| Objective To compare the difference between benign and malignant ascites in CT imaging features so as to explore CT signs associated with malignant ascites.Methods 143 cases of patients with ascites admitted in our hospital from which results were confirmed by surgical pathology or comprehensive measures were collected, including 92 cases benign ascites(26 cases tuberculous ascites, 31 cases other inflammatory ascites,35 cases liver cirrhosis ascites) and 51 cases maglinant ascites. Chi-square test was applied to compare the differences between two groups in CT features,including the volume and maximum density of ascites, the thickness and enhancement degree of parietal peritoneum, the changes in greater omentum and mesenterium alteration,the distribution of ascites in the omental bursal, the changes of lymphonodus above diaphragm and in peritoneal and pelvic cavity.Then to analysis the CT signs of malignant ascites related above independent predictors,By analysis of the CT signs with benign and malignant ascites.using multiariable logistic backward conditional regression analysis.Result(1) Malignant ascites are given priority to with moderate ascites(26/51), irregular or nodular thickening of the upper parietal peritoneum(28/51), irregular or nodular thickening of pelvic peritoneum(6/51), mild or moderate reinforcement of pelvic peritoneum( 12/51), big nodule in the greater omentum( 8/51), thickened the greater omentum with caked sign( 11/51),small nodule in the mesenterium( 29/51), the distribution of ascites in the omental bursal(10/51),enlargement of lymphonodus above diaphragm(26/51),enlargement of lymphnodus in peritoneal and pelvic cavity( 25/51).There were significant differences in irregular or nodular thickening of the upper parietal peritoneum, irregular or nodular thickening of pelvic peritoneum,mild or moderate reinforcement of pelvic peritoneum, smearing in the greater omentum, big nodule in the greater omentum, thickened the greater omentum with caked sign, smearing in the mesenterium,small nodule in the mesenterium, the distribution of ascites in the omental bursal,enlargement of lymphonodus above diaphragm,enlargement of lymphnodus in peritoneal and pelvic cavity between two groups( x2= 4.089, p=0.043; x2=55.027,p=0.000; x2=5.410,p=0.020; x2=8.036,p=0.005;x2=4.040,p=0.040; x2=9.009,p=0.003; x2=15.287,p=0.000; x2=21.497,p=0.000;x2=6.850,p=0.009; x2=30.806,p=0.000; x2=8.651,p=0.003; x2=19.292,p=0.000;x2=37.598,p=0.000). There were no significant differences in enlargement of lymphonodus above diaphragm between malignant ascites and tuberculous ascites(x2=0.312,p=0.577).(2) There were no significant differences in the volume and maximum density ascites, small nodule in the greater omentum, big nodule in the mesenterium, uniform thickening of the upper parietal peritoneum, mild or moderate reinforcement of the upper parietal peritoneum, severe reinforcement of the upper parietal peritoneum, severe reinforcement of the pelvic peritoneum(x2=3.839,p=0.05; x2=0.001,p=0.973; x2=0.393,p=0.531; x2=1.389,p=0.239;x2=1.817,p=0.178; x2=0.835,p=0.361; x2=2.258,p=0.133; x2=2.801,p=0.094;x2=2.487,p=0.115).(3) Multiariable logistic backward conditional regression analysis showed that irregular or nodular thickening of the upper parietal peritoneum, thickened the greater omentum with caked sign,small nodule in the mesenterium, enlargement of lymphonodus above diaphragm,enlargement of lymphnodus in peritoneal and pelvic cavity were the independent predicted factors of the malignant ascites.Conclusion 1. Multislice CT signs including irregular or nodular thickening of the upper parietal peritoneum, irregular or nodular thickening of pelvic peritoneum,mild or moderate reinforcement of pelvic peritoneum, smearing in the greater omentum, big nodule in the greater omentum, thickened the greater omentum with caked sign, smearing in the mesenterium,small nodule in the mesenterium, the distribution of ascites in the omental bursal,enlargement of lymphonodus above diaphragm,enlargement of lymphnodus in peritoneal and pelvic cavity of benign and malignant ascites have certain characteristics that can provide the basis for clinical identification. 2. Independent predictor of CT signs of malignant ascites-- irregular or nodular thickening of the upper parietal peritoneum, thickened the greater omentum with caked sign,small nodule in the mesenterium, enlargement of lymphonodus above diaphragm,enlargement of lymphnodus in peritoneal and pelvic cavity improve the accuracy of diagnosis of malignant ascites--improved the diagnosis of malignant ascites in some extend. |
