腹膜假黏液瘤的多模态磁共振表现与临床价值

Multimodal MRI features and clinical value in pseudomyxoma peritonei

摘要:

腹膜假黏液瘤（PMP）是一种以腹腔内黏液积聚和再分布为特征的恶性肿瘤。术前准确判断病变分布、腹膜癌指数及完全减瘤可行性，对治疗决策和预后评估至关重要。尽管增强CT仍为当前首选影像学检查，但其在微小病灶、复杂解剖区评估方面存在局限。磁共振成像（MRI）凭借其多参数成像和卓越的软组织分辨力，可通过T1加权成像、T2加权成像、弥散加权成像、动态增强扫描与5～10 min延迟增强扫描等序列，可更好地显示病变特征，并在原发灶追溯、病理分级预测、腹膜癌指数评估、可切除性判断及术后复发监测中展现出重要价值。该综述旨在系统阐述PMP的多模态MRI的技术要点、影像学表现，探讨其在诊断、术前分期、治疗决策及随访监测中的临床应用价值，同时指出，当前MRI在PMP中的应用仍面临扫描流程尚未标准化、高质量证据有限等问题。未来，随着结构化阅片、多中心前瞻性研究、影像组学和人工智能的发展，MRI有望进一步由定性描述走向定量评估与决策支持，为PMP精准诊疗提供更坚实的影像学基础。

Abstract:

Pseudomyxoma peritonei (PMP) is a neoplastic disease characterized by intraperitoneal mucin accumulation and redistribution. Accurate preoperative assessment of disease distribution, the peritoneal cancer index (PCI), and the feasibility of complete cytoreduction is crucial for treatment planning and prognostic evaluation. Although contrast-enhanced CT remains the current first-line imaging modality, it has limitations in detecting small-volume lesions and evaluating lesions in anatomically complex regions. Owing to its multiparametric imaging capability and excellent soft-tissue contrast, magnetic resonance imaging (MRI) can better characterize lesions through T1-weighted imaging, T2-weighted imaging, diffusion-weighted imaging, dynamic contrast-enhanced imaging, and 5 - 10 min delayed contrast-enhanced imaging. MRI has shown important value in identifying the primary tumor, predicting pathological grade, assessing PCI, evaluating resectability, and monitoring postoperative recurrence. This review systematically summarizes the technical essentials and imaging features of multimodal MRI in PMP and discusses its clinical value in diagnosis, preoperative staging, treatment decision-making, and follow-up monitoring. It also highlights that the current application of MRI in PMP still faces challenges, including the lack of standardized scanning protocols and limited high-quality evidence. In the future, with the development of structured reporting, multicenter prospective studies, radiomics, and artificial intelligence, MRI is expected to further evolve from qualitative description to quantitative assessment and decision support, providing a more solid imaging basis for precision diagnosis and treatment of PMP.