title: Preoperative CT and MRI prediction of non-resectability in patients treated for pseudomyxoma peritonei from mucinous appendiceal neoplasms.
abstract: OBJECTIVE
  To evaluate computed tomography (CT) and magnetic resonance imaging (MRI) findings for sign of hepatoduodenal ligament and small bowel non-resectability in patients with pseudomyxoma peritonei (PMP) and to compare assessments made by the radiologist based on their experiences.
  
  
  METHODS
  Between January 2009 and June 2014, all consecutive patients with PMP selected for curative surgery were scheduled to undergo CT and MRI examinations within two days of their surgery. Several imaging findings of hepatoduodenal ligament and small bowel involvements were retrospectively evaluated by a senior and a junior radiologist and compared with surgical findings.
  
  
  RESULTS
  Of the 82 patients enrolled in the study, 11 had non-resectable lesions with hepatoduodenal ligament infiltration (n = 4) and/or extensive small bowel involvement (n = 9). All patients underwent CT and 73 underwent MRI scan. Infiltration of the adipose tissue of the hepatoduodenal ligament by mucinous tumor was associated with non-resectability. For the senior and junior radiologists, the sensitivity and specificity were 75% and 100%, and 50% and 100% on CT (kappa value (k) = 0.79); 67% and 100%, and 33% and 97% on MRI (k = 0.38), respectively. Diffuse involvement of the mesentery and/or the small bowel serosa was also associated with non-resectability. For the senior and junior radiologists, the sensitivity and specificity were 67% and 100%, and 56% and 99% on CT (k = 0.82); 88% and 100%, and 38% and 100% on MRI (k = 0.58), respectively.
  
  
  CONCLUSIONS
  CT and MRI can both contribute to the diagnosis of non-resectability in patients with PMP. The use of MRI to identify small bowel involvement, in particular, benefits from a more experienced radiologist.
authors: Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France; Department of Radiology, Centre Hospitalier Lyon Sud, HCL, 165 Chemin du Grand Revoyet, 69310 Pierre-Bénite, France. Electronic address: menassel_badis@yahoo.fr.
authors: B
authors: B
authors: Menassel
authors: Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France; Department of Medical Information, Evaluation and Research, 162 Avenue Lacassagne, 69424 Lyon, France. Electronic address: antoine.duclos@chu-lyon.fr.
authors: A
authors: A
authors: Duclos
authors: Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France; Department of Digestive Surgery, Centre Hospitalier Lyon Sud, HCL, 165 Chemin du Grand Revoyet, 69310 Pierre-Bénite, France; EMR 3738, 165, Chemin du Petit Revoyet, 69921 Oullins, France. Electronic address: guillaume.passot@chu-lyon.fr.
authors: G
authors: G
authors: Passot
authors: Department of Abdominal and Interventional Radiology, Hôpital Lariboisière, AP-HP, 2 Rue Ambroise Paré, 75010 Paris, France; Paris Diderot University, Sorbonne Paris- Cité, 5 Rue Thomas Mann, 75013 Paris, France. Electronic address: anthony.dohan@aphp.fr.
authors: A
authors: A
authors: Dohan
authors: Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France; Department of Medical Information, Evaluation and Research, 162 Avenue Lacassagne, 69424 Lyon, France. Electronic address: cecile.payet@chu-lyon.fr.
authors: C
authors: C
authors: Payet
authors: Department of Pathology, Centre Hospitalier Lyon Sud, HCL, 165 Chemin du Grand Revoyet, 69310 Pierre-Bénite, France. Electronic address: sylvie.isaac@chu-lyon.fr.
authors: S
authors: S
authors: Isaac
authors: Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France; Department of Radiology, Centre Hospitalier Lyon Sud, HCL, 165 Chemin du Grand Revoyet, 69310 Pierre-Bénite, France; EMR 3738, 165, Chemin du Petit Revoyet, 69921 Oullins, France. Electronic address: pierre-jean.valette@chu-lyon.fr.
authors: P J
authors: PJ
authors: Valette
authors: Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France; Department of Digestive Surgery, Centre Hospitalier Lyon Sud, HCL, 165 Chemin du Grand Revoyet, 69310 Pierre-Bénite, France; EMR 3738, 165, Chemin du Petit Revoyet, 69921 Oullins, France. Electronic address: olivier.glehen@chu-lyon.fr.
authors: O
authors: O
authors: Glehen
authors: Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France; Department of Radiology, Centre Hospitalier Lyon Sud, HCL, 165 Chemin du Grand Revoyet, 69310 Pierre-Bénite, France; EMR 3738, 165, Chemin du Petit Revoyet, 69921 Oullins, France. Electronic address: pascal.rousset@chu-lyon.fr.
authors: P
authors: P
authors: Rousset
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy; D001063:Appendiceal Neoplasms / Q000175:diagnosis* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000175:diagnosis / Q000628:therapy*; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D011553:Pseudomyxoma Peritonei / Q000175:diagnosis / Q000628:therapy*; D012372:ROC Curve; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Computed tomography; Magnetic resonance imaging; Peritoneal carcinomatosis; Preoperative assessment; Pseudomyxoma peritonei; Resectability