Prospective Comparison of the Performance of MRI Versus CT in the Detection and Evaluation of Peritoneal Surface Malignancies
by
, , , ,
Claramae Shulyn Chia
1,2,3,4,*, 
Louis Choon Kit Wong
1,2,5,
Tiffany Priyanthi Hennedige
6,
Whee Sze Ong
7,
Hong-Yuan Zhu
1,2,
Grace Hwei Ching Tan
1,2,
Jin Wei Kwek
6,
Chin Jin Seo
1,2,
Jolene Si Min Wong
1,2,3,4,
Chin-Ann Johnny Ong
1,2,3,4,8,9,
Choon Hua Thng
6,
Khee Chee Soo
1,2,3,4 and
Melissa Ching Ching Teo
1,2,3,4 1
Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore
2
Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore 169608, Singapore
3
SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
4
SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
5
Duke-NUS Medical School, Singapore 169857, Singapore
6
Division of Oncological Imaging, National Cancer Centre Singapore, Singapore 169610, Singapore
7
Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore 169610, Singapore
8
Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore 169610, Singapore
9
Institute of Molecular and Cell Biology, A*STAR Research Entities, Singapore 138673, Singapore
*
Author to whom correspondence should be addressed.
Cancers 2022, 14(13), 3179; https://doi.org/10.3390/cancers14133179
Submission received: 27 April 2022
/
Revised: 30 May 2022
/
Accepted: 27 June 2022
/
Published: 29 June 2022
(This article belongs to the Special Issue Clinical Studies in Peritoneal Surface Malignancies)
Simple Summary
Early diagnosis, evaluation, and appropriate treatment of peritoneal surface malignancies remains difficult. While computed tomography and magnetic resonance imaging are commonly used for these purposes, it remains unknown whether one is superior to the other. The aim of the current study was therefore to prospectively compare the two imaging modalities, using intra-operative evaluation as a reference standard. Our findings indicate that they are comparable in the detection and evaluation of peritoneal surface malignancies. Thus, either imaging modality may be appropriate, depending on clinical indications and resource management. It should however be noted that both modalities are likely to underestimate the true burden of disease, which may negatively impact treatment decisions.
Abstract
Background: The performance of MRI versus CT in the detection and evaluation of peritoneal surface malignancies (PSM) remains unclear in the current literature. Our study is the first prospective study in an Asian center comparing the two imaging modalities, validated against intra-operative findings. Methods: A total of 36 patients with PSM eligible for CRS-HIPEC underwent both MRI and CT scans up to 6 weeks before the operation. The scans were assessed for the presence and distribution of PSM and scored using the peritoneal cancer index (PCI), which were compared against PCI determined at surgery. Results: Both MRI and CT were 100% sensitive and specific in detecting the overall presence of PSM. Across all peritoneal regions, the sensitivity and specificity for PSM detection was 49.1% and 93.0% for MRI, compared to 47.8% and 95.1% for CT (p = 0.76). MRI was more sensitive than CT for small bowel disease, although the difference did not reach statistical significance. Comparing PCI on imaging with intra-operative PCI, the mean difference was found to be −3.4 ± 5.4 (p < 0.01) for MRI, and −3.9 ± 4.1 (p < 0.01) for CT. The correlation between imaging and intra-operative PCI was poor, with a concordance coefficient of 0.76 and 0.79 for MRI and CT, respectively. Within individual peritoneal regions, there was also poor agreement between imaging and intra-operative PCI for both modalities, other than in regions 1 and 3. Conclusion: MRI and CT are comparable in the detection and evaluation of PSM. While sensitive in the overall detection of PSM, they are likely to underestimate the true disease burden.
