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Rofo 2012; 184(3): 205-213
DOI: 10.1055/s-0031-1281979
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

State-of-the-Art-Bildgebung bei Peritonealkarzinose

State-of-the-Art Imaging of Peritoneal Carcinomatosis
C. Pfannenberg
1   Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen
,
N. F. Schwenzer
1   Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen
,
B. L. Bruecher
2   Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen
› Author Affiliations
Further Information

Publication History

06 September 2011

31 October 2011

Publication Date:
23 December 2011 (online)

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Zusammenfassung

Bildgebende Verfahren sind von entscheidender Bedeutung bei der Bewertung von Patienten mit Verdacht auf eine peritoneale Metastasierung. Trotz erheblicher Fortschritte in der Schnittbildtechnologie bleibt die frühzeitige und adäquate Diagnostik der Peritonealkarzinose eine Herausforderung aufgrund der Vielfalt von Größe, Morphologie und Lokalisation der peritonealen Herde. Als neuer Therapieansatz bei peritonealer Metastasierung etabliert sich in spezialisierten Zentren die Peritonektomie kombiniert mit hyperthermer intraperitonealer Chemotherapie (HIPEC) als eine potenziell kurative Therapieoption bei ausgewählten Patienten. Entscheidend für die Prognose ist die möglichst komplette Zytoreduktion, die vom Ausmaß und der anatomischen Verteilung der peritonealen Tumorlast abhängt. Verschiedene bildgebende Verfahren werden zur Einschätzung der peritonealen Tumorausdehnung eingesetzt, um geeignete Patienten auszuwählen. Trotz bekannter Limitationen im Nachweis kleiner Läsionen und in der Diagnostik eines Dünndarmbefalls ist die kontrastangehobene MDCT aufgrund ihrer Genauigkeit, Verfügbarkeit und den geringen Kosten die Methode der Wahl in der Diagnostik der Peritonealkarzinose. Die MRT, insbesondere mit diffusionsgewichteten Sequenzen, und die FDG-PET/CT zeigen in aktuellen Studien überlegene Ergebnisse, bleiben aber aufgrund von Kosten, Untersuchungsdauer und Verfügbarkeit derzeit auf spezialisierte Zentren beschränkt. Alle Methoden zur Diagnostik der Peritonealkarzinose erfordern neben einem optimierten Untersuchungsprotokoll vor allem trainierte Radiologen, die mit den komplexen anatomischen Ausbreitungswegen und der variablen Morphologie peritonealer Läsionen vertraut sein sollten.

Abstract

Imaging studies are essential in the evaluation of patients with suspected or known peritoneal malignancy. Despite major advances in imaging technology in the last few years, the early and adequate detection of a peritoneal dissemination remains challenging because of the great variety in size, morphology and location of the peritoneal lesions. New therapeutic approaches in peritoneal-based neoplasms combining cytoreductive surgery and peritonectomy with hyperthermic intraoperative chemotherapy (HIPEC) suggest improved long-term survival, provided that a complete (macroscopic) cytoreduction is achieved. The preoperative radiological assessment of the extent and distribution of peritoneal involvement plays a vital role in the patient selection process. Despite its known limited accuracy in detecting small peritoneal lesions and the involvement of the small bowel/mesentery, contrast-enhanced MDCT remains the standard imaging modality in the assessment of peritoneal carcinomatosis. MRI, especially with diffusion-weighted images, and FDG-PET/CT are promising methods for the evaluation of peritoneal carcinomatosis with superior results in recent studies, but still have a limited role in selected cases because of high costs and limited availability. Generally, to obtain the most precise readings of peritoneal carcinomatosis, an optimized examination protocol and dedicated radiologists with a deep knowledge of peritoneal pathways and variable morphologies of peritoneal disease are required.

