Comparison of Diffusion-Weighted Magnetic Resonance Imaging and 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography for Detection of Peritoneal Carcinomatoses in Advanced Epithelial Ovarian Cancer

Comparison of Diffusion-Weighted Magnetic Resonance Imaging and 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography for Detection of Peritoneal Carcinomatoses in Advanced Epithelial Ovarian Cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of Diffusion-Weighted Magnetic Resonance Imaging and 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography for Detection of Peritoneal Carcinomatoses in Advanced Epithelial Ovarian Cancer Song-Qi Cai, Jian-Feng Huang, Min-Rong Wu, Jing-Jing Lu, Xiao-Liang Ma, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5014920/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives: To compare the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) and 18F-fluorodeoxyglucose combined positron emission tomography combined with computed tomography(FDG-PET/CT) in detecting peritoneal carcinomatoses in advanced epithelial ovarian cancer (EOC). Methods: This prospective study enrolled patients with stage III-IV EOC consecutively from October 2020 to February 2023. Participants underwent both DW-MRI and FDG-PET/CT. Three radiologists independently evaluated the radiological images using peritoneal cancer index (PCI) scoring systems. Clinical data, preoperative imaging assessments, and cytoreductive surgical outcomes were recorded. Univariate and multivariate analyses were performed to determine the critical regions for surgery associated with incomplete resection. The diagnostic performance of each imaging modality was calculated for each site. The interobserver agreement was assessed. Results: Forty-eight patients were enrolled in this study. No statistically significant differences were found between the imaging modalities ( p ≥0.142) based on the PCI scoring evaluation system. Omental lesions extend to the hepatic flexure or splenic flexure ( p =0.045, OR=20.891), and small bowel mesentery involvement ( p =0.039, OR=21.814) were identified as surgically critical regions associated with incomplete resection. DW-MRI demonstrated significantly higher accuracy than FDG-PET/CT ( p =0.049) in diagnosis at omental lesions extend to the hepatic flexure or splenic flexure and diaphragmatic peritoneum, with sensitivity and specificity of 0.773 and 0.792 for DW-MRI, and 0.619 and 0.696 for FDG-PET/CT, respectively. DW-MRI also showed higher interobservers agreement (k=0.654-0.782) compared to moderate agreement (k=0.515-0.745) in FDG-PET/CT. Conclusion: DW-MRI and FDG-PET/CT were comparable in assessing the entire abdominopelvic tumor burden based on PCI scoring system. DW-MRI has an advantage in detecting omental lesions extending to the hepatic flexure or splenic flexure, which is predictive of incomplete resection. Peritoneal carcinomatosis Diffusion-weighted imaging Positron-Emission Tomography computed tomography Epithelial ovarian cancer Cytoreductive surgery Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Approximately half of patients diagnosed with advanced epithelial ovarian cancer (EOC; International Federation of Gynecology and Obstetrics [FIGO] III/IV) [1]. Multiple analyses have confirmed that women with complete resection of all visible disease have the best survival outcomes [2–4] . In this context, describing and quantifying the tumor burden are essential for planning surgical procedures, with direct impacts on surgical morbidity. The peritoneal carcinosis index (PCI) has been considered the standard for describing carcinomatosis. The commonly used PCI, described by Jacquet and Sugarbaker, is used for colorectal cancer and mesothelioma, dividing the peritoneum and intraperitoneal organs into 13 regions[5]. However, Rosendahl et al. and Sudan et al. highlighted that specific anatomic regions hold more predictive value for achieving complete resection and survival in advanced EOC[6,7]. The predictive value of the PCI score or selected regions for resectability remains controversial[8]. Currently, computed tomography (CT) is commonly used for preoperative assessments to determine tumor resectability. However, CT is not ideal for evaluating the resectability of advanced EOC in primary debulking surgery (PDS)[9,10]. Diffusion-weighted magnetic resonance imaging (DW-MRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) are both widely available. Studies have indicated high specificity and moderate sensitivity for DW-MRI and FDG-PET/CT in predicting incomplete debulking[11–14]. They may provide complementary options for detailed reporting on the distribution of peritoneal carcinomatoses. However, the evidence is not yet conclusive enough to recommend routinely incorporating DW-MRI or FDG-PET/CT into clinical practice[15].  The objective of this study is to compare the diagnostic accuracy of DW-MRI and FDG-PET/CT in identifying the PCI as recorded during surgery and critical tumor sites relevant for surgery. Methods 1. Patients selection and clinical data recording The prospective study was approved by the institutional ethics board (No. B2021324). The study consecutively enrolled patients diagnosed with advanced EOC. Patients underwent FDG-PET/CT within 4 weeks before surgery from October 2020 to February 2023. For patients for whom FDG-PET/CT indicated complete resection at PDS is unlikely, abdominopelvic MRI was performed according to a predefined protocol at our institution within 1-2 weeks before surgery. Imaging results, along with the patient's performance status and comorbidities, were assessed by a multidisciplinary team to determine whether patients would receive PDS or neoadjuvant chemotherapy with interval debulking surgery (IDS). Written informed consent was obtained from all participants. Tumor extent was assessed based on laparoscopy findings (for those treated by IDS) and PDS results, recorded by gynecologic oncologist following a standardized template. The inclusion and exclusion criteria were summarized in Figure 1. The recorded clinical data included: age, preoperative levels of cancer antigen-125 (CA125) and human epididymis secretory protein 4 (HE4) marker, surgical staging according to the FIGO classification based on imaging (chest CT, abdominal-pelvic DW-MRI, or FDG-PET/CT) or surgical results, tissue history, and cytoreduction status (complete resection with no macroscopic residual disease; incomplete resection with any residual lesions after PDS or IDS). 2. Image Acquisition 2.1 DW-MRI acquisition. DW-MRI examinations were performed using dedicated phased-array body and spine coils on a 3T MR systems (Discovery MR 750, GE Healthcare). Patients fasted for 4-6 hours. The conventional abdominopelvic MRI protocol included axial T1-weighted imaging (T1WI) with or without fat saturation, axial and coronal fat-suppressed T2-weighted imaging (T2WI), and contrast-enhanced T1WI using 2D Flash with fat saturation. An axial and coronal diffusion weighted imaging (DWI) was obtained with b-values of 0 and 800 or 1000 s/mm 2 . All pulse sequences, except for the contrast-enhanced T1WI, were performed using free-breathing acquisition techniques. Respiration-triggered acquisition was employed for abdominal T2WI and DWI. An antispasmodic agent (butylscopolamine bromide, Buscopan®, 20 mg/ml, Boehringer Ingelheim) was administered. The total scan time was 35 minutes. 2.2 FDG-PET/CT acquisition. All patients fasted for at least 6 hours and had a plasma glucose level of ≤7.0 mmol/l before intravenous injection of 18F-FDG. FDG-PET/CT scans were performed using a total-body FDG-PET/CT scanner (uEXPLORER, United Imaging Healthcare, Shanghai, China) with an axial field of view of 194 cm. Whole-body acquisition was conducted approximately 70±6 minutes after the injection of 5.5 MBq/kg of 18F-FDG. PET reconstructions were carried out using the ordered subset expectation maximization algorithm with the following parameters: time-of-flight and point spread function modeling, 3 iterations, 20 subsets, matrix of 192 × 192, a slice thickness of 1.443 mm, and a full width at half maximum of the Gaussian filter function of 3 mm. 3. Imaging interpretation DW-MRI images were independently reviewed by three board-certified radiologists (C.S.Q, D.Y.Q and W.M.R) with 11, 15 and 7 years of experience in gynecological imaging, respectively. FDG-PET/CT images were reviewed by two nuclear physicians (L.G.B, M.X.L and L.J.J) with 11, 10 and 5 years of experience in gynecological imaging, respectively. The DW-MRI and FDG-PET/CT images were reviewed separately, with imaging observers blinded to each other's assessments and clinical findings. The assessment of selected anatomic regions and imaging PCI scores were obtained. 3.1 PCI scoring systems The conventional PCI scoring system divides the peritoneum and intraperitoneal organs equally into 13 regions [16]. Two vertical midclavicular lines and two horizontal lines at the anterior superior iliac spines and under the costal arcs divide the peritoneal cavity into 9 areas (0-8), while the upper and lower jejunum and ileum constitute the remaining 4 areas. For each region, a lesion size score of 0-3 is assigned based on the tumor size (0 = no visible tumor; 1 = tumor 5 cm). The sum (0-39) represents the conventional PCI score (Figure 2A and Supplemental Table 1). Another PCI scoring system, with additional points for involvement of selected regions, was proposed in gynecological research[17]. This system assigns additional points to selected regions, including the left and right diaphragm, liver surface, omental lesions extending to the hepatic flexure or splenic flexure, gastrohepatic space, small bowel mesentery, peritoneal disease (localized diseases involving the peritoneum of the middle abdomen; diffused thickening of the left and right paracolic gutter peritoneum, combined with thickening of the pelvic peritoneum, and/or involving the colon), bowel infiltration, and suprarenal lymph node metastases [17]. Each region is scored as either 0 or 2 (0 = no visible tumor; 2=have any lesions). The total score (0-16) represents the selected PCI score (Figure 2B and Supplemental Table 2). 