CT differentiation of diffuse malignant peritoneal mesothelioma and peritoneal carcinomatosis

Our plain-English summary of CT differentiation of diffuse malignant peritoneal mesothelioma and peritoneal carcinomatosis, by Y.F. Liang, G.Q. Zheng, Y.F. Chen, et al (Journal of Gastroenterology and Hepatology, 2016).

The study

• Authors: Y.F. Liang, G.Q. Zheng, Y.F. Chen, H. Song, W.J. Yin, L. Zhang
• Journal: Journal of Gastroenterology and Hepatology
• Published: 2016;31(4):709-15
• Cited by: 27 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background And Aim: Diffuse malignant peritoneal mesothelioma (DMPM) and peritoneal carcinomatosis (PC) have similar imaging in computer tomography (CT). We aimed to distinguish them.

Methods: Computer tomography findings were evaluated in 48 DMPM and 47 PC for the peritoneal, mesenteric, omentum, lymph nodes, viscera infiltration, ascites and pleural plaques.

Results: Two groups had no difference in terms of thickness, clinical manifestation, diameter of lymph nodes, ascites, and viscera infiltration. But they showed differences in the following: Ratio of asbestos exposure in DMPM group was higher. Smooth and irregular peritoneal thickening were more seen in DMPM group; peritoneal nodules were more commonly detected in PC group. Forty-eight cases of peritoneum in DMPM showed mild enhanced, while 14 patients in PC showed severe enhanced. Nodular type of omentum was more common in PC group than in DMPM group; omental cake was more commonly detected in DMPM group. Mesentery involvement was more commonly seen in DMPM group. Location of enlarged lymph nodes in cardiophrenic region was more frequently identified in DMPM, whereas location of enlarged lymph nodes in retroperitoneal region was more frequently identified in PC. Lymph nodes fusion was more frequently visualized in PC. Fixation of the intestinal wall was more common in DMPM. Pleural plaque was more common in DMPM. PC had distant metastasis except primary foci and peritoneum. In PC, tumor origins were ovary in 10, digestive system in 21, breast in one.

Conclusion: Using a combination of CT findings may increase our ability to distinguish PC from DMPM.

© 2015 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

In plain English

This retrospective study, from Cangzhou Central Hospital in Hebei, China, compared CT scans of 48 patients with diffuse malignant peritoneal mesothelioma (DMPM) and 47 patients with peritoneal carcinomatosis (PC), which is cancer that has spread to the abdominal lining from another organ. All were diagnosed between January 2010 and March 2013. Three radiologists reviewed the scans without knowing the final diagnosis. A history of asbestos exposure was recorded in 44 of the 48 DMPM patients (91.67%) and in none of the PC patients. Pleural plaques appeared in 43 DMPM patients and no PC patients. Smooth and irregular peritoneal thickening, "omental cake", mesentery thickening, enlarged lymph nodes in the cardiophrenic region and intestinal wall fixation were more common in DMPM. Peritoneal nodules, nodular omentum, enlarged retroperitoneal lymph nodes and fused lymph nodes were more common in PC. Seven PC patients had metastasis in addition to their peritoneal tumor, and no DMPM patient had distant organ metastasis. The amount of ascites did not differ significantly between the groups. The authors concluded that combining CT findings may help distinguish the two diseases.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of medical, pathological and CT records comparing two groups of patients
• Who was studied: 48 patients with diffuse malignant peritoneal mesothelioma (17 men, 31 women, average age 60) and 47 patients with peritoneal carcinomatosis (15 men, 32 women, average age 64), identified between January 2010 and March 2013 at Cangzhou Central Hospital, Cangzhou, Hebei, China
• Exposure: History of asbestos exposure, recorded for 44 of 48 DMPM patients and none of the PC patients. The article does not give fiber types or doses. The main comparison was of CT imaging features, not of exposure.
• Main results:
  • Pleural plaques were seen on CT in 43 of 48 DMPM patients and in none of the 47 PC patients
  • Smooth peritoneal thickening was seen in 12 of 48 DMPM patients (25.00%) and 2 of 47 PC patients (4.26%), P = 0.004. Irregular thickening was seen in 26 DMPM patients (54.17%) and 15 PC patients (31.91%), P = 0.029.
  • Peritoneal nodules were more common in PC: 24 of 47 patients (51.06%), compared with 7 of 48 DMPM patients (14.58%)
  • Significant peritoneal enhancement on contrast CT was seen in 14 PC patients (29.79% in the table) and in no DMPM patients
  • Omental cake was seen in 37 of 48 DMPM patients and 14 of 47 PC patients. Nodular omentum was seen in 51.06% of PC patients and 16.67% of DMPM patients.
  • Mesentery thickening was seen in 18 DMPM patients (37.5%) and 4 PC patients (8.51%)
  • Enlarged cardiophrenic lymph nodes were found in 18.75% of DMPM patients. Enlarged retroperitoneal lymph nodes were found in 40.43% of PC patients.
  • Lymph node fusion was seen in 7 PC patients and no DMPM patients
  • Intestinal wall fixation was seen in 36 DMPM patients and 23 PC patients
  • Ascites was present in 47 DMPM and 45 PC patients. Its level did not differ significantly between the groups.
  • Seven PC patients had metastasis in addition to their peritoneal tumor, five of them to the liver. No DMPM patient had distant organ metastasis.
  • In the PC group, the cancer originated in the ovary in 10 cases, the breast in 1 case and the digestive system in 21 cases
• The authors' conclusion: The authors concluded that using a combination of CT findings may increase the ability to distinguish PC from DMPM. In their view, the following suggest PC: nodular peritoneum and omentum, retroperitoneal lymph node enlargement and fusion, a definite primary tumor, and more organ metastasis. The following suggest DMPM: smooth or irregular peritoneal thickening (especially over 1 cm), omental cake, invasion of adjacent organs, cardiophrenic lymph node enlargement without complete fusion, and pleural plaques.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Omentum, Ascites, Pleural Plaques, Asbestos Exposure, Peritoneum, Mesentery, Metastasis.

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