Peritoneal malignancy: anatomy, pathophysiology and an update on modern day imaging

Area of Science:

• Oncology
• Radiology
• Surgical Oncology

Background:

• Outcomes for peritoneal malignancy have improved with radical cytoreductive surgery and intra-abdominal chemotherapy.
• Accurate patient selection is crucial due to the radical nature of these treatments.
• Radiologists play a key role in estimating pre-treatment disease burden for patient selection.

Purpose of the Study:

• To review the patterns of disease spread and anatomical basis in peritoneal malignancy.
• To outline essential aspects of reporting abdominal studies for patients with peritoneal malignancy.
• To provide an evidence-based update on multimodality imaging techniques for staging peritoneal malignancy.

Main Methods:

• Review of patterns of disease spread and anatomical considerations.
• Discussion of essential reporting aspects for abdominal imaging in peritoneal malignancy.
• Evidence-based update on the strengths and limitations of CT, MRI, and PET/CT.

Main Results:

• Accurate staging of peritoneal malignancy is challenging due to small, difficult-to-detect tumor deposits.
• No current imaging modality can detect the smallest peritoneal nodules, requiring histopathological evaluation.
• Radiologists must be precise in reporting to guide patient selection for radical treatment.

Conclusions:

• Precise radiological assessment is vital for selecting patients who will benefit from radical cytoreductive surgery.
• Identifying patients unlikely to achieve adequate cytoreductive outcomes is as important as selecting candidates.
• Multimodality imaging (CT, MRI, PET/CT) plays a significant role, but limitations in detecting small nodules must be acknowledged.