4. Surgical evaluation Following each PDS and exploratory laparotomy, the surgeon recorded findings using a standardized form, noting the location and size of any disease present. If complete resection seemed doubtful, an exploratory laparotomy was conducted. During this procedure, the abdominal and pelvic cavities were systematically evaluated to assess the extent and size of the disease. 5. Statistical analysis Statistical analysis was performed using SPSS statistical software (V26.0; IBM, Armonk, NY) and MedCalc (version 20.215; MedCalc Software Ltd, Ostend, Belgium). According to previous results, we anticipate a sensitivity of 80% and 90% for DW-MRI and FDG-PET/CT, and we set alpha at 0.05 and power at 0.80[15]. The sample size is 41. The diagnostic performances of the two imaging modalities in different anatomic regions were evaluated using receiver operating characteristic (ROC) curves, from which sensitivity and specificity were calculated. The areas under the ROC curves were compared between the two imaging methods. The inter-observer agreement for each region were compared by Fleiss Kappa. The agreement between the entire imaging PCIs and the PCIs confirmed by surgery was assessed using Bland-Altman statistics and correlation matrices. The difference between DW-MRI and FDG-PET/CT in assessing the two PCI scoring system was compared using Student's paired t-test or Mann-Whitney U test. Univariate analysis was conducted to compare clinical factors, entire surgery PCI, and different region carcinomatoses between complete and incomplete resection groups after PDS. Variables with p -value ＜0.05 were included in the multivariate models. Multivariate logistic regression analysis with forward stepwise elimination was conducted to identify factors associated with incomplete resection. All tests were two-sided, with statistically significant at a p -value < 0.05. Results 1. Patients This prospective study consecutively enrolled 48 patients with advanced EOC, with a median age of 55 years (range: 49-66 years). Thirty-three underwent PDS, 12 underwent IDS and exploratory laparotomy, and 3 declined further treatment after exploratory laparotomy. The patient characteristics are summarized in Table 1. Of the 35 patients (77.78%) who achieved complete resection, 26 patients in the PDS group and 9 patients in the IDS group. The remaining 10 patients (22.22%) who did not achieve complete resection，included 7 from the PDS group and 3 from the IDS group. The residual tumor distribution was summarized in Table 2. 2.  The comparison of DW-MRI and FDG-PET/CT diagnostic accuracy in selected anatomic regions  with surgery correlation The quality of DW-MRI and FDG-PET/CT images was evaluated in all patients and regions. There were significant differences observed in the diaphragmatic peritoneum ( p =0.017, Figure 3) and omental lesions extending to the hepatic flexure or splenic flexure ( p =0.049, Figure 4). No statistically significant differences were detected in other regions between the two imaging modalities ( p ≥0.114). The comparison of the two imaging modalities diagnostic accuracy in selected anatomic regions was summarized in Table 3. 3. The comparison of PCI_surgery and PCI_ imaging Forty-three percent (21/48) of patients were underestimated in the conventional PCI scoring system by either DW-MRI or FDG-PET/CT. Seventy-one percent（34/48）and 73% (35/48) were underestimated in the selected regions PCI scoring system by DW-MRI and FDG-PET/CT respectively. The mean differences in the conventional PCI scoring system (PCI_surgery - PCI_imaging) were 0.958 (CI: -4.556, 6.472) for DW-MRI and 1.574 (CI: -4.288, 7.437) for FDG-PET/CT. In selected regions, the mean differences (PCI_surgery - PCI_imaging) were 2.478 (CI: -3.463, 8.421) for DW-MRI and 2.188 (CI: -5.187, 9.562) for FDG-PET/CT (Figure 5). The correlation between DW-MRI and surgical result was 0.901 for conventional scoring system and 0.738 for the selected region PCI score system (both p <0.0001). The correlation between FDG-PET/CT and surgical result was 0.887 for conventional PCI score system and 0.594 for selected region PCI score system (both p <0.0001). There was no statistically significant difference between the imaging modalities in assessing the two PCI scoring systems ( p =0.142 and p =0.614). 4.  The clinical and regional carcinomatoses that related to the surgical residual disease In the PDS group, 7 of the 33 patients had residual disease after PDS. Significant differences (p≤0.014) were observed in the PCI scores between the two groups. In the univariate analyses, there were significant differences in specific regional carcinomatoses between the two groups, including lesions in the hepatogastric space, omental lesions extending to the hepatic flexure or splenic flexure, small bowel mesentery, and peritoneal disease. In the multivariate analysis, only omental lesions extending to the hepatic flexure or splenic flexure (OR (odd ratio) =20.891; p =0.045) and small bowel mesentery involvement (OR=21.843; p=0.039) remained as independent significant variables associated with incomplete resection (Table 4; Figure 6). Discussion As the PCI and critical anatomic sites with carcinomatoses in predicting incomplete resection for the patients with advanced EOC has been valued, the accurately noninvasive assessment of tumor burden before surgery become more and more important in clinical setting[6,8]. However, the certainty of the evidence was insufficient to advise routine addition of FDG-PET/CT or DW-MRI to clinical practice[15]. In this prospective single-center study, we compared the diagnostic accuracy of DW-MRI and FDG-PET/CT in preoperative assessment of PCIs and selected anatomic sites in patients who need further identify the tumor burden to optimize treatment selection. Both DW-MRI and FDG-PET/CT were found to underestimate the total PCI as determined during surgery. The modalities were more likely to underestimate the PCI in selected regions than the conventional PCI (~70% vs. 43.75%), indicating that accurately identify the critical anatomic sites before surgery still challenging. Though the correlation between PCI_DW-MRI and PCI_surgery was stronger than that between PCI_FDG-PET/CT and PCI_surgery (r=0.738-0.901 vs. 0.587-0.887), the two imaging modalities showed comparable diagnostic abilities, which is consistent with previous studies[18,19]. When examining peritoneal metastases region by region, DW-MRI demonstrated significantly higher accuracy than FDG-PET/CT in detecting lesions in the diaphragmatic peritoneum and omental lesions extending to the hepatic flexure or splenic flexure. Both of the two imaging modalities showed moderate inter-observer agreement, excepted for FDG-PET/CT in detecting lesions in the omental lesions extending to the bowl. One reason may be that DW-MRI is more sensitive in detecting mesenteric or serosal involvement due to the high signal intensity of lesions on high b-value images compared to the suppressed background signal [20,21]. Another reason may be the designed examination protocol for DW-MRI, which involves coronal scanning combined with respiratory triggering. This offers advantages for visualizing the diaphragmatic peritoneum and omental lesions extending to the hepatic flexure or splenic flexure, which are more challenging to detect on axial images. Note that 80% to 90% of residual disease is found in the small intestine with mesentery and/or in the hepatoduodenal ligament, both in our cohort and in previous studies [9,18,22]. Previous studies emphasize DW-MRI’s diagnostic capability in detecting small bowel lesions[23]. However, we found no advantage of DW-MRI over FDG-PET/CT in detecting lesions involving the small bowel mesentery and the hepatoduodenal ligament. The two imaging modalities demonstrated similar diagnostic efficiency and consistence among observers. Lesions, particularly those smaller than 0.5cm, involving the small intestine with mesentery and the hepatoduodenal ligament, remain challenging for preoperative diagnosis. Our study has some limitations. First, we did not compare DW-MRI and FDG-PET/CT against MDCT, which is more commonly used in clinical setting. However, the aim of this study is to identify the additional benefits of DWI-MRI and FDG-PET/CT in identifying critical anatomic sites that CT may not good at. Previous studies have shown that these imaging modalities typically offer better specificity and sensitivity than MDCT[14,23–25]. Second, the prospective nature and the focus of the study led to missing surgical details for three patients, and selected bias is evident. Lastly, this is a single-center study, and the results have not been further validated by multicenter trials. Strengths include the homogeneity of the patients, standardized surgeries performed by two certified gynecologic cancer surgeons at a single center, and perioperative PCI evaluations conducted. However, patient homogeneity could also be seen as a limitation，as it complicates the generalization of our findings to other centers. Conclusions DW-MRI and FDG-FDG-PET/CT were comparable in assessing the total abdominopelvic tumor burden using PCI score system. The imaging PCI often underestimated the true extent of peritoneal dissemination. The DW-MRI showed superior performance to FDG-PET/CT in assessing critical disease regions corresponding to the small bowel mesentery and omental lesions extending to the hepatic flexure or splenic flexure, which was independently predictive of incomplete resection. Declarations Author Contribution •Jian-Jun Zhou and Meng-Su Zeng contributed equally to guarantee this study.