What is the Optimal Preoperative Imaging Modality for Assessing Peritoneal Cancer Index? An Analysis From the United States HIPEC Collaborative

Rachel M. Lee, Mohammad Y. Zaidi, Adriana C. Gamboa, Shelby Speegle, Charles W. Kimbrough, Jordan M. Cloyd, Jennifer L. Leiting, Travis E. Grotz, Andrew J. Lee, Keith F. Fournier, Benjamin D. Powers, Sean P. Dineen, Joel Baumgartner, Jula Veerapong, Callisia N. Clarke, Jeffrey J. Sussman, Sameer Patel, Ryan J. Hendrix, Laura A. Lambert, Kara A. Vande WalleDaniel E. Abbott, Christopher J. LaRocca, Mustafa Raoof, Nadege Fackche, Fabian M. Johnston, Charles A. Staley, Shishir K. Maithel, Maria C. Russell

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


BACKGROUND: Radiographic prediction of peritoneal carcinomatosis index (PCI) can improve patient selection for cytoreductive surgery. We aimed to determine the correlation of computed tomography (CT)-predicted PCI (CT-PCI) and magnetic resonance imaging (MRI)-predicted PCI (MRI-PCI) with intraoperative-PCI, and if a preoperative-PCI cutoff is associated with incomplete cytoreduction.

PATIENTS AND METHODS: Patients from the US HIPEC Collaborative (2000-2017) with appendiceal, colorectal, or peritoneal mesothelioma (PM) histology who underwent cytoreductive surgery were included. Pearson correlation coefficients were used to determine correlation between preoperative and intraoperative-PCI values. Fisher r-to-z transformation was used to compare correlations.

RESULTS: A total of 488 patients were included. Of these, 34% had noninvasive appendiceal, 30% invasive appendiceal, 28% colorectal, and 8% PM histology. CT-PCI was correlated with intraoperative-PCI for patients with noninvasive and invasive appendiceal and colorectal histologies (r = 0.689, 0.554, and 0.571; all P < .001), but not PM (r = 0.188; P = .295). MRI-PCI was correlated with intraoperative-PCI for all histologies (non-invasive appendiceal: r = 0.591; P = .002; invasive appendiceal: r = 0.848; P < .001; colorectal: r = 0.729; P < .001; PM: r = 0.890; P = .007). Comparing CT and MRI, correlations were similar in noninvasive appendiceal and colorectal histologies; MRI was better for invasive appendiceal and PM (P = .005 and P = .021, respectively). Twenty-eight (6%) patients underwent an incomplete cytoreduction (cytoreduction score, 2-3). PCI greater than 15 was associated with cytoreduction score of 2 to 3 for both CT and MRI (CT-PCI: odds ratio, 3.0; P = .033; MRI-PCI: odds ratio, 7.6; P = .071).

CONCLUSIONS: In this multi-institutional cohort, CT and MRI-PCI correlate well with intraoperative-PCI. MRI appears to be superior for invasive appendiceal and peritoneal mesothelioma. External validation in a larger population is needed.

Original languageEnglish (US)
Pages (from-to)e1-e7
JournalClinical Colorectal Cancer
Issue number1
StatePublished - Mar 2020


  • Invasive appendiceal carcinoma
  • Noninvasive appendiceal carcinoma
  • Peritoneal mesothelioma
  • Radiographic PCI

PubMed: MeSH publication types

  • Journal Article
  • Comparative Study
  • Evaluation Study
  • Multicenter Study


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