Polici Michela, Palmeri Federica, Golia Erica, Parri Emanuela, Gentiloni Silveri Guido, Puglisi Francesco, De Santis Domenico, Zerunian Marta, Pucciarelli Francesco, Polidori Tiziano, Ciolina Maria, Sammartino Paolo, Laghi Andrea, Caruso Damiano
Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy.
PhD School in Translational Medicine and Oncology, Department of Medical-Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
Insights Imaging. 2025 Aug 8;16(1):171. doi: 10.1186/s13244-025-02060-z.
Peritoneal malignancies (PM) are defined as the spread of malignant epithelial cells in the peritoneal cavity. Until the recent past, the prognosis was considered extremely poor, and the treatment options had only palliative intent. Currently, new locoregional treatments have radically changed the outcome. CT is pivotal in PM diagnosis, staging, surgical planning, and determining therapeutic decisions. MRI should be evaluated in a preoperative setting for the evaluation of mesentery, serosal, and in any cases of contraindication of CT with contrast medium, while in the restaging clinical setting, it does not have a defined role. In the preoperative clinical setting, imaging could provide the surgeon with specific information concerning disease burden by showing the invasion of vital anatomic structures, and it is therefore essential to describe the feasibility of the surgery. However, recognizing the imaging findings of peritoneal deposits depends mainly on the histology of the primary tumor and the peritoneal spaces, thus rendering knowledge of peritoneal anatomy essential. In addition, some benign pathologies show similar imaging features that overlap with PM, making differential diagnosis difficult. It is still unclear which of the two methods, CT and MRI, is superior in terms of performance, and literature data are often controversial. Thus, the purpose of this review is to provide some practical tips for CT and MRI protocols and imaging findings essential to detect and characterize peritoneal deposits in each anatomical space, and to provide an overview of the main differential diagnosis with other peritoneal conditions. CRITICAL RELEVANCE STATEMENT: Peritoneal malignancies should be understood as a heterogeneous pattern of diseases, with variable prognosis and treatment options. CT remains the main imaging method; MRI finds application for involvement of the serosa and mesentery and when contrast-enhanced CT is not feasible. KEY POINTS: CT is the first imaging option to assess peritoneal malignancies and plan surgery; however, they have several limitations, especially in critical regions. MRI could be seen as a supporting imaging approach in a preoperative setting to study serosal, mesentery, and in case of contraindication of CT with contrast medium. Multidisciplinary approach should always be considered in the assessment of peritoneal malignancies due to their heterogeneity.
腹膜恶性肿瘤（PM）被定义为恶性上皮细胞在腹腔内的扩散。直到不久前，其预后仍被认为极差，治疗选择也仅具有姑息性目的。目前，新的局部区域治疗方法已从根本上改变了治疗结果。CT在PM的诊断、分期、手术规划以及确定治疗决策方面起着关键作用。在术前评估中，对于肠系膜、浆膜的评估以及在任何存在CT使用造影剂禁忌的情况下，都应考虑使用MRI；而在再分期的临床环境中，它并没有明确的作用。在术前临床环境中，影像学检查可以通过显示重要解剖结构的侵犯情况，为外科医生提供有关疾病负担的具体信息，因此描述手术的可行性至关重要。然而，识别腹膜转移灶的影像学表现主要取决于原发肿瘤的组织学类型和腹膜间隙，因此了解腹膜解剖结构至关重要。此外，一些良性病变表现出与PM相似的影像学特征，使得鉴别诊断困难。目前尚不清楚CT和MRI这两种方法在性能方面哪种更具优势，而且文献数据往往存在争议。因此，本综述的目的是为CT和MRI方案以及检测和鉴别每个解剖空间中的腹膜转移灶所必需的影像学表现提供一些实用技巧，并概述与其他腹膜疾病的主要鉴别诊断。关键相关性声明：腹膜恶性肿瘤应被理解为一种异质性疾病模式，预后和治疗选择各不相同。CT仍然是主要的影像学检查方法；MRI适用于浆膜和肠系膜受累以及增强CT不可行的情况。关键点：CT是评估腹膜恶性肿瘤和规划手术的首选影像学检查方法；然而，它们存在一些局限性，尤其是在关键区域。MRI可被视为术前评估浆膜、肠系膜以及CT使用造影剂禁忌情况下的辅助影像学检查方法。由于腹膜恶性肿瘤的异质性，在评估时应始终考虑多学科方法。
