title: Can radiological assessment of abdominal computerized scans diagnose encapsulating peritoneal sclerosis in long-term peritoneal dialysis patients?
abstract: OBJECTIVE
  Encapsulating peritoneal sclerosis (EPS) is a rare but potentially devastating complication of long-term peritoneal dialysis (PD). Changes to the peritoneal membrane occur with duration of PD therapy. To determine the potential effect of prospective computerized tomography (CT) scanning, we reviewed the scans of patients who had developed EPS compared with those without EPS.
  
  
  METHODS
  We retrospectively compared CT scans that had been prospectively performed in a screening program for PD patients after 4 years of PD and compared scans from 18 patients with confirmed EPS and 26 vintage matched controls without EPS. Anonymized scans were reported independently by two blinded experienced radiologists.
  
  
  RESULTS
  Peritoneal thickening, calcification, bowel tethering, thickening and dilatation were significantly more commonly reported in the EPS group. Total combined radiological scores, also including septation within peritoneal fluid, were significantly higher in the EPS group and the greatest for those who died as a consequence of EPS. Simplified scoring based on presence or absence, then for a score of ≥3.0, gave a receiver operating characteristic value of 0.87 for EPS, with a sensitivity of 78% and specificity of 85%, respectively. Inter-observer agreement varied from poor to good, being the greatest for calcification and bowel dilatation and the lowest for peritoneal thickening.
  
  
  CONCLUSIONS
  CT scan reporting can differentiate EPS from peritoneal changes associated with duration of PD therapy. Severity of abnormalities was associated with clinical outcomes. However, inter-observer agreement varies with different radiological appearances, and future studies are required to determine weighting of radiological changes to provide prognostic information for clinicians and patients.
authors.affiliation: Department of Radiology, Royal Free Hospital, London, UK.
authors.forename: Sam
authors.initials: S
authors.lastname: Stuart
authors.affiliation: Faculty of Health and Human Sciences, University of Hertfordshire, Hatfield, UK.
authors.forename: David
authors.initials: D
authors.lastname: Stott
authors.affiliation: Department of Radiology, Royal Free Hospital, London, UK.
authors.forename: Antony
authors.initials: A
authors.lastname: Goode
authors.affiliation: Department of Radiology, Royal Free Hospital, London, UK.
authors.forename: Charlotte J
authors.initials: CJ
authors.lastname: Cash
authors.affiliation: UCL Center for Nephrology, Royal Free Hospital, University College London Medical School, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Davenport
mesh_terms: D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015588:Observer Variation; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D056627:Peritoneal Fibrosis / Q000000981:diagnostic imaging* / Q000209:etiology; D010537:Peritoneum / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011379:Prognosis; D011860:Radiography, Abdominal / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
keywords: CT scan; encapsulating peritoneal sclerosis; peritoneal calcification; peritoneal dialysis