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Ultrasound will demonstrate superficial peritoneal and omental metastases as small as 2 to 3 mm in the presence of ascites.
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This study used state-of-the-art MR techniques with phased array body coils, breath-hold sequences which included T1-weighted images with fat saturation before and after intravenous gadolinium chelate. Both were much more accurate than ultrasound. They found in a group of 280 patients that CT and MR imaging had similar accuracy for staging advanced ovarian cancer. However a recent report from the Radiological Diagnostic Oncology Group reviewed the performance of ultrasound, MR imaging, and CT for diagnosing and staging ovarian cancer. The inferior spatial resolution, the problems of motion artefact related to respiration and bowel peristalsis, and the lack of an effective bowel opacification agent makes MR imaging a generally less accurate test than CT for the identification of peritoneal metastases. MR imaging of the peritoneum has been most successfully achieved using fat saturated T1-weighted sequences following intravenous gadolinium. Recent reports describe the use of MR imaging in identifying peritoneal implants. These methods are more interventional and time consuming and consequently are not widely used. The use of intraperitoneal positive contrast and pneumoperitoneum with CT has been suggested to improve the detection of small peritoneal metastases but these techniques do not routinely opacify all the peritoneal recesses. This article reviews the detection of peritoneal metastases.ĬT is considered the best imaging procedure for the evaluation of patients with known or suspected peritoneal metastases. Computed tomography and to a lesser extent sonography and MR imaging allow us to examine the complex anatomy of the peritoneal cavity accurately, which is the key to understanding the spread of peritoneal metastases. Intraperitoneal seeding via ascitic fluidīefore the introduction of cross-sectional imaging, the peritoneum and its reflections could only be imaged with difficulty, often requiring invasive techniques. Peritoneal metastases spread in four ways:ĭirect spread along peritoneal ligaments, mesenteries and omenta to non-contiguous organs The peritoneal ligaments, mesenteries, and omenta also serve as boundaries and conduits for disease spread. The potential peritoneal spaces, the peritoneal reflections forming peritoneal ligaments, mesenteries, omenta, and the natural flow of peritoneal fluid determine the route of spread of intraperitoneal fluid and consequently disease spread within the abdominal cavity. The peritoneum is the largest and most complexly arranged serous membrane in the body.