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Updated: Dec 28, 2025
Quantitation of Intra-peritoneal Ovarian Cancer Metastasis
Published on: July 18, 2016
Diagnostic performance of imaging for the detection of peritoneal metastases: a meta-analysis
I van 't Sant1,2, M P Engbersen3,4, P A Bhairosing5
1Department of Radiology, The Netherlands Cancer Institute, PO Box 90203, 1006, BE, Amsterdam, The Netherlands. i.jansen@nki.nl.
Purpose:
Detection of peritoneal metastases (PM) is key in the staging and management of gastrointestinal and ovarian cancer patients. The purpose of this meta-analysis was to determine the diagnostic performance of CT, PET(CT), and (DW)MRI in detecting PM.
Methods:
A literature search in Pubmed, Embase (Ovid), and Scopus was performed (January 1997-May 2018) to identify studies reporting on the accuracy of imaging PM in the diagnostic workup of gastrointestinal or ovarian cancers. Inclusion criteria were region-based or patient-based studies comprising > 15 patients, surgery/histology/radiological follow-up as a reference standard, and sufficient data to construct a 2 × 2 contingency table. Two observers performed data extraction. The sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated using a bivariate random-effects model and hierarchical summary operating curves (HSROC) were generated.
Results:
Of 3457 citations retrieved, twenty-four articles met all inclusion criteria. Thirty-seven datasets could be extracted for analysis including 20 for CT, 10 for PET(CT), and 7 for (DW)MRI. The pooled sensitivity, specificity, and DOR for the detection of PM for region-based studies for CT were 68% (CI, 46-84%), 88%(CI, 81-93%), and 15.9 (CI, 4.4-58.0) respectively; 80% (CI, 57-92%), 90% (CI, 80-96%), and 36.5 (CI, 6.7-199.5) for PET(CT), respectively; 92% (CI, 84-96%), 85% (CI, 78-91%), 63.3 (CI, 31.5-127.3) for (DW)MRI. In the patient-based group, not enough studies were included to make a pooled analysis for (DW)MRI and PET(CT).
Conclusion:
(DW)MRI and PET(CT) showed comparable diagnostic performance for the detection of peritoneal metastases in ovarian and gastrointestinal cancer patients. Since MRI is more widely available than PET(CT) in clinical practice, this potentially is the imaging method of choice in most centers in the future.
Key Points:
• Detection of peritoneal metastases plays an important role in the accurate staging of cancer patients, however, there is no accepted reference standard for the imaging of peritoneal metastases • This meta-analysis shows that (DW)MRI provided the highest sensitivity for the detection of peritoneal metastases in ovarian and gastrointestinal cancer patients • Although (DW)MRI and PET(CT) show a comparable overall diagnostic performance, (DW)MRI seems to be the imaging method of choice since it is more available in daily practice than PET(CT).
Insights
Diffusion-weighted MRI (DW-MRI) and PET-CT show similar diagnostic performance for detecting peritoneal metastases in gastrointestinal and ovarian cancers. DW-MRI offers higher sensitivity and is more accessible, making it a preferred imaging choice.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Peritoneal metastases (PM) are critical in staging and managing gastrointestinal and ovarian cancers.
- Accurate detection of PM impacts patient treatment and prognosis.
Purpose of the Study:
- To evaluate the diagnostic performance of CT, PET-CT, and diffusion-weighted MRI (DW-MRI) for detecting peritoneal metastases.
- To compare the sensitivity and specificity of these imaging modalities.
Main Methods:
- A meta-analysis of studies published between January 1997 and May 2018 was conducted.
- Data from 24 articles, including 37 datasets, were analyzed using bivariate random-effects models.
- Sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated.
Main Results:
- DW-MRI demonstrated the highest pooled sensitivity (92%) for detecting PM in region-based studies.
- PET-CT showed high sensitivity (80%) and specificity (90%).
- CT had a pooled sensitivity of 68% and specificity of 88%.
Conclusions:
- DW-MRI and PET-CT exhibit comparable diagnostic performance for detecting PM.
- DW-MRI's higher sensitivity and greater availability suggest it as a future imaging method of choice.
- Standardized reference standards for imaging PM are still needed.
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