CT differentiation of malignant peritoneal mesothelioma and tuberculous peritonitis

Our plain-English summary of CT differentiation of malignant peritoneal mesothelioma and tuberculous peritonitis, by W.J. Yin, G.Q. Zheng, Y.F. Chen, et al (La Radiologia Medica, 2016).

The study

• Authors: W.J. Yin, G.Q. Zheng, Y.F. Chen, D.Q. Chen, N.N. Sun, Y.X. Yang, X.Y. Sun, L.Q. Kang
• Journal: La Radiologia Medica
• Published: 2016;121(4):253-60
• Cited by: 21 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: The aim of this study was to determine which computed tomography (CT) findings were useful in differentiating malignant peritoneal mesothelioma (MPM) and tuberculous peritonitis (TBP).

Methods: CT scans performed in 53 patients with MPM and 27 patients with TBP confirmed by pathology were retrospectively reviewed. The CT findings were evaluated for the morphologic appearance of ascites, peritoneum, mesenterium and omentum involvement, enlarged lymph nodes, solid abdominal viscera infiltration and metastases, and thoracic changes. The Pearson χ (2) test was used to compare differences between groups.

Results: Patients in both groups displayed a high proportion of peritoneum and mesenterium thickening. However, there were no obvious differences observed for ascites or swollen lymph nodes. There were significant differences in the following aspects between the two groups: (1) smooth peritoneal thickening was more frequent in patients with TBP, while irregular thickening was more frequently observed in patients with MPM; (2) caked omentum stratification was more common in patients with MPM; (3) mesentery involvement was less commonly observed in patients with TBP; (4) abdominal viscera infiltration and pleural plaques were more common in patients with MPM (46/53 and 48/53, respectively) than in those with TBP (0/27 and 0/27); and (5) more patients in the TBP group (14/27) displayed pleural effusion, and extraperitoneal tuberculosis was more common in patients with TBP (20/27).

Conclusion: Although most CT findings analyzed are observed in both diseases, each disease has its own several unique characteristics. Therefore, using a combination of CT findings may increase our ability to distinguish TBP from MPM.

In plain English

This was a retrospective study from Cangzhou Central Hospital in Hebei, China. It compared CT scans of 53 patients with malignant peritoneal mesothelioma (MPM) and 27 patients with tuberculous peritonitis (TBP), a tuberculosis infection of the abdominal lining. All diagnoses were confirmed by pathology between January 2010 and October 2012. Three radiologists who did not know the diagnoses reviewed the scans. Fifty of the 53 MPM patients (94.3%) had a history of asbestos exposure. Irregular thickening of the peritoneum was more frequent with MPM (64.2%) than with TBP (11.1%). Smooth thickening was more frequent with TBP (74.1%) than with MPM (22.6%). Infiltration of abdominal organs was seen in 46 of 53 MPM patients and pleural plaques in 48 of 53, compared with none of the 27 TBP patients for either. Pleural effusion (14 of 27) and tuberculosis outside the peritoneum (20 of 27) were more common with TBP. Ascites and enlarged lymph nodes did not differ significantly between the groups. The authors concluded that combining CT findings may help distinguish the two diseases. The discussion gives a different pleural plaque count (50 cases).

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 comparison of CT findings in two groups of pathologically confirmed patients, read by three radiologists blinded to the final diagnosis
• Who was studied: 53 patients with malignant peritoneal mesothelioma (17 men, 36 women, average age 60) and 27 patients with tuberculous peritonitis (11 men, 16 women, average age 35), all pathologically confirmed, at Cangzhou Central Hospital, Hebei, China, January 2010 to October 2012
• Exposure: History of asbestos exposure was recorded. 50 of the 53 MPM patients (94.3%) had such a history. No fiber type or dose is given for the patients studied. The study's main focus was CT imaging findings rather than exposure.
• Main results:
  • Irregular peritoneal thickening was seen in 64.2% of MPM patients (34/53) and 11.1% of TBP patients (3/27), P less than 0.01
  • Smooth uniform peritoneal thickening was seen in 74.1% of TBP patients (20/27) and 22.6% of MPM patients (12/53)
  • Peritoneal thickening greater than 1 cm was seen in 13 MPM patients (24.5%) and in no TBP patients
  • Caked omentum was seen in 54.7% of MPM patients (29/53) and 29.6% of TBP patients (8/27), P less than 0.01
  • Mesentery involvement was seen in 88.7% of MPM patients (47/53) and 59.3% of TBP patients (16/27), P less than 0.01
  • Bowel wall fixation was more common in the MPM group (38/53, 71.7% in Table 2) than in the TBP group (1/27, 3.7%), P less than 0.01
  • Abdominal viscera infiltration was seen in 46/53 MPM patients and 0/27 TBP patients. Pleural plaques were seen in 48/53 MPM patients and 0/27 TBP patients.
  • In the TBP group, 14/27 had pleural effusion (versus 10/53, 18.9%, in the MPM group per Table 2) and 20/27 had extraperitoneal tuberculosis
  • Ascites (volume and density) and enlarged lymph nodes did not differ significantly between the groups (enlarged nodes: 34.0% of MPM patients, 33.3% of TBP patients, in Table 2)
  • Fever occurred in 18 TBP patients (66.7%) and in no MPM patients
• The authors' conclusion: The authors concluded that the most useful CT findings for MPM were pleural plaques in people with asbestos exposure, abdominal viscera infiltration, peritoneal local thickening greater than 1 cm, irregular thickening or nodules, and caked omentum. They named extraperitoneal tuberculosis, smooth uniform peritoneal thickening and a smudged omentum as the most useful findings for TBP. Combining CT findings may increase the ability to distinguish TBP from MPM.

Topics

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

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, CT Scan, Pathology, Ascites, Peritoneum, Omentum, Mesentery, Pleural Plaques.

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• p16/CDKN2A FISH in Differentiation of Diffuse Malignant Peritoneal Mesothelioma From Mesothelial Hyperplasia and Epithelial Ovarian Cancer — T. Ito, M. Hamasaki, et al. (2015)

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