•Song-Qi Cai and Jian-Feng Huang contributed equally to the study design, data acquirement and manuscript editing. As a result, they are listed as joint first authors of this article.•Funding acquisition: Song-Qi Cai, Yu-Qin Ding.•Investigation: all authors.•Resources: all authors.•Writing—review & editing: all authors. References Armstrong DK, Alvarez RD, Backes FJ, Bakkum-Gamez JN, Barroilhet L, Behbakht K, et al. Ovarian Cancer, Version 3.2022 Featured Updates to the NCCN Guidelines. 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Comparison of MRI and CT for Predicting the Peritoneal Cancer Index (PCI) Preoperatively in Patients Being Considered for Cytoreductive Surgical Procedures. Ann Surg Oncol 2015;22:1708–15. https://doi.org/10.1245/s10434-014-4041-7. Tables Table1 Patient demographics and clinical data Median/N Range/N% Age(years) 55 (49-66) Primary tumor site ovary 44 91.7% fallopian tube 3 6.2% primary peritoneal 1 2.1% Histology high grade serous adenocarcinoma 43 89.6% low grade serous adenocarcinoma 1 2.1% clear cell adenocarcinoma 4 8.3% CA125(U/ml) 890 （393-1698） HE4(pmol/L) 384.5 (157.5-747.25) Treatment for the primary diagnosed advanced high-grade ovarian cancer+ PDS 33 73.3% IDS 12 26.7% CA125，cancer antigen-125；HE4, human epididymis secretory protein 4 +3 patients underwent exploratory laparotomy but declined to have further treatment Table 2 Cytoreduction status and the residual tumor distribution PDS, primary debulking surgery; IDS, interval debulking surgery Table 3 DW-MRI and FDG-PET/CT diagnostic performance in selected anatomic regions Region DW-MRI FDG-PET/CT p (DW-MRI vs. PET/CT) Sensitivity Specificity ROC area k（95%CI） Sensitivity Specificity ROC area k（95%CI） Diaphragmatic peritoneum 0.903 0.592 0.910 0.782（0.671,0.867） 0.645 0.917 0.781 0.745（0.619,0.843） 0.005* Liver lesions 0.631 0.862 0.747 0.757（0.635,0.850） 0.526 0.724 0.625 0.712（0.576,0.820） 0.114 Lesions in the hepatogastric space 0.423 0.92 0.683 0.756（0.634,0.849） 0.550 0.875 0.713 0.635（0.474,0.769） 0.406 Omental lesions extend to the hepatic flexure or splenic flexure 0.773 0.792 0.772 0.645（0.491,0.773） 0.619 0.696 0.657 0.515（0.330,0.683） 0.049* Small bowel mesentery involvement 0.577 0.810 0.693 0.634（0.473,0.768） 0.630 0.714 0.684 0.671（0.5240.792） 0.603 Peritoneal disease 0.714 0.963 0.823 0.864（0.786,0.918） 0.667 0.840 0.765 0.725（0.583,0.834） 0.401 Bowel infiltration 0.524 0.833 0.679 0.704（0.565,0.814） 0.524 0.875 0.699 0.826（0.732,0.895） 0.804 Suprarenal lymph node metastases Suprarenal 0.842 0.957 0.899 0.912（0.745,1.00） 0.895 0.833 0.864 0.934（0.769,1.00） 0.507 ROC, receiver operating characteristic; CI, confidence interval * a significant difference was found in this item Table 4 The univariate and multivariate analyses in PDS group Univariate analysis Multivariate analysis OR (95% CI) p OR (95% CI) p Age(years) 1.042（0.964, 1.126） 0.304 …… …… CA125(U/ml) 1.000(0.999,1.000) 0.456 …… …… HE4(pmol/L) 1.000(0.999,1.000) 0.729 …… …… Diaphragmatic peritoneum(Y/N) 6.750(0.750,60.760) 0.089 …… …… Liver lesions(Y/N) 1.780(0.843,3.754) 0.130 …… …… Lesions in the hepatogastric space(Y/N) 3.464(1.430,8.393) 0.006 …… …… Omental lesions extend to the hepatic flexure or splenic flexure (Y/N) 27.000(2.886,252.624) 0.004 20.891（1.077,405.288） 0.045 Small bowel mesentery involvement(Y/N) 33.000(3.462,314.533) 0.002 21.843（1.175,406.170） 0.039 Peritoneal disease(Y/N) 41.400(4.23,405.216) 0.001 13.146（0.722,239.449） 0.082 Bowel infiltration (Y/N) 0.867(0.204, 3.676) 0.833 …… …… Suprarenal lymph node metastases Suprarenal(Y/N) 1.018(0.220,4.720) 0.982 …… …… Conventional PCI 1.410(1.121,1.774) 0.003 …… …… Selected regions PCI 1.175(1.033,1.336) 0.014 …… …… PDS, primary debulking surgery; OR, odd ratio; CI, confidence interval; CA125, cancer antigen-125; HE4, human epididymis secretory protein 4 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5014920","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":354866551,"identity":"ffc58704-0437-43ab-8299-081e82d3388f","order_by":0,"name":"Song-Qi Cai","email":"","orcid":"","institution":"Zhongshan Hospital Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Song-Qi","middleName":"","lastName":"Cai","suffix":""},{"id":354866552,"identity":"0911d591-1d68-4d6c-9cf4-40fb045805c5","order_by":1,"name":"Jian-Feng Huang","email":"","orcid":"","institution":"Zhongshan Hospital Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Jian-Feng","middleName":"","lastName":"Huang","suffix":""},{"id":354866554,"identity":"0c746f49-c804-4ecd-8694-8fe8e1b77cb1","order_by":2,"name":"Min-Rong Wu","email":"","orcid":"","institution":"Zhongshan Hospital (Xiamen) Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Min-Rong","middleName":"","lastName":"Wu","suffix":""},{"id":354866556,"identity":"98214f71-a25e-4dc8-8989-9d2baae649f9","order_by":3,"name":"Jing-Jing Lu","email":"","orcid":"","institution":"Zhongshan Hospital Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Jing-Jing","middleName":"","lastName":"Lu","suffix":""},{"id":354866558,"identity":"f9824a90-6221-417c-b3d0-9b8848c39e2e","order_by":4,"name":"Xiao-Liang Ma","email":"","orcid":"","institution":"Zhongshan Hospital Fudan 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Zeng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYNCDDwY2cqTpYJxRkGZMmhZmng+HEwmqku8//vBxwa9tcub8y59J2xgwJzCwHz66Ab9bEpKNZ/bdNrac8cZMOseALY+BJy3tBl63SDAck+btuZ244cYZNqAWnmIGCR4zvFrY+A+2/wZqqd9w4/gzaQsDicQGQlp4GJLZmHl+3E4wON9gJs1gYEBYi4REGrM0b8Ntww03eIwtewwSjNkI+QUUYp95/tyWNzh//OGNH3/+y/GzHz6GVwsYMLaB7EuA+o6gcjD4A8T8B4hTOwpGwSgYBSMPAADJHUl0TPjTPQAAAABJRU5ErkJggg==","orcid":"","institution":"Zhongshan Hospital Fudan University","correspondingAuthor":true,"prefix":"","firstName":"Meng-Su","middleName":"","lastName":"Zeng","suffix":""}],"badges":[],"createdAt":"2024-09-02 02:36:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5014920/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5014920/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":67112972,"identity":"c826d7d0-05fd-454e-8be5-790eba52902f","added_by":"auto","created_at":"2024-10-21 09:56:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":98447,"visible":true,"origin":"","legend":"\u003cp\u003eThe flowchart of this study.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5014920/v1/4be5fa9572bafccbd8864f26.png"},{"id":67113428,"identity":"ff6540ff-2b09-4d25-8b52-069b204f1b38","added_by":"auto","created_at":"2024-10-21 10:04:53","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":151822,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA. Conventional PCI scoring system:\u003c/strong\u003e ①Umbilical，②right upper quadrant，③epigastrium，④left upper quadrant，⑤left flank，⑥left lower quadrant，⑦pelvis，⑧right lower quadrant，⑨right flan，⑩ upper jejunum，⑪lower jejunum，⑫upper ileum，⑬lower ileum; \u003cstrong\u003eB. Selected regions PCI scoring system: \u003c/strong\u003e①left and right diaphragm, ②liver surface, ③omentum lesions extend to the hepatic flexure or splenic flexure, ④gastrohepatic space, ⑤small bowel mesentery, ⑥peritoneal disease，⑦bowel infiltration.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5014920/v1/63256482be09b3e9aa4ff240.png"},{"id":67112979,"identity":"3237f00d-a78d-404b-96f4-e25673dd8104","added_by":"auto","created_at":"2024-10-21 09:56:53","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":176274,"visible":true,"origin":"","legend":"\u003cp\u003eA 40-year-old female with FIGO IVb stage high-grade serous ovarian cancer. \u0026nbsp;A: Coral T2WI shows the lesions (white arrow) penetrate the diaphragm. B: The lesions demonstrate high signal on DWI (white arrow). C: Contrast-enhanced T1WI shows lesions penetrating through the entire diaphragm, which is in agree with the surgical findings. D: The lesions show high FDG uptake (black arrow).\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5014920/v1/290d7fd878457159b32c6e48.png"},{"id":67112976,"identity":"1c61d022-18df-4f27-bbe9-ca04c9c68d88","added_by":"auto","created_at":"2024-10-21 09:56:53","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":163390,"visible":true,"origin":"","legend":"\u003cp\u003eA 66-year-old female with FIGO IVb stage high-grade serous ovarian cancer, who had incomplete resection. \u0026nbsp;A: Coral T2WI shows a cystic-solid lesion (white star) in the greater omentum adherent to the hepatic flexure of the colon (white arrow). B: The solid components of the cystic-solid lesion were high signal on DWI. C: Contrast-enhanced T1WI shows the fat plane between the lesion and bowel was obliterated. D: the relationship of the lesion and the bowel was barely recognized in FDG-PET/CT.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5014920/v1/38d9c06e2445b8e3b46f2137.png"},{"id":67112973,"identity":"f50d205b-dd20-4f60-8439-c9e5cab2fae0","added_by":"auto","created_at":"2024-10-21 09:56:53","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":69328,"visible":true,"origin":"","legend":"\u003cp\u003eMean-difference plots and correlation between PCI_surgery and PCI_imaging (long dashed lines: 95% limits of agreement interval).