title: Screening for encapsulating peritoneal sclerosis in patients on peritoneal dialysis: role of CT scanning.
abstract: BACKGROUND
  We previously validated a scoring system for abdominal/pelvic CT scans in patients with symptomatic encapsulating peritoneal sclerosis (EPS). CT scans of patients with symptomatic EPS were significantly different from control peritoneal dialysis (PD) or haemodialysis patient scans; scans performed before EPS was clinically evident were near normal in 9 of 13 patients. We have now investigated CT scanning as a screening modality in a larger group of patients on long-term PD.
  
  
  METHODS
  Pre-diagnostic CT scans performed in 20 patients for routine screening or other indications at least 3 months before EPS developed, and later diagnostic scans when EPS was clinically evident, were scored by three radiologists. The control group included CT scans of 20 PD patients who had not developed EPS (median follow-up 2.25 years). Analysis was by non-parametric tests. CT scores ranged from 0 to 22; > 2.5 was considered abnormal.
  
  
  RESULTS
  Clinical EPS only developed after transplantation or transfer to HD. Diagnostic scans scored significantly higher than pre-diagnostic or control scans (median scores 9, 2 and 1; P < 0.001), confirming previous work. The pre-EPS diagnosis of 12 asymptomatic patients had a median CT score = 1.75, similar to the control group. Eight patients had had a limited episode of abdominal symptoms (seven required hospitalization), but did not have the clinical picture of EPS; their median CT score was 4.5 (P = 0.0016 cf control group). The time from pre-diagnostic scan to clinical EPS (median 0.82 years) and duration of PD at time of pre-diagnostic scan (median 7.1 years) did not differ significantly between the symptomatic and asymptomatic groups.
  
  
  CONCLUSIONS
  CT screening of asymptomatic PD patients is not indicated; EPS may occur within a year or less of a normal CT scan. Abdominal symptoms in long-term PD patients can be associated with CT scan abnormalities; these patients are at increased risk of EPS after stopping PD.
authors.affiliation: West London Renal and Transplant Centre, Imperial College NHS Trust, London, UK. catriona.goodlad08@imperial.ac.uk
authors.forename: Catriona
authors.initials: C
authors.lastname: Goodlad
authors.forename: Ruth
authors.initials: R
authors.lastname: Tarzi
authors.forename: Wladyslaw
authors.initials: W
authors.lastname: Gedroyc
authors.forename: Adrian
authors.initials: A
authors.lastname: Lim
authors.forename: Steven
authors.initials: S
authors.lastname: Moser
authors.forename: Edwina A
authors.initials: EA
authors.lastname: Brown
mesh_terms: D006801:Humans; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010532:Peritoneal Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D010537:Peritoneum / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012598:Sclerosis / Q000000981:diagnostic imaging* / Q000209:etiology; D014057:Tomography, X-Ray Computed