Imaging of Peritoneal Metastasis: Literature Review and Own Experience

Abstract

Peritoneal metastasis is typical for malignant neoplasms of the ovary, stomach, intestines and other localizations. Metastases can mimic other pathological changes. Ambiguous conclusions about the effectiveness of certain methods of visualization and differentiation of peritoneal metastasis given in the scientific literature explain the lack of a unified approach in its diagnosis. Imaging of the peritoneum directly impacts tumor burden assessment, prognosis, and treatment planning. Purpose of the study: to analyze the information content of modern methods of visualizing peritoneal metastasis, based on literature data and our own experience. Materials and methods. The study was carried out on the basis of a literature analysis of publications of the electronic search system PubMed. We also conducted our own research on the comparative effectiveness of visualization methods implemented in the conditions of the Republican Clinical Oncologic Dispensary of Ministry of Health of the Republic of Bashkortostan. Results: analysis of the literature showed that all visualization methods have certain capabilities and limitations. Diagnosis of metastases located in the small intestine and lesions less than 5 mm in size is significantly difficult. Adhesive processes in the abdominal cavity, difficult to differentiate confluent tumor masses and inflammatory changes also affect the examination results. Our own experience demonstrates the admissibility of using a combination of pelvic magnetic resonance imaging and abdominal computed tomography for preoperative visualization of peritoneal metastases. Imaging results using instrumental methods were comparable to surgical assessment. In addition to the diagnostic limitations stated in the scientific literature, we identified difficulties in interpreting the results due to the lack of criteria for assessing peritoneal pathology by radiologists. Conclusion. Thus, according to the literature, the standard for diagnosing peritoneal metastases has not been defined. Computed tomography and magnetic resonance imaging methods are relatively accessible methods for visualizing peritoneal metastasis and complement each other, taking into account the diagnostic limitations and capabilities of each. To improve the assessment of the tumor burden at the preoperative stage, it is worth considering the possibility of creating uniform protocols for describing peritoneal metastases by abdominal region by radiologists, which will significantly facilitate the assessment and treatment planning in the future.