MRI-based decision framework for peritoneal metastases: integrating rPCI, PAUSE, and PROMISE

Area of Science:

• Oncology
• Radiology
• Surgical Oncology

Background:

• Peritoneal metastases pose challenges for accurate preoperative assessment.
• Computed tomography (CT) has limitations in detecting small implants and evaluating critical regions like the mesentery.
• Accurate assessment is crucial for patient selection for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC).

Purpose of the Study:

• To propose an integrated Magnetic Resonance Imaging (MRI)-based framework for evaluating peritoneal metastases.
• To improve the interpretation and standardization of imaging reports for surgical planning.
• To enhance preoperative decision-making by aligning imaging findings with surgical feasibility.

Main Methods:

• Utilizing MRI for enhanced detection and characterization of peritoneal disease, especially in challenging areas.
• Employing the radiologic Peritoneal Cancer Index (rPCI) to quantify tumor burden.
• Integrating the PAUSE framework to assess surgical feasibility beyond tumor burden.
• Applying the PROMISE model for structured and actionable reporting.

Main Results:

• MRI offers superior accuracy in evaluating peritoneal disease compared to CT.
• The integrated MRI framework, combining rPCI, PAUSE, and PROMISE, standardizes reporting.
• This approach improves the translation of imaging findings into clinically actionable information for surgical planning.

Conclusions:

• An integrated MRI-based framework enhances the preoperative assessment of peritoneal metastases.
• This approach improves patient stratification and supports better surgical decision-making.
• Standardized MRI reporting facilitates complete cytoreductive surgery and potentially improves outcomes for selected patients receiving HIPEC.