• M P Engbersen, I Van' T Sant, C Lok, D M J Lambregts, G S Sonke, Beets-Tan R G H RGH Department of Radiology, The Netherlands Cancer Institute, PO Box 900203, 1006 BE, Amsterdam, the Netherlands; GROW School for Oncology and Developmen, W J van Driel, and M J Lahaye.
• Department of Radiology, The Netherlands Cancer Institute, PO Box 900203, 1006 BE, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.
• Eur J Radiol. 2019 May 1; 114: 146-151.

ObjectivesTo determine the diagnostic performance of MRI with diffusion-weighted imaging (DW-MRI) in assessing the peritoneal tumor load and predicting whether a complete cytoreduction can be achieved in patients with epithelial ovarian cancer (EOC).MethodsFor this observational prospective study, 25 patients with epithelial ovarian cancer scheduled for cytoreductive surgery were included. Patients underwent a 3 T DW-MRI scan prior to surgery. The MR protocol consisted of a T1 and T2 weighted, a contrast-enhanced T1 weighted, and a diffusion-weighted (b0, b1000) sequence. The Peritoneal Cancer Index (PCI) was determined on DW-MR images (MRI-PCI) by two readers, independently, and was compared to the PCI determined during surgery (S-PCI). The inter-observer agreement between the two radiologists was evaluated. In addition, receiver operating characteristics curves were calculated for predicting complete cytoreduction with the S-PCI and MRI-PCI.ResultsStaging with DW-MRI showed a correlation to surgical staging with an intraclass correlation coefficient (ICC) 0.86 and 0.85 for reader 1 and 2, respectively. Inter-observer agreement was excellent with an ICC of 0.90 (95% CI: 0.64-0.96). The MRI-PCI scores of reader 1 (AUC = 0.96), reader 2 (AUC = 0.98), and the S-PCI (AUC = 0.92) showed similar predictive values for complete cytoreduction.ConclusionDW-MRI is accurate in predicting the S-PCI and can be helpful to predict whether a complete resection in ovarian cancer patients is feasible.Copyright © 2019. Published by Elsevier B.V.

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