Adding Value of MRI over CT in Predicting Peritoneal Cancer Index and Completeness of Cytoreduction.

Chia-Ni Lin,Ting-Yao Wang,Cheng-Yi Huang,Tzu-Hao Huang,Li-Wen Lee,Weh-Shih Huang,Chao-Yu Chen,Yu-San Liao

doi:10.3390/diagnostics11040674

Chia-Ni Lin, Ting-Yao Wang + Show 6 more

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https://doi.org/10.3390/diagnostics11040674

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Abstract

Background: This study aimed to investigate the adding value of MRI over CT for preoperative cytoreductive surgery with hyperthermic intraperitoneal chemotherapies (CRS/HIPEC). Methods: Imaging and intraoperative peritoneal cancer index (PCI) were calculated in 62 patients with peritoneal metastasis. Predictive models for the completeness of cytoreductive score using PCI data were established using decision tree algorithms. Results: In gastric cancer patients, a large discrepancy and poor agreement was appreciated between CT and surgical PCI, and a nonsignificant difference was noted between MRI and surgical PCI. In colon cancer patients, a better agreement and higher correlation with a smaller error was observed in PCI score using MRI than in that using CT. However, the addition of MRI to CT was limited for appendiceal and ovarian cancer patients. For predicting incomplete cytoreduction, CT models yielded inadequate accuracy while MRI models were more accurate with fair discrimination ability. Conclusions: CT was suitable for estimating PCI and surgery outcome in appendiceal and ovarian cancer patients, while further MRI in addition to CT was recommended for colon and gastric cancer patients. However, for classifying patients with peritoneal carcinomatosis into complete and incomplete cytoreduction, MRI was more effective than CT.

Highlights

Peritoneal metastasis is defined as cancer that has spread or metastasized to the peritoneal cavity
Further MRI in addition to CT was suggested for colon and gastric cancer patients, but not for appendiceal and ovarian cancer patients, during preoperative cytoreductive surgery (CRS)/hyperthermic intraperitoneal chemotherapy (HIPEC) evaluation
For the prediction of surgical outcome, the prediction model based on CT-Peritoneal Cancer Index (PCI) was not accurate enough to be useful, whereas the MRI model reached an acceptable accuracy (79.0%) and fair discriminatory power (ROC area = 0.786)

Summary

Introduction

Peritoneal metastasis is defined as cancer that has spread or metastasized to the peritoneal cavity. It was considered as an advanced disease with a poor prognosis [1]. For patients with peritoneal metastasis [2]. CRS/HIPEC has become an important and promising treatment option for peritoneal metastasis [4], but is associated with a significant risk of morbidity and mortality [5,6]. It is essential to carefully identify the patients benefiting from treatments, as the inaccurate diagnosis of the extent of metastasis results in futile CRS/HIPEC [7,8]

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