Table 1.

Summary of studies evaluating different radiological imaging modalities for detection and staging of CPM.

Author, year, country	n	Study design	Imaging modality (n)	Study objective(s)	Sensitivity	Specificity	Other results/comments
Dromain et al., 2008, France [30]	30	PCS	PET/CT (30) vs. CT (30)	To assess and compare the performance of CT and PET/CT in the evaluation of PC	PET/CT 57% CT 82%	The interclass correlation was 0.53 (moderate) between CT and surgery and 0.12 (low) between PET/CT and surgery. Extent of the PC:CT 70% underestimation; PET/CT 80% underestimation
Koh et al., 2009, Australia [19]	19	PCS	CT	To evaluate the utility of preoperative CT in estimating PCI during the patient selection process	CT demonstrated 11% sensitivity for detection of nodules <0.5 mm. 94% sensitivity in lesions > 5 cm		Miliary/plaque-like peritoneal metastases, as confirmed at time of subsequent surgery were not reliably detect by CT
Franiel et al., 2009, Germany [34]	44	RCS	CT	To investigate whether 1 mm thin slices and MPRs of multidetector CT datasets interpreted in addition to isotropic 5 mm thick slices in one session improve the detection of PC	5 mm 64-91% 1 mm 64-96% MPR 82-100%	5 mm 91-100% 1 mm 91-100% MPR 86-100%	Significant increase in sensitivity (p = 0.025) between MPR and 1 mm slices for the least experienced radiologist
Marin et al., 2010, Italy [23]	18	PCS	CT	To prospectively investigate the diagnostic accuracy of a 64-section MDCT for the detection of PM (use of surgery and histopathological findings as the reference standard)	75% (CI 68-84)	92% (CI 85-96)	Sensitivity lesions > 0.5 cm in diameter: 89% (CI 75-97) Sensitivity lesions < 0.5 cm in diameter: 43% (CI 28-56)
Satoh et al., 2010, Japan [26]	237	RCS	PET/CT (107) vs MRI (130) vs MDCT (130)	To compare the diagnostic performances of PET/CT, MRI with and without DWI, and contrast-enhanced MDCT in the detection of peritoneal dissemination	MRI 56% MDCT 76% MRI DWI 84% PET/CT 89%		The positive predictive value of PET/CT (93%) was significantly higher than that of the other three modalities (contrast-enhanced MDCT, 73%; MRI without DWI, 70%; MRI with DWI, 72%)
Esquivel et al., 2010, multicentre [32]	52	PCS	CT	To compare CT defined PCI with surgically defined PCI	Inaccuracies of CT-based assessment of lesion sizes were observed in the RUQ (p = 0.004), LLQ (p < 0.0005), RLQ (p = 0.003), distal jejunum (p = 0.004), and distal ileum (p < 0.0005) Overall, CT underestimated PCI in 33% of cases compared with surgical assessment
Duhr et al., 2011, Germany [31]	37	PCS	CT	To compare sensitivity and specificity of CT to surgically defined PCI	50%	62%	Better correlation demonstrated in upper and middle abdominal regions
Berthelot, 2011, France [17]	28	RCS	PET/CT	To assess the performance of FDG-PET/CT examinations for the diagnosis and evaluation of the extent of PC	82%	100%
Choi et al., 2012, Korea [28]	245	RCS	PET/CT (245) vs. CT (245)	Compare CRC surveillance postsurgery with PET/CT vs. serial CT. Diagnosis confirmed at 6/12 follow-up	PET/CT 100% CT 85.1%	PET/CT 97.3% CT 97%	Overall reported diagnostic accuracy: PET/CT: 97.3% CT 95.8%
Bamba et al., 2012, Japan [20]	23	RCS	PET/CT vs. CT	To compare accuracy of PET/CT and conventional CT in detection of CPM	Overall detection accuracy: PET/CT 82.6% CT 30%
Pasqual, 2014, Italy [24]	58	RCS	PET/CT (47) vs. CT (58)	To evaluate the accuracy of CT and PET/CT to predict the presence of PM, to quantify the extent by comparing the imaging PCI with intraoperative PCI, and to assess the accuracy of CT and PET-CT of predicting complete CRS	PET/CT 82% CT 91%	PET/CT 67% CT 33%	Correlation between pre-op and intra-op PCI in both CT and PET/CT (p < 0.05), but both underestimated the intraoperative PCI and failed to adequately assess all the cases with a PCI value higher than 20 (p < 0.05)
Audollent et al., 2015 France [16]	37	RCS	PET/CT	To assess the rate of false-positive findings on FDG-PET/CT in patients with CPM	False-positive findings in 11% of patients—principle causes highlighted as previous surgery resulting in granuloma formation, or previous surgery with foreign body implantation (e.g., synthetic/biological mesh)
Li et al., 2015, China [21]	1441	Meta-analysis	PET (378) PET/CT (1063)	Pooled analysis to evaluate diagnostic accuracy of FDG PET compared with PET/CT in detecting peritoneal carcinomatosis	PET/CT 84% PET 60%	PET/CT 94% PET 98%
Flicek et al., 2016, USA [33]	42	RCS	CT	To compare sensitivity and specificity of CT to surgically defined PCI	76%	69%	PPV 85% NPV 56%
Brendle et al., 2016, Germany [27]	74	RCS	MRI ¥ MRI DWI ¥ MRI/PET ¥ MRI/DWI/PET ¥ PET/CT ¥	To investigate the diagnostic performance of different combinations of anatomical and functional imaging techniques in PET/MRI and PET/CT for the evaluation of CPM	Diagnostic accuracy MRI 30% MRI DWI 37% MRI/PET 41% MRI/DWI/PET 55% PET/CT 58%
Liberale et al., 2017, Belgium [22]	26	RCS	PET/CT	To evaluate the performance of 18fluorodeoxyglucose positron-emission tomography (FDG-PET)/computed tomography (CT) in detection of PC from CRC and correlated the most metabolically active quadrant with the most affected peritoneal area determined during surgery	85%	88%	Correlation of 77.3% of the most scored quadrant in surgery and PET/CT
Kim et al., 2017, Korea [18]	671	Meta-analysis	PET/CT	To evaluate the diagnostic accuracy of FDG PET/CT for detecting peritoneal carcinomatosis	77-93% (95% CI)	89-94% (95% CI)	Across 14 studies (671 patients), the overall sensitivity of FDG PET/CT was 0.87 [95% CI (0.77-0.93)] and a pooled specificity of 0.92 [95% CI; (0.89-0.94)]
Dohan et al., 2017, France [29]	28	RCS	CT (28) CT+MRI (28)	The aim was to determine the incremental value of MRI compared with CT in the preoperative estimation of the peritoneal carcinomatosis index (PCI)	MRI 44% CT 63% CT+MRI 81%		CT+MRI is more accurate at predicting surgical PCI compared with one or other in isolation
Laghi et al., 2017, Italy [25]	934	Meta-analysis	CT MRI PET/CT	Pooled analysis of data to define sensitivity and specificity of CT, MRI, and PET/CT in detection of peritoneal carcinomatosis	CT 83% MRI 86% PET/CT 82%	CT 86% MRI 88% PET/CT 93%

n: number of participants; PCS: prospective cohort study; RCS: retrospective cohort study; MPRS: multiplanar reconstructions; MDCT: multidetector computed tomography; DWI: diffusion weighted imaging; ¥: individual breakdown of scans not disclosed.