\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-5014920/v1/c97984894054372e3faed0a2.png"},{"id":67113429,"identity":"7d38d619-a7d4-4404-ae4c-1c3268e815e2","added_by":"auto","created_at":"2024-10-21 10:04:53","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":252659,"visible":true,"origin":"","legend":"\u003cp\u003eA 67-year-old female with FIGO IVb stage high-grade serous ovarian cancer, who had incomplete resection. \u0026nbsp;A: Coral T2WI shows lesions penetrating the root of mesentery (arrow), and the right paracolic sulci has a mass-like lesion (black star). B: The mesentery lesions showed high signal on DWI. C: Contrast-enhanced T1WI shows lesions enhanced moderately. D: the lesions were demonstrated in surgery (arrow).\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-5014920/v1/5359f3fd9d88433fa16d3783.png"},{"id":67114743,"identity":"97eff686-5bea-4aa2-8f2d-242cb726a052","added_by":"auto","created_at":"2024-10-21 10:20:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1725805,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5014920/v1/6091b04d-869b-4c26-a0fe-213c47074973.pdf"},{"id":67112977,"identity":"50fbc632-aac1-470e-ac5d-2632167dce5c","added_by":"auto","created_at":"2024-10-21 09:56:53","extension":"docx","order_by":9,"title":"","display":"","copyAsset":false,"role":"supplement","size":18924,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaltables.docx","url":"https://assets-eu.researchsquare.com/files/rs-5014920/v1/8bbb166708945a9fdfc60c8a.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of Diffusion-Weighted Magnetic Resonance Imaging and 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography for Detection of Peritoneal Carcinomatoses in Advanced Epithelial Ovarian Cancer","fulltext":[{"header":"Introduction","content":"\u003cp\u003eApproximately half of patients diagnosed with advanced\u0026nbsp;epithelial ovarian cancer\u0026nbsp;(EOC;\u0026nbsp;International Federation of Gynecology and Obstetrics [FIGO] III/IV) [1].\u0026nbsp;Multiple analyses have confirmed that women with complete resection of all visible disease have the best survival outcomes [2\u0026ndash;4] .\u0026nbsp;In this context,\u0026nbsp;describing and quantifying the tumor burden are essential for planning surgical procedures, with direct impacts on surgical morbidity.\u0026nbsp;The peritoneal carcinosis index (PCI) has been considered the standard for describing carcinomatosis. The commonly used PCI, described by\u0026nbsp;Jacquet and Sugarbaker, is used for colorectal cancer and mesothelioma, dividing the peritoneum and intraperitoneal organs into 13 regions[5]. However, Rosendahl et al. and Sudan et al. highlighted that specific anatomic regions hold more predictive value for achieving complete resection and survival in advanced EOC[6,7].\u0026nbsp;The predictive value of the PCI score or selected regions for resectability remains controversial[8].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCurrently, computed tomography (CT) is commonly used for preoperative assessments to determine tumor resectability. However, CT is not ideal for evaluating the resectability of advanced EOC in primary debulking surgery (PDS)[9,10]. Diffusion-weighted magnetic resonance imaging (DW-MRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) are both widely available. Studies have indicated high specificity and moderate sensitivity for DW-MRI and FDG-PET/CT in predicting incomplete debulking[11\u0026ndash;14]. They may provide complementary options for detailed reporting on the distribution of peritoneal carcinomatoses.\u0026nbsp;However, the evidence is not yet conclusive enough to recommend routinely incorporating DW-MRI or FDG-PET/CT into clinical practice[15].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe objective of this study is to compare the diagnostic accuracy of DW-MRI and FDG-PET/CT in identifying the PCI as recorded during surgery and critical tumor sites relevant for surgery.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e1. Patients selection and clinical data recording\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prospective study was approved by the institutional ethics board (No. B2021324). The study consecutively enrolled patients diagnosed with advanced EOC. Patients underwent FDG-PET/CT within 4 weeks before surgery from October 2020 to\u0026nbsp;February 2023.\u0026nbsp;For patients for whom FDG-PET/CT indicated complete resection at PDS is unlikely, abdominopelvic MRI was performed according to a predefined protocol at our institution within 1-2 weeks before surgery. Imaging results, along with the patient\u0026apos;s performance status and comorbidities, were assessed by a multidisciplinary team to determine whether patients would receive PDS or\u0026nbsp;neoadjuvant chemotherapy\u0026nbsp;with interval debulking surgery (IDS).\u0026nbsp;Written informed consent was obtained from all participants. Tumor extent was assessed based on laparoscopy findings (for those treated by IDS) and PDS results, recorded by gynecologic oncologist following a standardized template. The inclusion and exclusion criteria were summarized in Figure 1.\u003c/p\u003e\n\u003cp\u003eThe recorded clinical data included: age, preoperative levels of cancer antigen-125 (CA125) and human epididymis secretory protein 4 (HE4) marker, surgical staging according to the FIGO classification based on imaging (chest CT, abdominal-pelvic DW-MRI, or FDG-PET/CT) or surgical results, tissue history, and cytoreduction status (complete resection with no macroscopic residual disease; incomplete resection with any residual lesions after PDS or IDS).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Image Acquisition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e2.1 DW-MRI acquisition.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDW-MRI examinations were performed using dedicated phased-array body and spine coils on a 3T MR systems (Discovery MR 750, GE Healthcare). Patients fasted for 4-6 hours. The conventional abdominopelvic MRI protocol included axial T1-weighted imaging (T1WI) with or without fat saturation, axial and coronal fat-suppressed T2-weighted imaging (T2WI), and contrast-enhanced T1WI using 2D Flash with fat saturation. An axial and coronal diffusion weighted imaging (DWI) was obtained with b-values of 0 and 800 or 1000 s/mm\u003csup\u003e2\u003c/sup\u003e. All pulse sequences, except for the contrast-enhanced T1WI, were performed using free-breathing acquisition techniques. Respiration-triggered acquisition was employed for abdominal T2WI and DWI. An antispasmodic agent (butylscopolamine bromide, Buscopan\u0026reg;, 20 mg/ml, Boehringer Ingelheim) was administered. The total scan time was 35 minutes.\u003c/p\u003e\n\u003cp\u003e2.2 FDG-PET/CT acquisition.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll patients fasted for at least 6 hours and had a plasma glucose level of \u0026le;7.0 mmol/l before intravenous injection of 18F-FDG. FDG-PET/CT scans were performed using a total-body FDG-PET/CT scanner (uEXPLORER, United Imaging Healthcare, Shanghai, China) with an axial field of view of 194 cm. Whole-body acquisition was conducted approximately 70\u0026plusmn;6 minutes after the injection of 5.5 MBq/kg of\u0026nbsp;18F-FDG. PET reconstructions were carried out using the ordered subset expectation maximization algorithm with the following parameters: time-of-flight and point spread function modeling, 3 iterations, 20 subsets, matrix of 192 \u0026times; 192, a slice thickness of 1.443 mm, and a full width at half maximum of the Gaussian filter function of 3 mm.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Imaging interpretation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDW-MRI images were independently reviewed by three board-certified radiologists (C.S.Q, D.Y.Q and W.M.R) with 11, 15 and 7 years of experience in gynecological imaging, respectively. FDG-PET/CT images were reviewed by two nuclear physicians (L.G.B, M.X.L and L.J.J) with 11, 10 and 5 years of experience in gynecological imaging, respectively. The DW-MRI and FDG-PET/CT images were reviewed separately, with imaging observers blinded to each other\u0026apos;s assessments and clinical findings. The assessment of selected anatomic regions and imaging PCI scores were obtained.\u003c/p\u003e\n\u003cp\u003e3.1 PCI scoring systems\u003c/p\u003e\n\u003cp\u003eThe conventional PCI scoring system divides the peritoneum and intraperitoneal organs equally into 13 regions [16]. Two vertical midclavicular lines and two horizontal lines at the anterior superior iliac spines and under the costal arcs divide the peritoneal cavity into 9 areas (0-8), while the upper and lower jejunum and ileum constitute the remaining 4 areas. For each region, a lesion size score of 0-3 is assigned based on the tumor size (0 = no visible tumor; 1 = tumor \u0026lt; 0.5 cm; 2 = tumor 0.5-5 cm; and 3 = tumor \u0026gt; 5 cm). The sum (0-39) represents the conventional PCI score (Figure 2A and Supplemental Table 1).\u003c/p\u003e\n\u003cp\u003eAnother PCI scoring system,\u0026nbsp;with additional points for involvement of selected regions,\u0026nbsp;was proposed in gynecological research[17].