Key words

peritoneal carcinomatosis - MR imaging - PET-CT - CT - preoperative evaluation
 

  • Literatur

  • 1 Glehen O, Kwiatkowski F, Sugarbaker PH et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: A multi-institutional study. J Clin Oncol 2004; 22: 3284-3292
    CrossrefPubMedGoogle Scholar
  • 2 Coakley FV, Choi PH, Gougoutas CA et al. Peritoneal metastases: detection with spiral CT in patients with ovarian cancer. Radiology 2002; 223: 495-499
    CrossrefPubMedGoogle Scholar
  • 3 Sadeghi B, Arvieux C, Glehen O et al. Peritoneal carcinomatosis from non-gynecologic malignancies. Results of the EVOCAPE 1 Multicentric Prospective Study. Cancer 2000; 88: 358-363
    CrossrefPubMedGoogle Scholar
  • 4 Sugarbaker PH. Peritonectomy procedures. Cancer Treat Res 1996; 82: 235-253
    PubMedGoogle Scholar
  • 5 Al-Shammaa HA, Li Y, Yonemura Y. Current status and future strategies of cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis. World J Gastroenterol 2008; 14: 1159-1166
    CrossrefPubMedGoogle Scholar
  • 6 Esquivel J, Sticca R, Sugarbaker PH et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Society of Surgical Oncology. Ann Surg Oncol 2007; 14: 128-133
    PubMedGoogle Scholar
  • 7 Brücher B, Königsrainer A. Die Peritonealkarzinose. CHAZ 2010; 11: 17-31
    PubMedGoogle Scholar
  • 8 Verwaal VJ, van Ruth S, de Bree E et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol 2003; 21: 3737-3743
    CrossrefPubMedGoogle Scholar
  • 9 Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res 1996; 82: 359-374
    PubMedGoogle Scholar
  • 10 Yan TD, Sim J, Morris DL. Selection of Patients with Colorectal Peritoneal Carcinomatosis for Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy. Ann Surg Oncol 2007; 14: 1807-1817
    CrossrefPubMedGoogle Scholar
  • 11 Königsrainer I, Aschoff P, Zieker D et al. Selektion zur Peritonektomie mit hyperthermer intraoperativer Chemotherapie (HIPEC) bei Peritonealkarzinose. Zentralbl Chir 2008; 133: 468-472
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Meyers MA, Oliphant M, Berne AS et al. The peritoneal ligaments and mesenteries: pathways of intraabdominal spread of disease. Radiology 1987; 163: 593-604
    PubMedGoogle Scholar
  • 13 Levy AD, Shaw JC, Sobin LH. Secondary Tumors and Tumorlike lesions of the Peritoneal Cavity: Imaging Features with Pathologic Correlation. RadioGraphics 2009; 29: 347-373
    CrossrefPubMedGoogle Scholar
  • 14 Gore RM, Newmark GM, Thakrar KH et al. Pathways of abdominal tumour spread: the role of the subperitoneal space. Cancer Imaging 2009; 9: 112-120
    PubMedGoogle Scholar
  • 15 Patel CM, Sahdev X XXX, Reznek RH. CT, MRI and PET imaging in peritoneal malignancy. Cancer Imaging 2011; 11: 123-139
    CrossrefPubMedGoogle Scholar
  • 16 Raptopoulos V, Gourtsoyiannis N. Peritoneal carcinomatosis. Eur Radiol 2001; 11: 2195-2206
    CrossrefPubMedGoogle Scholar
  • 17 Yeh HC. Ultrasonography of peritoneal tumors. Radiology 1979; 133: 419-424
    PubMedGoogle Scholar
  • 18 Hanbidge AE, Lynch D, Wilson SR. US of the Peritoneum. RadioGraphics 2003; 23: 663-685
    CrossrefPubMedGoogle Scholar
  • 19 Kyriazi S, Kaye SB, deSouza NM. Imaging ovarian cancer and peritoneal metastases – current and emerging techniques. Nat Rev Clin Oncol 2010; 7: 381-393
    CrossrefPubMedGoogle Scholar
  • 20 Gonzalez-Moreno S, Gonzalez-Bayon L, Ortega-Perez G et al. Imaging of Peritoneal Carcinomatosis. Cancer J 2009; 15: 184-189
    CrossrefPubMedGoogle Scholar
  • 21 Jacquet P, Jelinek JS, Steves MA et al. Evaluation of computed tomography in patients with peritoneal carcinomatosis. Cancer 1993; 72: 1631-1636
    CrossrefPubMedGoogle Scholar
  • 22 Jacquet P, Jelinek JS, Chang D et al. Abdominal computed tomographic scan in the selection of patients with mucinous peritoneal carcinomatosis for cytoreductive surgery. J Am Coll Surg 1995; 181: 530-538
    PubMedGoogle Scholar
  • 23 Pannu HK, Bristow RE, Montz FJ et al. Multidetector CT of peritoneal carcinomatosis from ovarian cancer. RadioGraphics 2003; 23: 687-701
    CrossrefPubMedGoogle Scholar
