Klumpp B, Aschoff P, Schwenzer N, Koenigsrainer I, Beckert S, Claussen C D, Miller S, Koenigsrainer A, Pfannenberg C
Eberhard-Karls-University Tuebingen, Department for Diagnostic and Interventional Radiology, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany.
Diakonie Klinikum Stuttgart, Südwestdeutsches PET-Zentrum, Seidenstrasse 47, 70174 Stuttgart, Germany.
Cancer Imaging. 2013 Dec 30;13(4):540-7. doi: 10.1102/1470-7330.2013.0044.
In patients with peritoneal carcinomatosis, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is an evolving approach with curative intention. Previous studies indicate a correlation between preoperative magnetic resonance imaging (MRI) and surgical findings regarding the extent of peritoneal carcinomatosis. The aim of this study was to assess retrospectively whether preoperative MRI can predict the outcome and is therefore a suitable tool for patient selection.
Fifteen patients with laparoscopically proven peritoneal carcinomatosis were preoperatively examined using a 1.5-T whole-body MRI system. Results were correlated with surgical exploration. Follow-up was done by contrast-enhanced abdominal computed tomography and, if suspicious for recurring disease, laparoscopy or laparotomy. Survival time and interval to recurring disease were correlated with the preoperative peritoneal carcinomatosis index (PCI) on MRI (Spearman's rank correlation).
In five patients radical resection could not be achieved (PCI 34 ± 6.9); survival time was 78.2 ± 54.1 days. In seven patients recurring disease was found 430 ± 261.2 days after initial complete cytoreduction (PCI 11.6 ± 6.9); survival time was 765.9 ± 355 days. Two patients are still alive after 3 years. Two patients with initially complete cytoreduction are without recurring disease after 3 years (PCI 5 and 12). One patient was lost for follow-up.
Results of the preoperative MRI correlate well with the surgical PCI, postoperative resection status, and survival time. MRI might be a suitable technique for patient selection when considering peritonectomy and HIPEC. In our patients the outcome seems to correlate well with the extent of peritoneal carcinomatosis found by the preoperative MRI.
在腹膜癌患者中，细胞减灭术（CRS）和腹腔热灌注化疗（HIPEC）是一种具有治愈意图的不断发展的治疗方法。既往研究表明，术前磁共振成像（MRI）与腹膜癌扩散程度的手术发现之间存在相关性。本研究的目的是回顾性评估术前MRI是否能够预测预后，从而成为患者选择的合适工具。
15例经腹腔镜证实为腹膜癌的患者术前使用1.5T全身MRI系统进行检查。结果与手术探查结果相关。通过增强腹部计算机断层扫描进行随访，如果怀疑疾病复发，则进行腹腔镜检查或剖腹手术。生存时间和疾病复发间隔与MRI上的术前腹膜癌指数（PCI）相关（Spearman等级相关性）。
5例患者无法实现根治性切除（PCI 34±6.9）；生存时间为78.2±54.1天。7例患者在初次完全细胞减灭术后430±261.2天发现疾病复发（PCI 11.6±6.9）；生存时间为765.9±355天。2例患者3年后仍然存活。2例最初实现完全细胞减灭的患者3年后无疾病复发（PCI分别为5和12）。1例患者失访。
术前MRI结果与手术PCI、术后切除状态和生存时间密切相关。在考虑腹膜切除术和HIPEC时，MRI可能是患者选择的合适技术。在我们的患者中，预后似乎与术前MRI发现的腹膜癌扩散程度密切相关。
