González-Moreno Santiago, González-Bayón Luis, Ortega-Pérez Gloria, González-Hernando Concepción
Peritoneal Surface Oncology Program, Department of Surgical Oncology, Centro Oncológico MD Anderson International España, Calle Arturo Soria 270, Madrid 28033, Spain.
Cancer J. 2009 May-Jun;15(3):184-9. doi: 10.1097/PPO.0b013e3181a58ec3.
Imaging studies are crucial in the evaluation of patients with suspected or known peritoneal cancerous dissemination. Despite the major progress that has occurred in radiological technology in the last few years, adequate and early detection of peritoneal surface disease remains a challenge. Improvements in spatial resolution are still insufficient to detect small volume peritoneal implants, often resulting in an underestimation of peritoneal disease burden, as assessed at subsequent surgical exploration. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy has provided unprecedented results in the management of peritoneal-based neoplasms, provided that a complete (adequate) cytoreduction is achieved. Diagnostic imaging tests are used to select patients who may benefit from this combined treatment by ruling out extraperitoneal involvement and signs of unresectable peritoneal disease. Furthermore, a careful assessment of the disease distribution within the peritoneal cavity, guided by a deep knowledge of the disease's clinical and biological behavior helps in planning the surgical procedure. Close interaction and cooperation between surgeons and radiologists is of utmost importance in this regard, and dedicated, motivated radiologists are required. Contrast-enhanced, multidetector computed tomography scan remains the standard imaging modality in the assessment of peritoneal carcinomatosis. Magnetic resonance imaging may offer complementary valuable data. Positron emission tomography (PET) has a more limited role, its main indication being the detection of unsuspected extraperitoneal involvement in nonmucinous neoplasms.
影像学检查在疑似或已知腹膜癌播散患者的评估中至关重要。尽管过去几年放射技术取得了重大进展，但腹膜表面疾病的充分早期检测仍然是一项挑战。空间分辨率的提高仍不足以检测到小体积的腹膜种植灶，这常常导致对腹膜疾病负担的低估，后续手术探查时的评估结果就是如此。细胞减灭术联合围手术期腹腔内化疗在基于腹膜的肿瘤治疗中取得了前所未有的成果，前提是实现了完全（充分）的细胞减灭。诊断性影像学检查用于通过排除腹膜外受累和不可切除的腹膜疾病迹象来选择可能从这种联合治疗中获益的患者。此外，在对疾病临床和生物学行为深入了解的指导下，仔细评估腹膜腔内疾病的分布有助于规划手术程序。在这方面，外科医生和放射科医生之间密切的互动与合作至关重要，需要有敬业且积极主动的放射科医生。对比增强多层螺旋计算机断层扫描仍然是评估腹膜癌转移的标准影像学检查方法。磁共振成像可能提供有价值的补充数据。正电子发射断层扫描（PET）的作用较为有限，其主要适应证是检测非黏液性肿瘤中未被怀疑的腹膜外受累情况。
