Fig. 3

A 51 year old male patient with cancer at the rectosigmoid junction and clinical suspicion of peritoneal metastases underwent a WB/DWI-MRI (a/b) in addition to a CT scan (c) to evaluate operability. WB/DWI-MRI showed extensive peritoneal cancer spread, partially shown by the white arrowheads in the zoomed-in image (b) of the coronal b1000 DWI (a), with an estimated PCI of 26. The tumour deposit at the splenic flexure of the colon (arrow in b) was also recognized on CT, shown by the white arrow on the coronal CT image (c), but the other lesions were not seen on CT. Disease load was clearly underestimated with an estimated PCI of 8. At explorative laparotomy extensive peritoneal disease was confirmed (PCI 33) and the patient received optimal palliative care