\u0026nbsp;This system assigns additional points to selected regions, including the left and right diaphragm, liver surface, omental lesions extending to the hepatic flexure or splenic flexure, gastrohepatic space, small bowel mesentery, peritoneal disease (localized diseases involving the peritoneum of the middle abdomen; diffused thickening of the left and right paracolic gutter peritoneum, combined with thickening of the pelvic peritoneum, and/or involving the colon), bowel infiltration, and suprarenal lymph node metastases [17]. Each region is scored as either 0 or 2 (0 = no visible tumor; 2=have any lesions). The total score (0-16) represents the selected PCI score (Figure 2B and Supplemental Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eSurgical evaluation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing each PDS and exploratory laparotomy, the surgeon recorded findings using a standardized form, noting the location and size of any disease present. If complete resection seemed doubtful, an exploratory laparotomy was conducted. During this procedure, the abdominal and pelvic cavities were systematically evaluated to assess the extent and size of the disease.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5. Statistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analysis was performed using SPSS statistical software (V26.0; IBM, Armonk, NY) and MedCalc (version 20.215; MedCalc Software Ltd, Ostend, Belgium). According to previous results, we anticipate a sensitivity of 80% and 90% for DW-MRI and FDG-PET/CT, and we set alpha at 0.05 and power at 0.80[15]. The sample size is 41. The diagnostic performances of the two imaging modalities in different anatomic regions were evaluated using receiver operating characteristic (ROC) curves, from which sensitivity and specificity were calculated. The areas under the ROC curves were compared between the two imaging methods. The inter-observer agreement for each region were compared by Fleiss Kappa. The agreement between the entire imaging PCIs and the PCIs confirmed by surgery was assessed using Bland-Altman statistics and correlation matrices. The difference between DW-MRI and FDG-PET/CT in assessing the two PCI scoring system was compared using Student\u0026apos;s paired t-test or Mann-Whitney U test. Univariate analysis was conducted to compare clinical factors, entire surgery PCI, and different region carcinomatoses between complete and incomplete resection groups after PDS. Variables with \u003cem\u003ep\u003c/em\u003e-value ＜0.05 were included in the multivariate models. Multivariate logistic regression analysis with forward stepwise elimination was conducted to identify factors associated with incomplete resection. All tests were two-sided, with statistically significant at a \u003cem\u003ep\u003c/em\u003e-value \u0026lt; 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e1. Patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis prospective study consecutively enrolled 48 patients with advanced EOC, with a median age of 55 years (range: 49-66 years). Thirty-three underwent PDS, 12 underwent IDS and exploratory laparotomy, and 3 declined further treatment after exploratory laparotomy. The patient characteristics are summarized in Table 1.\u003c/p\u003e\n\u003cp\u003eOf the 35 patients (77.78%) who achieved complete resection, 26 patients in the PDS group and 9 patients in the IDS group. The remaining 10 patients (22.22%) who did not achieve complete resection，included 7 from the PDS group and 3 from the IDS group. The residual tumor distribution was summarized in Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003c/strong\u003e\u003cstrong\u003eThe comparison of DW-MRI and FDG-PET/CT diagnostic accuracy in selected anatomic regions\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003c/strong\u003e\u003cstrong\u003ewith surgery correlation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe quality of DW-MRI and FDG-PET/CT images was evaluated in all patients and regions. There were significant differences observed in the diaphragmatic peritoneum (\u003cem\u003ep\u003c/em\u003e=0.017, Figure 3) and omental lesions extending to the hepatic flexure or splenic flexure (\u003cem\u003ep\u003c/em\u003e=0.049, Figure 4). No statistically significant differences were detected in other regions between the two imaging modalities (\u003cem\u003ep\u003c/em\u003e\u0026ge;0.114). The comparison of the two imaging modalities diagnostic accuracy in selected anatomic regions was summarized in Table 3.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. The comparison of PCI_surgery and PCI_ imaging\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eForty-three percent (21/48) of patients were underestimated in the conventional PCI scoring system by either DW-MRI or FDG-PET/CT. Seventy-one percent（34/48）and 73% (35/48) were underestimated in the selected regions PCI scoring system by DW-MRI and FDG-PET/CT respectively.\u0026nbsp;The mean differences in the conventional PCI scoring system (PCI_surgery - PCI_imaging) were 0.958 (CI: -4.556, 6.472) for DW-MRI and 1.574 (CI: -4.288, 7.437) for FDG-PET/CT. In selected regions, the mean differences (PCI_surgery - PCI_imaging) were 2.478 (CI: -3.463, 8.421) for DW-MRI and 2.188 (CI: -5.187, 9.562) for FDG-PET/CT (Figure 5). The correlation between DW-MRI and surgical result was 0.901 for conventional scoring system and 0.738 for the selected region PCI score system (both \u003cem\u003ep\u003c/em\u003e\u0026lt;0.0001). The correlation between FDG-PET/CT and surgical result was 0.887 for conventional PCI score system and 0.594 for selected region PCI score system (both \u003cem\u003ep\u003c/em\u003e\u0026lt;0.0001). There was no statistically significant difference between the imaging modalities in assessing the two PCI scoring systems (\u003cem\u003ep\u003c/em\u003e=0.142 and \u003cem\u003ep\u003c/em\u003e=0.614).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003c/strong\u003e\u003cstrong\u003eThe clinical and regional carcinomatoses that related to the surgical residual disease\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the PDS group, 7 of the 33 patients had residual disease after PDS. Significant differences (p\u0026le;0.014) were observed in the PCI scores between the two groups. In the univariate analyses, there were significant differences in specific regional carcinomatoses between the two groups, including lesions in the hepatogastric space, omental lesions extending to the hepatic flexure or splenic flexure, small bowel mesentery, and peritoneal disease. In the multivariate analysis, only omental lesions extending to the hepatic flexure or splenic flexure (OR (odd ratio) =20.891; \u003cem\u003ep\u003c/em\u003e=0.045) and small bowel mesentery involvement (OR=21.843; p=0.039) remained as independent significant variables associated with incomplete resection (Table 4; Figure 6).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAs the PCI and critical anatomic sites with carcinomatoses in predicting incomplete resection for the patients with advanced EOC has been valued, the accurately noninvasive assessment of tumor burden before surgery become more and more important in clinical setting[6,8]. However,\u0026nbsp;the certainty of the evidence was insufficient to advise routine addition of FDG-PET/CT or DW-MRI to clinical practice[15]. In this prospective single-center study, we compared the diagnostic accuracy of DW-MRI and FDG-PET/CT in preoperative assessment of PCIs and selected anatomic sites in patients who need further identify the tumor burden to\u0026nbsp;optimize treatment selection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBoth DW-MRI and FDG-PET/CT were found to underestimate the total PCI as determined during surgery. The modalities were more likely to underestimate the PCI in selected regions than the conventional PCI (~70% vs. 43.75%), indicating that accurately identify the critical anatomic sites before surgery still challenging. Though the correlation between PCI_DW-MRI and PCI_surgery was stronger than that between PCI_FDG-PET/CT and PCI_surgery (r=0.738-0.901 vs. 0.587-0.887), the two imaging modalities showed comparable diagnostic abilities, which is consistent with previous studies[18,19].\u003c/p\u003e\n\u003cp\u003eWhen examining peritoneal metastases region by region, DW-MRI demonstrated significantly higher accuracy than FDG-PET/CT in detecting lesions in the diaphragmatic peritoneum and omental lesions extending to the hepatic flexure or splenic flexure. Both of the two imaging modalities showed moderate inter-observer agreement, excepted for FDG-PET/CT in detecting lesions in the omental lesions extending to the bowl. One reason may be that DW-MRI is more sensitive in detecting mesenteric or serosal involvement due to the high signal intensity of lesions on high b-value images compared to the suppressed background signal [20,21]. \u0026nbsp;Another reason may be the designed examination protocol for DW-MRI, which involves coronal scanning combined with\u0026nbsp;respiratory triggering. This offers advantages for visualizing the diaphragmatic peritoneum and omental lesions extending to the hepatic flexure or splenic flexure, which are more challenging to detect on axial images.\u003c/p\u003e\n\u003cp\u003eNote that 80% to 90% of residual disease is found in the small intestine with mesentery and/or in the hepatoduodenal ligament, both in our cohort and in previous studies [9,18,22]. Previous studies emphasize DW-MRI’s diagnostic capability in detecting small bowel lesions[23]. However, we found no advantage of DW-MRI over FDG-PET/CT in detecting lesions involving the small bowel mesentery and the hepatoduodenal ligament. The two imaging modalities demonstrated similar diagnostic efficiency and consistence among observers. Lesions, particularly those smaller than 0.5cm, involving the small intestine with mesentery and the hepatoduodenal ligament, remain challenging for preoperative diagnosis.