MRI with diffusion-weighted imaging to predict feasibility of complete cytoreduction with the peritoneal cancer index (PCI) in advanced stage ovarian cancer patients. Issue 114 (May 2019)

• Record Type: Journal Article
• Authors: Engbersen, M.P.; van' t Sant, I.; Lok, C.; Lambregts, D.M.J.; Sonke, G.S.; Beets-Tan, R.G.H.; van Driel, W.J.; Lahaye, M.J.
• Is Part Of: European journal of radiology. Issue 114(2019)
• Page Start: 146
• Page End: 151
• Publication Date: 2019-05
• Subjects: ADC apparent diffusion coefficient -- AUC area under the curve -- CRS cytoreductive surgery -- CT Computed Tomography -- DW-MRI Diffusion-weighted magnetic resonance imaging -- DLS diagnostic laparoscopy -- EPI Echo-planar imaging -- FFE Fast field echo -- FIGO International Federation of Gynecology and Obstetrics -- ICC Intraclass correlation coefficient -- MRI-PCI magnetic resonance imaging Peritoneal Cancer Index -- PCI peritoneal cancer index -- ROC receiver operator characteristics -- S-PCI Surgical Peritoneal Cancer Index -- SS single shot -- TSE Turbo spin echo; Cytoreductive surgery -- Diffusion-weighted MRI -- Advanced-stage ovarian cancer -- Peritoneal carcinomatosis; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2019.03.007
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: Accurate preoperative assessment of the peritoneal tumor load can be done with Diffusion-Weighted MRI. Diffusion-weighted MRI is able to predict per-operative findings using the Peritoneal Cancer Index. The MRI-PCI showed able to predict whether a complete cytoreduction is feasible for advanced stage ovarian cancer patients. Abstract: Objectives: To determine the diagnostic performance of MRI with diffusion-weighted imaging (DW-MRI) in assessing the peritoneal tumor load and predicting whether a complete cytoreduction can be achieved in patients with epithelial ovarian cancer (EOC). Methods: For this observational prospective study, 25 patients with epithelial ovarian cancer scheduled for cytoreductive surgery were included. Patients underwent a 3 T DW-MRI scan prior to surgery. The MR protocol consisted of a T1 and T2 weighted, a contrast-enhanced T1 weighted, and a diffusion-weighted (b0, b1000) sequence. The Peritoneal Cancer Index (PCI) was determined on DW-MR images (MRI-PCI) by two readers, independently, and was compared to the PCI determined during surgery (S-PCI). The inter-observer agreement between the two radiologists was evaluated. In addition, receiver operating characteristics curves were calculated for predicting complete cytoreduction with the S-PCI and MRI-PCI. Results: Staging with DW-MRI showed a correlation to surgical staging with an intraclass correlation coefficient (ICC) 0.86 and 0.85 for reader 1 and 2, respectively. Inter-observer agreement was excellent with an ICC of 0.90 (95% CI: 0.64-0.96). The MRI-PCI scores of reader 1 (AUC = 0.96), reader 2 (AUC = 0.98), and the S-PCI (AUC = 0.92) showed similar predictive values for complete cytoreduction. Conclusion: DW-MRI is accurate in predicting the S-PCI and can be helpful to predict whether a complete resection in ovarian cancer patients is feasible.