Diagnostic value of whole-body MRI with diffusion-weighted sequence for detection of peritoneal metastases in colorectal malignancy

Huan Zhang, Weixing Dai, Caixia Fu, Xu Yan, Alto Stemmer, Tong Tong, Guoxiang Cai, Huan Zhang, Weixing Dai, Caixia Fu, Xu Yan, Alto Stemmer, Tong Tong, Guoxiang Cai

Abstract

Objective: To assess the diagnostic accuracy of whole-body MRI using diffusion-weighted sequence (WB-DWI) to determine the peritoneal cancer index (PCI) in correlation with surgical and histopathological findings.

Methods: Twenty-seven patients underwent preoperative WB-MRI, followed by cytoreductive surgery for primary tumors of the appendix (n = 15), colorectum (n = 12), and associated peritoneal disease. A total of 351 regions were retrospectively reviewed. The sensitivity, specificity, and accuracy were calculated at 13 anatomical sites. The WB-DWI PCI and PCI type were compared with surgical and histopathological findings.

Results: No statistical difference was found between the WB-DWI PCI and surgical PCI (P = 0.574). WB-DWI correctly predicted the PCI type in 24 of 27 patients with high accuracy (88.9%), including 10 of 10 patients with small-volume tumor, 12 of 14 with moderate-volume tumor, and 2 of 3 with large-volume tumor. WB-DWI correctly depicted tumors in 163 of 203 regions, with 40 false-negative and 23 false-positive regions. The overall sensitivity, specificity, and accuracy of WB-DWI for the detection of peritoneal tumors were 80.3%, 84.5%, and 82.1%, respectively. For lesions < 0.5 cm in diameter, WB-DWI demonstrated good sensitivity (69.4%).

Conclusions: WB-DWI accurately predicted PCI before surgery in patients undergoing evaluation for cytoreductive surgery.

Keywords: MRI; colorectal malignancy; diffusion-weighted imaging; peritoneal cancer index; peritoneal metastases.

Figures

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A 34-year-old man with a history of resection of adenocarcinoma of left colon. WB-DWI showed anterior abdominal wall with focal nodular of hyperintensity during postoperative follow-up, which was confirmed as PM in the subsequent cytoreductive surgery. The preoperative PCI of WB-DWI was 5. The surgery PCI was 2. The PCI Types were matched.
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A 36-year-old man with signet cell cancer of the rectum was diagnosed as multiple peritoneal metastases on preoperative WB-DWI, while preoperative positron emission tomography-CT (PET-CT) was negative. PM was confirmed in the followed cytoreductive surgery along with the resection for primary lesion. The PCI of preoperative WB-DWI and surgery were 13 and 18 respectively, with a same PCI Type.
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Comparison of PCI on preoperative WB-DWI and surgical PCI score.

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