Cirrhotic and malignant ascites: Differential CT diagnosis

Abstract

To assess the diagnostic accuracy of the different computed tomography (CT) signs for differentiating between malignant and cirrhotic ascites. We performed a retrospective study of 102 CT scans in adults, distributed into two groups based on the cirrhotic or malignant etiology of their ascites. The CT signs studied were ascites volume and relative distribution between the greater peritoneal cavity (GPC) and the omental bursa (OB), the density of the ascites, the thickness of the gallbladder wall, the thickness of the parietal peritoneum and its degree of enhancement, and tethered-bowel sign. The CT signs associated with malignant ascites were: presence of fluid in the omental bursa (P=0.003), thickening of the peritoneum its degree of enhancement (P=0.005), increased density of the ascites (P=0.01), and loss of mobility of bowel loops in the ascites (P=0.001). There was no difference in gallbladder wall thickness between the two groups. The CT scan can play a role in diagnosing malignant ascites. We confirm the usefulness of the indirect signs composed of distribution of ascites fluid, thickening and enhancement of the parietal peritoneum, and loss of mobility of the bowel loops in the ascites.