Appendix cancer CT scan

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]

Overview

Abdominal CT scan is pretty helpful in the diagnosis and management of appendix cancer. Findings on CT scan suggestive of appendix cancer include [finding 1], [finding 2], and [finding 3]. CT scan is one of the best imaging modalities to assess disease burden, metastatic lesions as well as disease stage.

CT scan

• Plenty of experts believe that enhanced CT is the imaging modality of choice for appendix cancer.
• On CT, appendix cancer is characterized by the following findings:
  • Soft tissue thickening
  • Wall irregularity
  • Presence of pseudomyxoma peritonei
  • Calcification
  • Internal septations
  • Periappendiceal fat stranding and intraperitoneal free fluid which is a nonspecific finding
  • Cystic lesion

Appendiceal adenocarcinoma complicated by retroperitoneal abscess. Case courtesy of Dr Francis Fortin, Radiopaedia.org, rID: 58007

• • Liver metastasis
• Peritoneal carcinomatosis index (PCI): a widely accepted metric for assessment of disease border in appendix cancer
  • Estimated by contrast enhanced cross sectional imaging.
  • Both MRI and CT scan has been used and are globally accepted imaging modalities.
  • Small peritoneal seeding might be difficult to appreciate on CT.
  • Sometimes it is challenging to distinguish between tumor and mucin.
  • There are reports in favor of diffusion weighted MRI superiority compared to CT in evaluating extent of peritoneal involvement.

• • Table and figure below demonstrate abdominal regions as well as scoring system for PCI.

Peritoneal Carcinomatosis Index (PCI) Regions

PCI Scoring System

Lesion Size Score
LS0	No tumor seen
LS1	Tumor up to 0.5 cm
LS2	Tumor up to 5 cm cm
LS3	Tumor > 5 cm or confluence
Maximum Score = 3
Regions (0-3)
0	Central
1	Right Upper
2	Epigasterium
3	Left Upper
4	Left Flank
5	Left Lower
6	Pelvis
7	Right Upper
8	Right Flank
9	Upper Jejunum
10	Lower Jejunum
11	Upper Illeum
12	lower Illeum
Maximum Score = 36
Total Maximum Score = 39

• CT scan also helps in discovering distant metastatic lessons in the other organs like bone, lungs, and brain.