\u003c/p\u003e\n\u003cp\u003eOur study has some limitations. First, we did not compare DW-MRI and FDG-PET/CT against MDCT, which is more commonly used in clinical setting. However, the aim of this study is to identify the additional benefits of DWI-MRI and FDG-PET/CT in identifying critical anatomic sites that CT may not good at. Previous studies have shown that these imaging modalities typically offer better specificity and sensitivity than MDCT[14,23–25]. Second, the prospective nature and the focus of the study led to missing surgical details for three patients, and selected bias is evident. Lastly, this is a single-center study, and the results have not been further validated by multicenter trials. Strengths include the homogeneity of the patients, standardized surgeries performed by two certified gynecologic cancer surgeons at a single center, and perioperative PCI evaluations conducted. However, patient homogeneity could also be seen as a limitation，as it complicates the generalization of our findings to other centers.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eDW-MRI and FDG-FDG-PET/CT were comparable in assessing the total abdominopelvic tumor burden using PCI score system. The imaging PCI often underestimated the true extent of peritoneal dissemination. The DW-MRI showed superior performance to FDG-PET/CT in assessing critical disease regions corresponding to the small bowel mesentery and omental lesions extending to the hepatic flexure or splenic flexure, which was independently predictive of incomplete resection.\u003c/p\u003e "},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003e\u0026bull;Jian-Jun Zhou and Meng-Su Zeng contributed equally to guarantee this study.\u0026bull;Song-Qi Cai and Jian-Feng Huang contributed equally to the study design, data acquirement and manuscript editing. As a result, they are listed as joint first authors of this article.\u0026bull;Funding acquisition: Song-Qi Cai, Yu-Qin Ding.\u0026bull;Investigation: all authors.\u0026bull;Resources: all authors.\u0026bull;Writing\u0026mdash;review \u0026amp; editing: all authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eArmstrong DK, Alvarez RD, Backes FJ, Bakkum-Gamez JN, Barroilhet L, Behbakht K, et al. Ovarian Cancer, Version 3.2022 Featured Updates to the NCCN Guidelines. JNCCN Journal of the National Comprehensive Cancer Network 2022;20:973\u0026ndash;80. https://doi.org/10.6004/jnccn.2022.0047.\u003c/li\u003e\n\u003cli\u003eChang SJ, Hodeib M, Chang J, Bristow RE. Survival impact of complete cytoreduction to no gross residual disease for advanced-stage ovarian cancer: A meta-analysis. Gynecol Oncol 2013;130:493\u0026ndash;8. https://doi.org/10.1016/j.ygyno.2013.05.040.\u003c/li\u003e\n\u003cli\u003eArmstrong DK, Bundy B, Wenzel L, Huang HQ, Baergen R, Lele S, et al. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med 2006;354:34\u0026ndash;43. https://doi.org/10.1056/NEJMOA052985.\u003c/li\u003e\n\u003cli\u003eShin KK, Chi DS. Maximal cytoreductive effort in epithelial ovarian cancer surgery. J Gynecol Oncol 2010;21:75\u0026ndash;80. https://doi.org/10.3802/jgo.2010.21.2.75.\u003c/li\u003e\n\u003cli\u003eJacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res 1996;82:359\u0026ndash;74. https://doi.org/10.1007/978-1-4613-1247-5_23.\u003c/li\u003e\n\u003cli\u003eRosendahl M, Harter P, Bj\u0026oslash;rn SF, H\u0026oslash;gdall C. Specific regions, rather than the entire peritoneal carcinosis index, are predictive of complete resection and survival in advanced epithelial ovarian cancer. International Journal of Gynecological Cancer 2018;28:316\u0026ndash;22. https://doi.org/10.1097/IGC.0000000000001173.\u003c/li\u003e\n\u003cli\u003eSuidan RS, Ramirez PT, Sarasohn DM, Teitcher JB, Iyer RB, Zhou Q, et al. A multicenter assessment of the ability of preoperative computed tomography scan and CA-125 to predict gross residual disease at primary debulking for advanced epithelial ovarian cancer. Gynecol Oncol 2017;145:27\u0026ndash;31. https://doi.org/10.1016/j.ygyno.2017.02.020.\u003c/li\u003e\n\u003cli\u003eJ\u0026oacute;nsd\u0026oacute;ttir B, Lomnytska M, Poromaa IS, Silins I, St\u0026aring;lberg K. The Peritoneal Cancer Index is a Strong Predictor of Incomplete Cytoreductive Surgery in Ovarian Cancer. Ann Surg Oncol 2021;28:244\u0026ndash;51. https://doi.org/10.1245/s10434-020-08649-6.\u003c/li\u003e\n\u003cli\u003eBorley J, Wilhelm-Benartzi C, Yazbek J, Williamson R, Bharwani N, Stewart V, et al. Radiological predictors of cytoreductive outcomes in patients with advanced ovarian cancer. BJOG 2015;122:843\u0026ndash;9. https://doi.org/10.1111/1471-0528.12992.\u003c/li\u003e\n\u003cli\u003eSuidan RS, Ramirez PT, Sarasohn DM, Teitcher JB, Mironov S, Iyer RB, et al. A multicenter prospective trial evaluating the ability of preoperative computed tomography scan and serum CA-125 to predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer. Gynecol Oncol 2014;134:455\u0026ndash;61. https://doi.org/10.1016/j.ygyno.2014.07.002.\u003c/li\u003e\n\u003cli\u003eShim SH, Lee SJ, Kim SO, Kim SN, Kim DY, Lee JJ, et al. Nomogram for predicting incomplete cytoreduction in advanced ovarian cancer patients. Gynecol Oncol 2015;136:30\u0026ndash;6. https://doi.org/10.1016/J.YGYNO.2014.11.004.\u003c/li\u003e\n\u003cli\u003eAlessi A, Martinelli F, Padovano B, Serafini G, Lorusso D, Lorenzoni A, et al. FDG-PET/CT to predict optimal primary cytoreductive surgery in patients with advanced ovarian cancer: preliminary results. Tumori 2016;102:103\u0026ndash;7. https://doi.org/10.5301/TJ.5000396.\u003c/li\u003e\n\u003cli\u003eEspada M, Garcia-Flores JR, Jimenez M, Alvarez-Moreno E, De Haro M, Gonzalez-Cortijo L, et al. Diffusion-weighted magnetic resonance imaging evaluation of intra-abdominal sites of implants to predict likelihood of suboptimal cytoreductive surgery in patients with ovarian carcinoma. Eur Radiol 2013;23:2636\u0026ndash;42. https://doi.org/10.1007/s00330-013-2837-7.\u003c/li\u003e\n\u003cli\u003eMichielsen K, Dresen R, Vanslembrouck R, De Keyzer F, Amant F, Mussen E, et al. Diagnostic value of whole body diffusion-weighted MRI compared to computed tomography for pre-operative assessment of patients suspected for ovarian cancer. Eur J Cancer 2017;83:88\u0026ndash;98. https://doi.org/10.1016/j.ejca.2017.06.010.\u003c/li\u003e\n\u003cli\u003eRoze JF, Hoogendam JP, van de Wetering FT, Spijker R, Verleye L, Vlayen J, Veldhuis WB, Scholten RJPM ZR, Roze. Positron emission tomography (PET) and magnetic resonance imaging (MRI) for assessing tumour resectability in advanced epithelial ovarian/fallopian tube/primary peritoneal cancer (Review) Roze. Cochrane Database of Systematic Reviews 2018:1\u0026ndash;23. https://doi: 10.1002/14651858.CD012567.pub2\u003c/li\u003e\n\u003cli\u003eSugarbaker PH, Jablonski KA. Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy. Ann Surg 1995;221:124\u0026ndash;32. https://doi.org/10.1097/00000658-199502000-00002.\u003c/li\u003e\n\u003cli\u003eJiang R, Zhu J, Kim JW, Liu J, Kato K, Kim HS, et al. Study of upfront surgery versus neoadjuvant chemotherapy followed by interval debulking surgery for patients with stage IIIC and IV ovarian cancer, SGOG SUNNY (SOC-2) trial concept. J Gynecol Oncol 2020;31:e86. https://doi.org/10.3802/jgo.2020.31.e86.\u003c/li\u003e\n\u003cli\u003eMikkelsen MS, Petersen LK, Blaakaer J, Marinovskij E, Rosenkilde M, Andersen G, et al. Assessment of peritoneal metastases with DW-MRI, CT, and FDG PET/CT before cytoreductive surgery for advanced stage epithelial ovarian cancer. European Journal of Surgical Oncology 2021;47:2134\u0026ndash;41. https://doi.org/10.1016/j.ejso.2021.03.239.\u003c/li\u003e\n\u003cli\u003eSchmidt S, Meuli RA, Achtari C, Prior JO. Peritoneal carcinomatosis in primary ovarian cancer Staging: Comparison between MDCT, MRI, and 18F-FDG PET/CT. Clin Nucl Med 2015;40:371\u0026ndash;7. https://doi.org/10.1097/RLU.0000000000000768.\u003c/li\u003e\n\u003cli\u003eRizzo S, Del Grande M, Manganaro L, Papadia A, Del Grande F. Imaging before cytoreductive surgery in advanced ovarian cancer patients. International Journal of Gynecological Cancer 2020;30:133\u0026ndash;8. https://doi.org/10.1136/ijgc-2019-000819.\u003c/li\u003e\n\u003cli\u003eLee EYP, An H, Perucho JAU, Chiu KWH, Hui ES, Chu MMY, et al. Functional tumour burden of peritoneal carcinomatosis derived from DWI could predict incomplete tumour debulking in advanced ovarian carcinoma. Eur Radiol 2020;30:5551\u0026ndash;9. https://doi.org/10.1007/s00330-020-06887-6.\u003c/li\u003e\n\u003cli\u003eHeitz F, Harter P, Alesina PF, Walz MK, Lorenz D, Groeben H, et al. Pattern of and reason for postoperative residual disease in patients with advanced ovarian cancer following upfront radical debulking surgery. Gynecol Oncol 2016;141:264\u0026ndash;70. https://doi.org/10.1016/j.ygyno.2016.03.015.\u003c/li\u003e\n\u003cli\u003eFehniger J, Thomas S, Lengyel E, Liao C, Tenney M, Oto A, et al. A prospective study evaluating diffusion weighted magnetic resonance imaging (DW-MRI) in the detection of peritoneal carcinomatosis in suspected gynecologic malignancies. Gynecol Oncol 2016;142:169\u0026ndash;75. https://doi.org/10.1016/j.ygyno.2016.04.018.\u003c/li\u003e\n\u003cli\u003eRizzo S, De Piano F, Buscarino V, Pagan E, Bagnardi V, Zanagnolo V, et al. Pre-operative evaluation of epithelial ovarian cancer patients: Role of whole body diffusion weighted imaging MR and CT scans in the selection of patients suitable for primary debulking surgery. A single-centre study. Eur J Radiol 2020;123. https://doi.org/10.1016/J.EJRAD.2019.108786.