{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T20:13:54Z","timestamp":1789416834439,"version":"build-2803163510"},"reference-count":40,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Cytoreduction status is a critical prognostic factor in ovarian cancer, yet preoperative selection of patients suitable for primary debulking surgery and accurate prediction of surgical outcome remain challenging. This study aimed to evaluate the prognostic ability of MRI-based Fagotti score and Peritoneal Cancer Index (PCI) for predicting resectability of peritoneal disease in ovarian cancer patients. Methods: This was a prospective single-center observational study. Patients with suspected primary ovarian cancer who underwent preoperative MRI of the abdomen and pelvis with a dedicated protocol were considered. MRI-based Fagotti score and PCI were determined by two readers independently, using a combination of T2W, Diffusion-Weighted Imaging (DWI), and contrast-enhanced T1W sequences. In cases of discordance, a third radiologist reviewed the scans and consensus was reached. ROC analysis and logistic regression were used to evaluate prognostic performance. The reference standard to predict resectability was optimal cytoreduction defined as residual disease \u22641 cm. Results: Forty-six women with epithelial ovarian cancer (mean age 56.3 \u00b1 2.6 years) who underwent preoperative MRI, followed by laparoscopy and\/or laparotomy, were included in the study. Both MRI-based Fagotti score and PCI showed high predictive value for predicting resectability (AUC 0.92 and 0.94, respectively). Optimal cut-offs were \u22646 for Fagotti score and \u226420 for PCI. Patients with scores below these thresholds had &gt;60-fold (Fagotti) and &gt;100-fold (PCI) increased odds for successful primary cytoreduction (p &lt; 0.001). Conclusions: MRI-based Fagotti score and PCI may serve as powerful noninvasive predictors of surgical outcome in ovarian cancer. MRI may reliably guide treatment decisions, reducing unnecessary laparotomies and optimizing patient selection.<\/jats:p>","DOI":"10.3390\/cancers18010165","type":"journal-article","created":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T17:51:21Z","timestamp":1767376281000},"page":"165","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Prediction of Resectability of Peritoneal Disease in Ovarian Cancer Patients Using the Peritoneal Cancer Index (PCI) and Fagotti Score on MRI"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2678-0845","authenticated-orcid":false,"given":"Marianna","family":"Konidari","sequence":"first","affiliation":[{"name":"1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Gourtsoyianni","sequence":"additional","affiliation":[{"name":"1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Thomakos","sequence":"additional","affiliation":[{"name":"1st Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgia","family":"Lymperopoulou","sequence":"additional","affiliation":[{"name":"1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3242-9066","authenticated-orcid":false,"given":"Chara","family":"Tzavara","sequence":"additional","affiliation":[{"name":"Biostatistics Department, National and Kapodistrian University of Athens, 15784 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasilios","family":"Pergialiotis","sequence":"additional","affiliation":[{"name":"1st Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandros","family":"Rodolakis","sequence":"additional","affiliation":[{"name":"1st Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6009-1088","authenticated-orcid":false,"given":"Lia Angela","family":"Moulopoulos","sequence":"additional","affiliation":[{"name":"1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charis","family":"Bourgioti","sequence":"additional","affiliation":[{"name":"1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1200\/JCO.2002.20.5.1248","article-title":"Survival Effect of Maximal Cytoreductive Surgery for Advanced Ovarian Carcinoma During the Platinum Era: A Meta-Analysis","volume":"20","author":"Bristow","year":"2002","journal-title":"J. Clin. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/S0140-6736(14)62223-6","article-title":"Primary Chemotherapy versus Primary Surgery for Newly Diagnosed Advanced Ovarian Cancer (CHORUS): An Open-Label, Randomised, Controlled, Non-Inferiority Trial","volume":"386","author":"Kehoe","year":"2015","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1097\/IGC.0000000000001041","article-title":"European Society of Gynaecological Oncology (ESGO) Guidelines for Ovarian Cancer Surgery","volume":"27","author":"Querleu","year":"2017","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1680","DOI":"10.1016\/S1470-2045(18)30566-7","article-title":"Neoadjuvant Chemotherapy versus Debulking Surgery in Advanced Tubo-Ovarian Cancers: Pooled Analysis of Individual Patient Data from the EORTC 55971 and CHORUS Trials","volume":"19","author":"Vergote","year":"2018","journal-title":"Lancet Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.ejca.2020.02.020","article-title":"Comparison of Survival between Primary Debulking Surgery and Neoadjuvant Chemotherapy for Stage III\/IV Ovarian, Tubal and Peritoneal Cancers in Phase III Randomised Trial","volume":"130","author":"Onda","year":"2020","journal-title":"Eur. J. Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1136\/ijgc-2020-001640","article-title":"Randomized Trial of Primary Debulking Surgery versus Neoadjuvant Chemotherapy for Advanced Epithelial Ovarian Cancer (SCORPION-NCT01461850)","volume":"30","author":"Fagotti","year":"2020","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.ygyno.2012.09.013","article-title":"Neoadjuvant Chemotherapy in Advanced Ovarian Cancer: On What Do We Agree and Disagree?","volume":"128","author":"Vergote","year":"2013","journal-title":"Gynecol. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1002\/cncr.24149","article-title":"Role of Surgical Outcome as Prognostic Factor in Advanced Epithelial Ovarian Cancer: A Combined Exploratory Analysis of 3 Prospectively Randomized Phase 3 Multicenter Trials","volume":"115","author":"Reuss","year":"2009","journal-title":"Cancer"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1056\/NEJMoa0908806","article-title":"Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Ovarian Cancer","volume":"363","author":"Vergote","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.ygyno.2013.05.040","article-title":"Survival Impact of Complete Cytoreduction to No Gross Residual Disease for Advanced-Stage Ovarian Cancer: A Meta-Analysis","volume":"130","author":"Chang","year":"2013","journal-title":"Gynecol. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Tangjitgamol, S., Manusirivithaya, S., Laopaiboon, M., Lumbiganon, P., and Bryant, A. (2016). Interval Debulking Surgery for Advanced Epithelial Ovarian Cancer. Cochrane Database Syst. Rev., 1.","DOI":"10.1002\/14651858.CD006014.pub7"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1245\/ASO.2006.08.021","article-title":"A Laparoscopy-Based Score To Predict Surgical Outcome in Patients With Advanced Ovarian Carcinoma: A Pilot Study","volume":"13","author":"Fagotti","year":"2006","journal-title":"Ann. Surg. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Jacquet, P., and Sugarbaker, P.H. (1996). Clinical Research Methodologies in Diagnosis and Staging of Patients with Peritoneal Carcinomatosis. Peritoneal Carcinomatosis: Principles of Management. Cancer Treatment and Research, Springer.","DOI":"10.1007\/978-1-4613-1247-5"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"178.e1","DOI":"10.1016\/j.ajog.2009.10.856","article-title":"Comparison of Peritoneal Carcinomatosis Scoring Methods in Predicting Resectability and Prognosis in Advanced Ovarian Cancer","volume":"202","author":"Ballester","year":"2010","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.annonc.2023.11.015","article-title":"ESGO-ESMO-ESP Consensus Conference Recommendations on Ovarian Cancer: Pathology and Molecular Biology and Early, Advanced and Recurrent Disease","volume":"35","author":"Ledermann","year":"2024","journal-title":"Ann. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2712","DOI":"10.1007\/s00330-024-11124-5","article-title":"Imaging of Peritoneal Metastases of Ovarian and Colorectal Cancer: Joint Recommendations of ESGAR, ESUR, PSOGI, and EANM","volume":"35","author":"Vandecaveye","year":"2025","journal-title":"Eur. Radiol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Pinto, P., Burgetova, A., Cibula, D., Haldorsen, I.S., Indrielle-Kelly, T., and Fischerova, D. (2023). Prediction of Surgical Outcome in Advanced Ovarian Cancer by Imaging and Laparoscopy: A Narrative Review. Cancers, 15.","DOI":"10.3390\/cancers15061904"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1245\/s10434-020-08649-6","article-title":"The Peritoneal Cancer Index Is a Strong Predictor of Incomplete Cytoreductive Surgery in Ovarian Cancer","volume":"28","author":"Lomnytska","year":"2021","journal-title":"Ann. Surg. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2729","DOI":"10.1245\/s10434-014-4329-7","article-title":"Prognostic and Predictive Value of the Peritoneal Cancer Index in Primary Advanced Epithelial Ovarian Cancer Patients After Complete Cytoreductive Surgery: Study of Tumor Bank Ovarian Cancer","volume":"22","author":"Gasimli","year":"2015","journal-title":"Ann. Surg. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1097\/IGC.0000000000000327","article-title":"Prognostic Significance of Sugarbaker\u2019s Peritoneal Cancer Index for the Operability of Ovarian Carcinoma","volume":"25","author":"Lampe","year":"2015","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1097\/IGC.0b013e3182a616a7","article-title":"Accuracy and Reproducibility of the Peritoneal Cancer Index in Advanced Ovarian Cancer during Laparoscopy and Laparotomy","volume":"23","author":"Gouy","year":"2013","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.ejrad.2019.03.007","article-title":"MRI with Diffusion-Weighted Imaging to Predict Feasibility of Complete Cytoreduction with the Peritoneal Cancer Index (PCI) in Advanced Stage Ovarian Cancer Patients","volume":"114","author":"Engbersen","year":"2019","journal-title":"Eur. J. Radiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.ygyno.2024.10.003","article-title":"Prediction of Non-Resectability in Tubo-Ovarian Cancer Patients Using Peritoneal Cancer Index\u2014A Prospective Multicentric Study Using Imaging (ISAAC Study)","volume":"191","author":"Pinto","year":"2024","journal-title":"Gynecol. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.ejca.2017.06.010","article-title":"Diagnostic Value of Whole Body Diffusion-Weighted MRI Compared to Computed Tomography for Pre-Operative Assessment of Patients Suspected for Ovarian Cancer","volume":"83","author":"Michielsen","year":"2017","journal-title":"Eur. J. Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"108786","DOI":"10.1016\/j.ejrad.2019.108786","article-title":"Pre-Operative Evaluation of Epithelial Ovarian Cancer Patients: Role of Whole Body Diffusion Weighted Imaging MR and CT Scans in the Selection of Patients Suitable for Primary Debulking Surgery. A Single-Centre Study","volume":"123","author":"Rizzo","year":"2020","journal-title":"Eur. J. Radiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1097\/IGC.0b013e31823de6ae","article-title":"Prognostic Value of Residual Tumor Size in Patients With Epithelial Ovarian Cancer FIGO Stages IIA-IV","volume":"22","author":"Polterauer","year":"2012","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"983","DOI":"10.7150\/jca.32317","article-title":"Role of Laparotomy-Based Parameters in Assessment of Optimal Primary Debulking Surgery and Long-Term Outcomes in Patients with Stage IIIC Epithelial Ovarian Cancer","volume":"11","author":"Zhou","year":"2020","journal-title":"J. Cancer"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e65","DOI":"10.3802\/jgo.2018.29.e65","article-title":"A Triage Strategy in Advanced Ovarian Cancer Management Based on Multiple Predictive Models for R0 Resection: A Prospective Cohort Study","volume":"29","author":"Feng","year":"2018","journal-title":"J. Gynecol. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s12957-018-1339-0","article-title":"Prediction of Suboptimal Cytoreductive Surgery in Patients with Advanced Ovarian Cancer Based on Preoperative and Intraoperative Determination of the Peritoneal Carcinomatosis Index","volume":"16","author":"Llueca","year":"2018","journal-title":"World J. Surg. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.ygyno.2008.04.042","article-title":"External Validation of a Laparoscopic-Based Score to Evaluate Resectability of Advanced Ovarian Cancers: Clues for a Simplified Score","volume":"110","author":"Brun","year":"2008","journal-title":"Gynecol. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1016\/j.ejso.2013.03.022","article-title":"Diagnostic Accuracy of Hand-Assisted Laparoscopy in Predicting Resectability of Peritoneal Carcinomatosis from Gynecological Malignancies","volume":"39","author":"Varnoux","year":"2013","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"550","DOI":"10.4103\/ijc.IJC_306_17","article-title":"Role of Laparoscopy in Predicting Surgical Outcomes in Patients Undergoing Interval Cytoreduction Surgery for Advanced Ovarian Carcinoma: A Prospective Validation Study","volume":"54","author":"Tomar","year":"2017","journal-title":"Indian J. Cancer"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1016\/j.ygyno.2018.10.017","article-title":"Concordance of a Laparoscopic Scoring Algorithm with Primary Surgery Findings in Advanced Stage Ovarian Cancer","volume":"151","author":"Hansen","year":"2018","journal-title":"Gynecol. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"8111","DOI":"10.1038\/s41598-021-86928-2","article-title":"Validation of Three Predictive Models for Suboptimal Cytoreductive Surgery in Advanced Ovarian Cancer","volume":"11","author":"Llueca","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"462.e1","DOI":"10.1016\/j.ajog.2013.07.016","article-title":"A Multicentric Trial (Olympia\u2013MITO 13) on the Accuracy of Laparoscopy to Assess Peritoneal Spread in Ovarian Cancer","volume":"209","author":"Fagotti","year":"2013","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"S198","DOI":"10.1016\/j.jacr.2018.03.015","article-title":"ACR Appropriateness Criteria \u00ae Staging and Follow-Up of Ovarian Cancer","volume":"15","author":"Kang","year":"2018","journal-title":"J. Am. Coll. Radiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.1016\/j.acra.2019.04.005","article-title":"The Accuracy of Multi-Detector Computed Tomography and Laparoscopy in the Prediction of Peritoneal Carcinomatosis Index Score in Primary Ovarian Cancer","volume":"26","author":"Ahmed","year":"2019","journal-title":"Acad. Radiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1007\/s11547-020-01170-6","article-title":"Radiological Assessment of Peritoneal Cancer Index on Preoperative CT in Ovarian Cancer Is Related to Surgical Outcome and Survival","volume":"125","author":"Avesani","year":"2020","journal-title":"Radiol. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/s13048-018-0415-y","article-title":"A Predictive Score for Optimal Cytoreduction at Interval Debulking Surgery in Epithelial Ovarian Cancer: A Two- Centers Experience","volume":"11","author":"Ghisoni","year":"2018","journal-title":"J. Ovarian Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1245\/s10434-014-4041-7","article-title":"Comparison of MRI and CT for Predicting the Peritoneal Cancer Index (PCI) Preoperatively in Patients Being Considered for Cytoreductive Surgical Procedures","volume":"22","author":"Low","year":"2015","journal-title":"Ann. Surg. Oncol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/1\/165\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T05:26:54Z","timestamp":1767677214000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/1\/165"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,2]]},"references-count":40,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["cancers18010165"],"URL":"https:\/\/doi.org\/10.3390\/cancers18010165","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,2]]}}}