  • 24 De Bree E, Koops W, Kröger R et al. Peritoneal carcinomatosis from colorectal or appendiceal origin: correlation of preoperative CT with intraoperative findings and evaluation of interobserver agreement. J Surg Oncol 2004; 86: 64-73
    CrossrefPubMedGoogle Scholar
  • 25 Yan TD, Haveric N, Carmignani CP et al. Abdominal computed tomography scans in the selection of patients with malignant peritoneal mesothelioma for comprehensive treatment with cytoreductive surgery and perioperative intraperitoneal chemotherapy. Cancer 2005; 103: 839-849
    CrossrefPubMedGoogle Scholar
  • 26 De Bree E, Koops W, Kröger R et al. Preoperative computed tomography and selection of patients with colorectal peritoneal carcinomatosis for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol 2006; 32: 65-71
    CrossrefPubMedGoogle Scholar
  • 27 Yan TD, Morris DL, Shigeki K et al. Preoperative Investigations in the Management of Peritoneal Surface Malignancy with Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy: Expert Consensus Statement. J Surg Oncol 2008; 98: 224-227
    CrossrefPubMedGoogle Scholar
  • 28 Franiel T, Diederichs G, Engelken F et al. Multi-detector CT in peritoneal carcinomatosis: diagnostic role of thin slices and multiplanar reconstructions. Abdom Imaging 2009; 34: 49-54
    CrossrefPubMedGoogle Scholar
  • 29 Kim SJ, Kim H, Kim YH et al. Peritoneal Metastasis: detection with 16-or 64-Detector Row CT in Patients Undergoing Surgery for Gastric Cancer. Radiology 2009; 253: 407-415
    CrossrefPubMedGoogle Scholar
  • 30 Koh J, Yan TD, Glenn D et al. Evaluation of Preoperative Computed Tomography in Estimating Peritoneal cancer Index in Colorectal Peritoneal Carcinomatosis. Ann Surg Oncol 2009; 16: 327-333
    CrossrefPubMedGoogle Scholar
  • 31 Marin D, Catalano C, Baski M et al. 64-Section multi-detector row CT in the preoperative diagnosis of peritoneal carcinomatosis: correlation with histopathological findings. Abdom Imaging 2010; 35: 694-700
    CrossrefPubMedGoogle Scholar
  • 32 Choi HJ, Lim MC, Bae J et al. Region-based diagnostic performance of multidetector CT for detecting peritoneal seeding in ovarian cancer patients. Arch Gynecol Obstet 2011; 283: 353-360
    CrossrefPubMedGoogle Scholar
  • 33 Esquivel J, Chua TC, Stojadinovic A et al. Accuracy and Clinical Relevance of Computed Tomography Scan Interpretation of Peritoneal Cancer Index in Colorectal Cancer Peritoneal Carcinomatosis: A Multi-Institutional Study. J Surg Oncol 2010; 102: 565-570
    CrossrefPubMedGoogle Scholar
  • 34 Pfannenberg C, Königsrainer I, Aschoff P et al. 18F-FDG-PET/CT to select patients with peritoneal carcinomatosis for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol 2009; 16: 1295-1303
    CrossrefPubMedGoogle Scholar
  • 35 Tempany CM, Zou KH, Silverman SG et al. Staging of advanced ovarian cancer: comparison of imaging modalities – report from the Radiological Diagnostic Oncology Group. Radiology 2000; 215: 761-767
    PubMedGoogle Scholar
  • 36 Low RN, Semelka RC, Worawattanakul S et al. Extrahepatic abdominal imaging in patients with malignancy: comparison of MR imaging and helical CT in 164 patients. J Magn Reson Imaging 2000; 12: 269-277
    CrossrefPubMedGoogle Scholar
  • 37 Ricke J, Sehouli J, Hach C et al. Prospective evaluation of contrast-enhanced MRI in the depiction of peritoneal spread in primary or recurrent ovarian cancer. Eur Radiol 2003; 13: 943-949
    PubMedGoogle Scholar
  • 38 Low RN. MR imaging of the peritoneal spread of malignancy. Abdom Imaging 2007; 32: 267-283
    CrossrefPubMedGoogle Scholar
  • 39 Fujii S, Matsusue E, Kanasaki Y et al. Detection of peritoneal dissemination in gynecological malignancy: evaluation by diffusion-weighted MR imaging. Eur Radiol 2008; 18: 18-23
    CrossrefPubMedGoogle Scholar
  • 40 Low RN, Sebrechts CP, Barone RM et al. Diffusion-weighted MRI of peritoneal tumors: comparison with conventional MRI and surgical and histopathologic findings – a feasibility study. Am J Roentgenol 2009; 193: 461-470
    CrossrefPubMedGoogle Scholar