\u003c/li\u003e\n\u003cli\u003eLow RN, Barone RM, Lucero J. Comparison of MRI and CT for Predicting the Peritoneal Cancer Index (PCI) Preoperatively in Patients Being Considered for Cytoreductive Surgical Procedures. Ann Surg Oncol 2015;22:1708\u0026ndash;15. https://doi.org/10.1245/s10434-014-4041-7.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"586\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 60.7509%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable1 Patient demographics and clinical data\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.2491%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45.9044%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 14.8464%;\"\u003e\n \u003cp\u003eMedian/N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.2491%;\"\u003e\n \u003cp\u003eRange/N%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45.9044%;\"\u003e\n \u003cp\u003eAge(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8464%;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.2491%;\"\u003e\n \u003cp\u003e(49-66)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45.9044%;\"\u003e\n \u003cp\u003ePrimary tumor site\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8464%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 39.2491%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45.9044%;\"\u003e\n \u003cp\u003eovary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8464%;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.2491%;\"\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45.9044%;\"\u003e\n \u003cp\u003efallopian tube\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8464%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.2491%;\"\u003e\n \u003cp\u003e6.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45.9044%;\"\u003e\n \u003cp\u003eprimary peritoneal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8464%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.2491%;\"\u003e\n \u003cp\u003e2.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45.9044%;\"\u003e\n \u003cp\u003eHistology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8464%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 39.2491%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45.9044%;\"\u003e\n \u003cp\u003ehigh grade serous adenocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8464%;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.2491%;\"\u003e\n \u003cp\u003e89.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45.9044%;\"\u003e\n \u003cp\u003elow grade serous adenocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8464%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.2491%;\"\u003e\n \u003cp\u003e2.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45.9044%;\"\u003e\n \u003cp\u003eclear cell adenocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8464%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.2491%;\"\u003e\n \u003cp\u003e8.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45.9044%;\"\u003e\n \u003cp\u003eCA125(U/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8464%;\"\u003e\n \u003cp\u003e890\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.2491%;\"\u003e\n \u003cp\u003e（393-1698）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45.9044%;\"\u003e\n \u003cp\u003eHE4(pmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8464%;\"\u003e\n \u003cp\u003e384.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.2491%;\"\u003e\n \u003cp\u003e(157.5-747.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45.9044%;\"\u003e\n \u003cp\u003eTreatment for the primary diagnosed advanced high-grade ovarian cancer+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8464%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.2491%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45.9044%;\"\u003e\n \u003cp\u003ePDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8464%;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.2491%;\"\u003e\n \u003cp\u003e73.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45.9044%;\"\u003e\n \u003cp\u003eIDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8464%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.2491%;\"\u003e\n \u003cp\u003e26.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCA125，cancer antigen-125；HE4, human epididymis secretory protein 4\u003c/p\u003e\n\u003cp\u003e+3 patients underwent exploratory laparotomy but declined to have further treatment\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Cytoreduction status and the residual tumor distribution\u003c/strong\u003e\u003cbr\u003e\u003cimg 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\" style=\"width: 606px; height: 429.142px;\" width=\"606\" height=\"429.142\"\u003e\u003c/p\u003e\n\u003cp\u003ePDS, primary debulking surgery; IDS, interval debulking surgery\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"955\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"11\" style=\"width: 955px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3 DW-MRI and FDG-PET/CT diagnostic performance in selected anatomic regions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003eRegion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 381px;\"\u003e\n \u003cp\u003eDW-MRI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 369px;\"\u003e\n \u003cp\u003eFDG-PET/CT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e (DW-MRI vs. PET/CT)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003eSensitivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eSpecificity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eROC area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003ek（95%CI）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003eSensitivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003eSpecificity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eROC area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003ek（95%CI）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eDiaphragmatic peritoneum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.903\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.592\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.910\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.782（0.671,0.867）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.645\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.917\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.781\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.745（0.619,0.843）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.005*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eLiver lesions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.631\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.862\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.747\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.757（0.635,0.850）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.526\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.724\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.625\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.712（0.576,0.820）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eLesions in the hepatogastric space\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.423\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.683\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.756（0.634,0.849）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.550\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.875\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.713\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.635（0.474,0.769）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.406\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eOmental lesions extend to the hepatic flexure or splenic flexure\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.773\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.792\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.772\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.645（0.491,0.773）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.619\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.696\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.657\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.515（0.330,0.683）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.049*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eSmall bowel mesentery involvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.577\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.810\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.693\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.634（0.473,0.768）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.630\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.684\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.671（0.5240.792）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.603\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003ePeritoneal disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.963\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.823\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.864（0.786,0.918）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.667\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.840\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.765\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.725（0.583,0.834）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.401\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eBowel infiltration\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.524\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.833\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.679\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.704（0.565,0.814）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.524\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.875\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.699\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.826（0.732,0.895）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.804\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eSuprarenal lymph node metastases Suprarenal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.842\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.957\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.899\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.912（0.745,1.