The role of imaging in diagnosis and management of malignant peritoneal mesothelioma: a systematic review

Abdom Radiol (NY). 2022 May;47(5):1725-1740. doi: 10.1007/s00261-022-03464-x. Epub 2022 Mar 7.


Purpose: Imaging of the peritoneum and related pathology is a challenge. Among peritoneal diseases, malignant peritoneal mesothelioma (MPeM) is an uncommon tumor with poor prognosis. To date, there are no specific guidelines or imaging protocols dedicated for the peritoneum and MPeM. The objective of this study was to analyze the literature describing imaging modalities used for MPeM to determine their relative clinical efficacy and review commonly reported imaging features of MPeM to promote standardized reporting.

Methods: We performed a systematic review of original research articles discussing imaging modalities in MPeM from 1999 to 2020. Effectiveness measures and common findings were compared across imaging modalities.

Results: Among 582 studies analyzed, the most-used imaging modality was CT (54.3%). In the differentiation of MPeM from peritoneal carcinomatosis, one study found CT had a diagnostic sensitivity of 53%, specificity of 100%, and accuracy of 68%. Two studies found fluorodeoxyglucose positron emission tomography (FDG-PET) had sensitivity of 86-92%, specificity of 83-89%, and accuracy of 87-89%. Another study found magnetic resonance imaging (MRI) was the best predictor of the peritoneal carcinomatosis index. Characteristics shown to best differentiate MPeM from other diseases included ascites, peritoneal thickening, mesenteric thickening, pleural plaques, maximum tumor dimension, and number of masses.

Conclusion: Most published MPeM imaging studies utilized CT. PET/CT or MRI appear promising, and future studies should compare effectiveness of these modalities. MPeM imaging reports should highlight ascites, number of and maximum tumor dimension, peritoneal/mesenteric thickening, and associated pleural plaques, allowing for better aggregation of MPeM imaging data across studies.

Keywords: Computed tomography; Imaging; Magnetic resonance imaging; Malignant peritoneal mesothelioma; Peritoneal malignancy; Positron emission tomography.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Ascites
  • Humans
  • Mesothelioma* / diagnostic imaging
  • Mesothelioma* / therapy
  • Peritoneal Neoplasms* / diagnostic imaging
  • Peritoneal Neoplasms* / therapy
  • Positron Emission Tomography Computed Tomography
  • Tomography, X-Ray Computed / methods