Diagnostic Accuracy of Different Computed Tomography Signs for Differentiating Between Malignant and Cirrhotic Ascites Keeping Ascitic Fluid Cytology as Gold Standard.

Ibtesam Zafar,Amir Khan,Muhammad Nasir Naeem Khan,Muhammad Waseem Asad,Muzammil Rasheed Bhutta,Ayesha Isani Majeed

doi:10.7759/cureus.20254

Abstract

ObjectiveThe goal of this research was to define the diagnostic precision of CT signs to distinguish malignant ascites from cirrhotic ascites. Ascitic fluid cytology was kept as the gold standard.Study designThis research was a prospective cross-sectional study.Place and duration of the studyParticipants’ recruitment started on July 15, 2021, and the whole study lasted about three months till October 15, 2021, at the Radiology Department of Pakistan Institute of Medical Sciences, Islamabad.Patients and methodsA total of 80 patients were included in the research and divided into two groups grounded on the cirrhotic or malignant etiology of the ascites based on their fluid cytology. Ascites volume, relative spread between the lesser sac and greater peritoneal cavity, the wall thickness of gallbladder, density of ascites, parietal peritoneum thickness and degree of its enhancement, and presence of septa and loculations were some of the major CT signs studied.ResultsThe average age of patients included in this study was 36.2 ± 6.67 years (range 29-49 years). Of the 80 patients, 50 (62.5 %) were men, and 30 (37.5 %) were women. CT signs associated with the malignant ascites reported in this study were fluid present in the lesser sac (p = 0.03), peritoneal thickening and degree of its enhancement (p = 0.05), increased ascites density (p= 0.001), and presence of septa and loculations (63.6 % of malignant ascites). However, gallbladder wall thickness did not show any variation between both groups.ConclusionWe conclude that in the diagnosis of malignant ascites, CT scan imaging can play a vital role. This research approves and testifies the benefits of indirect signs such as the spread of ascites, increased density of ascites, thickening and enhancement of parietal peritoneum, and ascitic fluid complexity in pointing out malignancy as a cause of ascites.

Highlights

IntroductionAscites is a frequent finding in a number of pathologic disorders including hepatic failure, cardiac dysfunction, metabolic imbalances, inflammatory processes, and neoplasms leading to accumulation of free fluid in the peritoneal cavity [1]
Computed tomography (CT) signs associated with the malignant ascites reported in this study were fluid present in the lesser sac (p = 0.03), peritoneal thickening and degree of its enhancement (p = 0.05), increased ascites density (p= 0.001), and presence of septa and loculations (63.6 % of malignant ascites)
Ascites is a frequent finding in a number of pathologic disorders including hepatic failure, cardiac dysfunction, metabolic imbalances, inflammatory processes, and neoplasms leading to accumulation of free fluid in the peritoneal cavity [1]

Summary

Introduction

Ascites is a frequent finding in a number of pathologic disorders including hepatic failure, cardiac dysfunction, metabolic imbalances, inflammatory processes, and neoplasms leading to accumulation of free fluid in the peritoneal cavity [1]. Hepatic cirrhosis is undoubtedly the most frequent etiology of ascites, single-handedly accountable for over and above three-quarters of cases [2]. The main differential is the ascites due to malignant etiology accounting for about 10% of cases and the remaining 5% of cases are attributed to other causes [1,2]. The recognition of ascites as an oncologic challenge is always problematic, the difficulty being to distinguish between the cause of ascites as hepatic cirrhosis or malignancy. How to cite this article Zafar I, Majeed A, Asad M, et al (December 07, 2021) Diagnostic Accuracy of Different Computed Tomography Signs for Differentiating Between Malignant and Cirrhotic Ascites Keeping Ascitic Fluid Cytology as Gold Standard.

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