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.895\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.833\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.864\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.934（0.769,1.00） \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.507\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eROC,\u0026nbsp;receiver operating characteristic; CI, confidence interval\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e*\u003c/strong\u003ea significant difference was found in this item\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 623px;\"\u003e\n \u003cp\u003eTable 4 The univariate and multivariate analyses in PDS group\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 230px;\"\u003e\n \u003cp\u003eUnivariate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 230px;\"\u003e\n \u003cp\u003eMultivariate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 183px;\"\u003e\n \u003cp\u003eOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003eAge(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e1.042（0.964, 1.126）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026hellip;\u0026hellip;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026hellip;\u0026hellip;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003eCA125(U/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e1.000(0.999,1.000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.456\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026hellip;\u0026hellip;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026hellip;\u0026hellip;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003eHE4(pmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e1.000(0.999,1.000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.729\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026hellip;\u0026hellip;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026hellip;\u0026hellip;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003eDiaphragmatic peritoneum(Y/N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e6.750(0.750,60.760)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026hellip;\u0026hellip;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026hellip;\u0026hellip;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003eLiver lesions(Y/N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e1.780(0.843,3.754)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026hellip;\u0026hellip;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026hellip;\u0026hellip;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003eLesions in the hepatogastric space(Y/N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e3.464(1.430,8.393)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026hellip;\u0026hellip;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026hellip;\u0026hellip;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003eOmental lesions extend to the hepatic flexure or splenic flexure (Y/N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e27.000(2.886,252.624)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 183px;\"\u003e\n \u003cp\u003e20.891（1.077,405.288）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003eSmall bowel mesentery involvement(Y/N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e33.000(3.462,314.533)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 183px;\"\u003e\n \u003cp\u003e21.843（1.175,406.170）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003ePeritoneal disease(Y/N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e41.400(4.23,405.216)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 183px;\"\u003e\n \u003cp\u003e13.146（0.722,239.449）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003eBowel infiltration (Y/N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e0.867(0.204, 3.676)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.833\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026hellip;\u0026hellip;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026hellip;\u0026hellip;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003eSuprarenal lymph node metastases Suprarenal(Y/N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e1.018(0.220,4.720)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.982\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026hellip;\u0026hellip;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026hellip;\u0026hellip;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003eConventional PCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e1.410(1.121,1.774)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026hellip;\u0026hellip;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026hellip;\u0026hellip;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003eSelected regions PCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e1.175(1.033,1.336)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026hellip;\u0026hellip;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026hellip;\u0026hellip;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ePDS, primary debulking surgery; OR, odd ratio; CI, confidence interval; CA125, cancer antigen-125; HE4, human epididymis secretory protein 4\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Peritoneal carcinomatosis, Diffusion-weighted imaging, Positron-Emission Tomography computed tomography, Epithelial ovarian cancer, Cytoreductive surgery","lastPublishedDoi":"10.21203/rs.3.rs-5014920/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5014920/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives: \u003c/strong\u003eTo compare the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) and 18F-fluorodeoxyglucose combined positron emission tomography combined with computed tomography(FDG-PET/CT) in detecting \u0026nbsp;peritoneal carcinomatoses in advanced epithelial ovarian cancer (EOC).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This prospective study enrolled patients with stage III-IV EOC consecutively from October 2020 to February 2023. Participants underwent both DW-MRI and FDG-PET/CT. Three radiologists independently evaluated the radiological images using peritoneal cancer index (PCI) scoring systems. Clinical data, preoperative imaging assessments, and cytoreductive surgical outcomes were recorded. Univariate and multivariate analyses were performed to determine the critical regions for surgery associated with incomplete resection. The diagnostic performance of each imaging modality was calculated for each site. The interobserver agreement was assessed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Forty-eight patients were enrolled in this study. \u0026nbsp;\u0026nbsp;No statistically significant differences were found between the imaging modalities (\u003cem\u003ep\u003c/em\u003e≥0.142) based on the PCI scoring evaluation system. Omental lesions extend to the hepatic flexure or splenic flexure (\u003cem\u003ep\u003c/em\u003e=0.045, OR=20.891), and small bowel mesentery involvement (\u003cem\u003ep\u003c/em\u003e=0.039, OR=21.814) were identified as surgically critical regions associated with incomplete resection. DW-MRI demonstrated significantly higher accuracy than FDG-PET/CT (\u003cem\u003ep\u003c/em\u003e=0.049) in diagnosis at omental lesions extend to the hepatic flexure or splenic flexure and diaphragmatic peritoneum, with sensitivity and specificity of 0.773 and 0.792 for DW-MRI, and 0.619 and 0.696 for FDG-PET/CT, respectively. DW-MRI also showed higher interobservers agreement (k=0.654-0.782) compared to moderate agreement (k=0.515-0.745) in FDG-PET/CT.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eDW-MRI and FDG-PET/CT were comparable in assessing the entire abdominopelvic tumor burden based on PCI scoring system. DW-MRI has an advantage in detecting omental lesions extending to the hepatic flexure or splenic flexure, which is predictive of incomplete resection.\u003c/p\u003e","manuscriptTitle":"Comparison of Diffusion-Weighted Magnetic Resonance Imaging and 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography for Detection of Peritoneal Carcinomatoses in Advanced Epithelial Ovarian Cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-21 09:56:48","doi":"10.21203/rs.3.rs-5014920/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"395fcef4-8c2e-476a-9e55-25df2a44783e","owner":[],"postedDate":"October 21st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-21T10:04:50+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-21 09:56:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5014920","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5014920","identity":"rs-5014920","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}