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Is MDCT an accurate tool to differentiate between benign and malignant etiology in diffuse peritoneal disease?

  • Peritoneum
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Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

There is often considerable overlap of imaging findings in benign and malignant peritoneal diseases. We evaluated patients with diffuse peritoneal disease, to assess the diagnostic value of MDCT in predicting benign or malignant etiology in patients with unknown etiology, by analyzing the various patterns of involvement, particularly tuberculosis (TB) vs malignancy.

Methods

One hundred and thirty-six patients with diffuse peritoneal disease who had abdominal CT and subsequently underwent omental biopsies were included in the study. Peritoneal, mesenteric and omental involvement by disease was evaluated on CT using specific parameters. The presence of lymphadenopathy, ascites, scalloping of organs, involvement of liver and spleen, were also compared between benign and malignant conditions using histopathology as the gold standard.

Results

In 136 patients, 72 benign and 64 malignant pathologies were classified as per histopathology. Higher age (p < 0.001), increasing omental thickness (mean 25.2 mm, p = 0.004), omental caking (p < 0.001), > 10 mm mesenteric/peritoneal nodules (p < 0.03), visceral scalloping (p = 0.001), free ascites (p = 0.003), serosal involvement (p = 0.004) and bilateral pleural effusion (p = 0.02) were associated with malignant etiology. Mesenteric thickening/stranding (p = 0.02), mesenteric adenopathy (p < 0.001), necrotic nodes (p = 0.02), splenomegaly (p =  < 0.001) and higher attenuation (> 20HU) of ascitic fluid (p < 0.001) were associated with benign etiology. The presence of mesenteric thickening or stranding (p = 0.01), splenomegaly (p = 0.02), higher ascitic fluid attenuation > 20HU (p =  < 0.01), mesenteric adenopathy (p < 0.01), necrotic nodes (p = 0.03) favored tuberculosis. CT had diagnostic accuracy (79.3, 86.7%), sensitivity (79.2, 74.6%) and specificity (79.4, 97%) for observers 1 and 2, respectively (Kappa 0.713).

Conclusion

Contrast-enhanced MDCT has good sensitivity, specificity and accuracy in differentiating benign and malignant etiologies of diffuse peritoneal disease. Multiple common parameters can be used to differentiate between tuberculous peritonitis and peritoneal carcinomatosis.

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Funding

We gratefully acknowledge funding support from institutional Fluid research grant (IRB Min. No.11092) towards this study. There are no other financial or nonfinancial interests that are directly or indirectly related to our study.

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Authors and Affiliations

  1. Department of Radiodiagnosis, Christian Medical College, Vellore, 632004, Tamil Nadu, India

    Shyjumon George, Kirthi Sathyakumar & Anu Eapen

  2. Department of Pathology, Christian Medical College, Vellore, 632004, Tamil Nadu, India

    Mandeep Singh Bindra

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  1. Shyjumon George
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  2. Kirthi Sathyakumar
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  3. Mandeep Singh Bindra
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  4. Anu Eapen
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by SG and KS. The first draft of the manuscript was written by SG and all authors commented on previous versions of the manuscript. Reviewing and editing was done by KS, MSB and AE. All authors read and approved the final manuscript.

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Correspondence to Anu Eapen.

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We have no competing interests to declare that are relevant to the content of this article.

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Ethics approval and informed consent were waived by the Institutional Ethics Committee in view of the observational and retrospective nature of the study.

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George, S., Sathyakumar, K., Bindra, M.S. et al. Is MDCT an accurate tool to differentiate between benign and malignant etiology in diffuse peritoneal disease?. Abdom Radiol 47, 3921–3929 (2022). https://doi.org/10.1007/s00261-022-03641-y

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