  • 41 Bozkurt M, Doganay S, Kantarci M et al. Comparison of peritoneal tumor imaging using conventional MR imaging and diffusion-weighted MR imaging with different b values. Eur J Radiol 2010; DOI: 10.1016/j.ejrad.2010.06.004.
    PubMedGoogle Scholar
  • 42 Kyriazi S, Collins DJ, Morgan VA et al. Diffusions-weighted Imaging of Peritoneal Disease for Noninvasive Staging of Advanced Ovarian Cancer. RadioGraphics 2010; 30: 1269-1285
    CrossrefPubMedGoogle Scholar
  • 43 Satoh Y, Ichikawa T, Motosugi U et al. Diagnosis of Peritoneal Dissemination: Comparison of 18F-FDG PET/CT, Diffusion-Weighted MRI, and Contrast-Enhanced MDCT. Am J Roentgenol 2011; 196: 447-453
    CrossrefPubMedGoogle Scholar
  • 44 Blodgett TM, Meltzer CC, Townsend DW. PET/CT: Form and Function. Radiology 2007; 242: 360-385
    CrossrefPubMedGoogle Scholar
  • 45 Antoch G, Saoudi N, Kuehl H et al. Accuracy of whole-body dual-modality fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography (FDG-PET/CT) for tumor staging in solid tumors: comparison with CT and PET. J Clin Oncol 2004; 22: 4357-4368
    CrossrefPubMedGoogle Scholar
  • 46 Fletcher JW, Djulbegovic B, Soares HP et al. Recommendations on the use of 18F-FDG-PET in Oncology. J Nucl Med 2008; 49: 480-508
    CrossrefPubMedGoogle Scholar
  • 47 Podoloff DA, Ball DW, Ben-Josef E et al. NCCN Task Force: Clinical Utility of PET in a Variety of Tumor Types. JNCCN 2009; 7: 1-23
    PubMedGoogle Scholar
  • 48 Tanaka T, Kawai Y, Kanai M et al. Usefulness of FDG-positron emission tomography in diagnosing peritoneal recurrence of colorectal cancer. Am J Surg 2002; 184: 433-436
    CrossrefPubMedGoogle Scholar
  • 49 Turlakow A, Yeung HW, Salmon AS et al. Peritoneal carcinomatosis: role of (18)F-FDG PET. J Nucl Med 2003; 44: 1407-1412
    PubMedGoogle Scholar
  • 50 Whiteford MH, Whiteford HM, Yee LF et al. Usefulness of FDG-PET scan in the assessment of suspected metastatic or recurrent adenocarcinoma of the colon and rectum. Dis Colon Rectum 2000; 43: 759-767
    CrossrefPubMedGoogle Scholar
  • 51 Suzuki A, Kawano T, Takahashi N et al. Value of 18F-FDG PET in the detection of peritoneal carcinomatosis. Eur J Nucl Med Mol Imaging 2004; 31: 1413-1420
    PubMedGoogle Scholar
  • 52 Mangili G, Picchio M, Sirini S et al. Integrated PET/CT as a first-line re-staging modality in patients with suspected recurrence of ovarian cancer. Eur J Nucl Med Mol Imaging 2007; 34: 658-666
    CrossrefPubMedGoogle Scholar
  • 53 Dirisamer A, Schima W, Heinisch M et al. Detection of histologically proven peritoneal carcinomatosis with fused 18F-FDG-PET/MDCT. Eur J Radiol 2009; 69: 536-541
    CrossrefPubMedGoogle Scholar
  • 54 Dirisamer A, Halpern BS, Flöry D et al. Performance of integrated FDG-PET/contrast-enhanced CT in the staging and restaging of colorectal cancer: Comparison with PET and enhanced CT. Eur J Radiol 2010; 73: 324-328
    CrossrefPubMedGoogle Scholar
  • 55 Berthelot C, Morel O, Girault S et al. Use of FDG-PET/CT for peritoneal carcinomatosis before hyperthermic intraperitoneal chemotherapy. Nucl Med Commun 2011; 32: 23-29
    CrossrefPubMedGoogle Scholar
  • 56 Kitajima K, Murakami K, Yamasaki E et al. Diagnostic accuracy of integrated FDG-PET/contrast-enhanced CT in staging ovarian cancer: comparison with enhanced CT. Eur J Nucl Med Mol Imaging 2008; 35: 1912-1920
    CrossrefPubMedGoogle Scholar
  • 57 Funicelli L, Travaini LL, Landoni F et al. Peritoneal carcinomatosis from ovarian cancer: the role of CT and 18F FDG-PET/CT. Abdom Imaging 2010; 35: 701-707
    CrossrefPubMedGoogle Scholar
  • 58 Gu P, Pan LL, Wu SQ. CA 125, PET alone, PET-CT, CT and MRI in diagnosing recurrent ovarian carcinoma. A systematic review and meta-analysis. Eur J Radiol 2009; 71: 164-174
    CrossrefPubMedGoogle Scholar
  • 59 Pannu HK, Bristow RE, Cohade C et al. PET-CT in Recurrent Ovarian Cancer: Initial Observations. RadioGraphics 2004; 24: 209-223
    CrossrefPubMedGoogle Scholar
  • 60 Pfannenberg AC, Königsrainer I, Aschoff P et al. 18F-FDG-PET/CT bei Peritonealkarzinose: Stellenwert im Rahmen der Patientenselektion zur zytoreduktiven Chirurgie und hyperthermen intraperitonealen Chemotherapie (HIPEC). Fortschr Röntgenstr 2009; 181: S138
    PubMedGoogle Scholar