Intraperitoneal contrast material combined with CT for detection of peritoneal metastases of ovarian cancer.
OBJECTIVE
To determine the sensitivity and specificity of CT-peritoneography (CT-P) in detecting peritoneal carcinomatosis in primary or recurrent ovarian cancer.


METHODS
Twenty-five patients were submitted to a standard abdominal CT (CT) as well as a computed tomography after intraperitoneal infusion of contrast material (CT-P). Twenty patients had ovarian masses clinically suspected to be malignant. In five patients with ovarian cancer who underwent prior debulking surgery, recurrent disease was suspected.


RESULTS
In 21/25 patients an ovarian malignancy was histologically confirmed. During surgery peritoneal spread was found in 13 patients; only in 5 cases CT correctly suggested peritoneal metastases (sensitivity 38%). However, in 10/13 women CT-P indicated peritoneal spread, increasing the overall sensitivity from 38% to 77%. Sensitivity varied substantially according to the different abdominal areas, and was lowest in the left subphrenic space (25%). The sensitivity of CT-P was 71% and 72% in the right paracolic gutter and the pelvis, respectively. Sensitivity of CT-P was not found to be size-dependent, but was mainly related to the morphology of the lesions, with 100% sensitivity in nodular lesions, and only 21% sensitivity for flat peritoneal lesions. CT-P did not improve detection of omental metastases, and was not advantageous when ascites was present. Previous surgery reduced overall specificity from 80% to 57%.


CONCLUSIONS
CT-P greatly improved the sensitivity of CT in the preoperative detection of peritoneal spread of ovarian malignancy. However, the technique failed to detect flat peritoneal metastases, and had a low specificity in patients with a history of prior abdominal surgery.
Gryspeerdt
S
S
Department of Radiology, University Hospital of Leuven, Belgium.
Clabout
L
L
Van Hoe
L
L
Berteloot
P
P
Vergote
I B
IB
D003287:Contrast Media / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007274:Injections, Intraperitoneal; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000601:surgery; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary* / Q000601:surgery; D011300:Preoperative Care; D011856:Radiographic Image Enhancement / Q000379:methods*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media