Diagnostic Imaging and Laparoscopy

Pretreatment and preoperative assessment of peritoneal carcinomatosis (PC) can be very challenging in the field of imaging, and a comprehensive study could require integration of multidetector computed tomography (MDCT), magnetic resonance imaging (MRI) with conventional and diffusion-weighted sequences, and positron emission tomography (PET) or PET/CT [1, 2]. These imaging tools are able to provide accurate information on morphology, size, and location of peritoneal implants, lymph node enlargement, and presence of ascites. A detailed preoperative assessment of PC is essential to provide the surgeon with a detailed preoperative map of carcinomatosis and allow evaluation of the radiological Peritoneal Cancer Index (PCI) [3, 4]. This score correlates with patient prognosis, and the ability to calculate it using CT and MR with diffusion-weighted imaging (DWI) before any treatment is begun can guide therapeutic management of the patient. It can differentiate patients who are candidates for surgical intervention with hyperthermic intraperitoneal chemotherapy (HIPEC) from those with a high radiological PCI and who are therefore candidates for systemic chemotherapy [5]. The principal diagnostic techniques for accurate evaluation of peritoneal malignancy are represented by MDCT, MRI, PET, and combined PET/MDCT or PET/MRI. The role of ultrasound (US) imaging is limited in peritoneal imaging. However, this imaging modality is often the first one used when peritoneal disease is discovered incidentally, and it remains one of the diagnostic techniques for image-guided biopsy to obtain a histological diagnosis [1].