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Practice Guideline
. 2025 May;35(5):2712-2722.
doi: 10.1007/s00330-024-11124-5. Epub 2024 Nov 5.

Imaging of peritoneal metastases of ovarian and colorectal cancer: joint recommendations of ESGAR, ESUR, PSOGI, and EANM

Vincent Vandecaveye  1   2 , Pascal Rousset  3 , Stephanie Nougaret  4   5 , Artem Stepanyan  6 , Milagros Otero-Garcia  7 , Olivera Nikolić  8 , Maira Hameed  9   10 , Karolien Goffin  11   12 , Ignace H J de Hingh  13   14 , Max J Lahaye  15   16 ; European Society of Gastrointestinal and Abdominal Radiology (ESGAR); European Society of Urogenital Radiology (ESUR); Peritoneal Surface Oncology Group International (PSOGI); European Association of Nuclear Medicine (EANM)
Collaborators, Affiliations
Practice Guideline

Imaging of peritoneal metastases of ovarian and colorectal cancer: joint recommendations of ESGAR, ESUR, PSOGI, and EANM

Vincent Vandecaveye et al. Eur Radiol. 2025 May.

Abstract

Objectives: Diagnostic imaging of peritoneal metastases in ovarian and colorectal cancer remains pivotal in selecting the most appropriate treatment and balancing clinical benefit with treatment-related morbidity and mortality. To address the challenges related to diagnostic imaging and detecting and reporting peritoneal metastatic spread, a joint guideline was created by the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Society of Urogenital Radiology (ESUR), Peritoneal Surface Oncology Group International (PSOGI), and European Association of Nuclear Medicine (EANM).

Methods: A targeted literature search was performed and consensus recommendations were proposed using Delphi questionnaires and a five-point Likert scale.

Results: A total of three Delphi rounds were performed. Consensus was reached on the position of diagnostic imaging for assessment of operability, treatment response monitoring, and follow-up of peritoneal metastases, optimal imaging modality and their technical imaging requirements depending on the indication and how to optimise communication of imaging results by the report and multidisciplinary board discussion. The complete list of recommendations is provided.

Conclusion: These expert consensus statements aim to guide appropriate indications, acquisition, interpretation, and reporting of imaging for operability assessment, treatment response monitoring, and follow-up of peritoneal metastases in ovarian and colorectal cancer patients.

Key points: Question Staging peritoneal metastases (PM) helps to guide clinical decision-making for colorectal and ovarian cancer patients. How can we optimise the use of imaging techniques to assess PM? Findings Imaging plays a crucial role in the detection, operability assessment, treatment response monitoring, and follow-up of peritoneal metastases in colorectal and ovarian cancer patients. Clinical relevance These expert consensus statements aim to guide appropriate indication, acquisition, interpretation, and reporting of imaging for operability assessment, treatment response monitoring, and follow-up of peritoneal metastases in ovarian and colorectal cancer patients.

Keywords: CT; Colorectal cancer; MRI; Ovarian cancer; Peritoneal metastases.

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Conflict of interest statement

Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is M.J.L. Conflict of interest: V.V. is a member of the Scientific Editorial Board (section: Oncology) for European Radiology. The remaining authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Statistics and biometry: No complex statistical methods were necessary for this paper. Informed consent: Written informed consent was not required for these recommendations. Ethical approval: Institutional Review Board approval was not required for these recommendations. Study subjects or cohorts overlap: Not applicable. Methodology: A joint guideline was created by the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Society of Urogenital Radiology (ESUR), Peritoneal Surface Oncology Group International (PSOGI) and European Association of Nuclear Medicine (EANM)

Figures

Fig. 1
Fig. 1
Patient presenting with a new diagnosis of fallopian tube cancer. A, B FDG-PET/CT imaging reveals faint diffuse uptake over the small bowel mesentery, accompanied by non-specific minimal mesenteric infiltration and ascites seen on CT. C, D Additional WB-DWI/MRI shows diffuse linear and micronodular infiltration of the small bowel mesentery and serosa, along with the presence of ascites on coronal reformatted DWI and T2-weighted sequences. Laparoscopy confirmed extensive presence of diffuse miliary metastases, with an average lesion size of 3 mm
See this image and copyright information in PMC

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