphasic Contrast Agent Protocol and Spectral Photon Counting Computed Tomography K-Edge Imaging

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