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Perit Dial Int 29(5): 517-522
2009
© 2009 International Society for Peritoneal Dialysis
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Clinical Sciences

COMPUTED TOMOGRAPHIC FINDINGS CHARACTERISTIC FOR ENCAPSULATING PERITONEAL SCLEROSIS: A CASE-CONTROL STUDY

Anniek Vlijm1, Jaap Stoker2, Shandra Bipat2, Anje M. Spijkerboer2, Saffire S.K.S. Phoa2, Robbert Maes3, Dirk G. Struijk1,4 and Raymond T. Krediet1

Division of Nephrology,1 Department of Medicine, and Department of Radiology,2 Academic Medical Center, University of Amsterdam, Amsterdam; Department of Radiology,3 Gemini Hospital, Den Helder; Dianet Foundation,4 Utrecht–Amsterdam, The Netherlands

Correspondence to: A. Vlijm, Department of Nephrology, Academic Medical Center, Meibergdreef 9, Room A01-111, 1105 AZ Amsterdam, The Netherlands. a.vlijm{at}amc.uva.nl

{diamondsuit} Background: Computed tomography (CT) is often used to confirm the diagnosis of encapsulating peritoneal sclerosis (EPS) but there is no consensus on specific CT abnormalities. To establish CT findings characteristic for EPS, we compared CT findings between EPS patients and long-term peritoneal dialysis (PD) patients without EPS.

{diamondsuit} Methods: We included as cases all EPS patients in our center from 1996 to 2008 that underwent a CT scan at the time of diagnosis. Controls were all other long-term PD patients (PD duration ≥ 4 years) without EPS that had a CT scan for different reasons. The CT scans were blindly and independently reviewed by 3 radiologists: 2 abdominal radiologists with PD knowledge (Observers 1 and 2) and 1 radiologist without PD experience (Observer 3).

{diamondsuit} Results: We included 15 EPS patients and 16 controls. Observer 1 found 6 CT findings that were significantly more often present in EPS than in controls (p ≤ 0.05): peritoneal enhancement, thickening, and calcifications; adhesions of bowel loops; signs of obstruction; and fluid loculation/septation. Observer 2 scored almost identically but Observer 3 scored differently. The sensitivity and specificity of a combination of specific CT findings were, respectively, 100% and 94% for Observers 1 and 2, and 79% and 88% for Observer 3.

{diamondsuit} Conclusion: CT scans showed characteristic abnormalities that were significantly more often present in EPS patients compared to long-term PD control patients. CT can be used to confirm the diagnosis of EPS when experienced radiologists apply a combination of specific CT findings.

KEY WORDS: Encapsulating peritoneal sclerosis (EPS); computed tomography (CT); case-control study.

Received 17 July 2008; accepted 15 October 2008.




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