Unravelling Peritoneal Carcinomatosis Using Cross-Sectional Imaging Modalities
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Published:2023-07-03
Issue:13
Volume:13
Page:2253
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ISSN:2075-4418
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Container-title:Diagnostics
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language:en
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Short-container-title:Diagnostics
Author:
Veron Sanchez Ana1ORCID, Bennouna Ilias1, Coquelet Nicolas1, Cabo Bolado Jorge2, Pinilla Fernandez Inmaculada3, Mullor Delgado Luis A.4, Pezzullo Martina5, Liberale Gabriel1, Gomez Galdon Maria1, Bali Maria A.1
Affiliation:
1. Hospital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium 2. Teleconsult, Milton Keynes MK12 5NE, UK 3. Hospital Universitario La Paz, 28046 Madrid, Spain 4. Hospital Universitario Gregorio Marañon, 28009 Madrid, Spain 5. Hôpital Universitaire de Bruxelles, Hôpital Erasme, 1070 Brussels, Belgium
Abstract
Peritoneal carcinomatosis (PC) refers to malignant epithelial cells that spread to the peritoneum, principally from abdominal malignancies. Until recently, PC prognosis has been considered ill-fated, with palliative therapies serving as the only treatment option. New locoregional treatments are changing the outcome of PC, and imaging modalities have a critical role in early diagnosis and disease staging, determining treatment decision making strategies. The aim of this review is to provide a practical approach for detecting and characterizing peritoneal deposits in cross-sectional imaging modalities, taking into account their appearances, including the secondary complications, the anatomical characteristics of the peritoneal cavity, together with the differential diagnosis with other benign and malignant peritoneal conditions. Among the cross-sectional imaging modalities, computed tomography (CT) is widely available and fast; however, magnetic resonance (MR) performs better in terms of sensitivity (92% vs. 68%), due to its higher contrast resolution. The appearance of peritoneal deposits on CT and MR mainly depends on the primary tumour histology; in case of unknown primary tumour (3–5% of cases), their behaviour at imaging may provide insights into the tumour origin. The timepoint of tumour evolution, previous or ongoing treatments, and the peritoneal spaces in which they occur also play an important role in determining the appearance of peritoneal deposits. Thus, knowledge of peritoneal anatomy and fluid circulation is essential in the detection and characterisation of peritoneal deposits. Several benign and malignant conditions show similar imaging features that overlap those of PC, making differential diagnosis challenging. Knowledge of peritoneal anatomy and primary tumour histology is crucial, but one must also consider clinical history, laboratory findings, and previous imaging examinations to achieve a correct diagnosis. In conclusion, to correctly diagnose PC in cross-sectional imaging modalities, knowledge of peritoneal anatomy and peritoneal fluid flow characteristics are mandatory. Peritoneal deposit features reflect the primary tumour characteristics, and this specificity may be helpful in its identification when it is unknown. Moreover, several benign and malignant peritoneal conditions may mimic PC, which need to be considered even in oncologic patients.
Subject
Clinical Biochemistry
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