Difficulties in differentiating the nature of ascites based on ultrasound imaging

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Journal of Ultrasonography

Polish Ultrasound Society (Polskie Towarzystwo Ultrasonograficzne)

Subject: Medicine

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ISSN: 2084-8404
eISSN: 2451-070X

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VOLUME 17 , ISSUE 69 (June 2017) > List of articles

Difficulties in differentiating the nature of ascites based on ultrasound imaging

Andrzej Smereczyński / Katarzyna Kołaczyk * / Elżbieta Bernatowicz

Keywords : ascites, greater omentum, tumor implants

Citation Information : Journal of Ultrasonography. Volume 17, Issue 69, Pages 96-100, DOI: https://doi.org/10.15557/JoU.2017.0013

License : (CC BY 4.0)

Received Date : 19-June-2016 / Accepted: 18-September-2016 / Published Online: 10-August-2017

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ABSTRACT

Transabdominal ultrasound not always allows to determine the nature of ascites based solely on its characteristics. Aim: The aim of the study was to present difficulties in determining the nature of ascites using transabdominal ultrasonography solely based on extra-organ lesions as well as, after the inclusion of the overall abdominal assessment and the clinical picture. Materials and methods: A total of 18 patients with non-neoplastic ascites and 62 patients with neoplastic ascites whose final diagnosis was based on cytological and histopathological findings were evaluated between 2005 and 2015. Abdominal ultrasound was performed to detect the presence of fluid in all accessible spaces, and, additionally, to determine the presence of potential peritoneal tumor implants as well as to evaluate the parietal peritoneum and the greater omentum. Different digital ultrasound machines equipped with 3–6 MHz and linear 7–12 MHz transducers were used in the study. Double-sided Fisher’s exact test with statistical significance at p < 0.05 was used for the analysis of the obtained results. Results: Statistically significant differences between benign and neoplastic ascites were found for: anechoic peritoneal fluid (<0.0001); fluid and thickened omentum with smooth surface (<0.0001); fluid and thickened omentum with smooth surface and varices (0.01); fluid and thickened omentum with hypoechoic foci (0.049); fluid and thickened omentum with tumor implants (0.009). The inclusion of the overall assessment of abdominal organs and the clinical data allowed for an improvement in ultrasonographic diagnostic accuracy in benign and neoplastic ascites from 83.3% and 67.7% to 94.4% and 93.5%, respectively. Conclusions: When used alone, an assessment of acoustic fluid characteristics and extra-organ peritoneal lesions limits the possibility to differentiate between benign and malignant ascites. These results improve after the inclusion of sonographic assessment of all abdominal organs in combination with clinical data.

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REFERENCES

  1. Interna Szczeklika. Podręcznik chorób wewnętrznych. Medycyna Praktyczna, Kraków 2012.
  2. Ayantude AA, Parsons SL: Pattern and prognostic factors in patients with malignant ascites: a retrospective study. Ann Oncol 2007; 18: 945–949.
    [CROSSREF]
  3. Goerg C, Schwerk WB: Malignant ascites: sonographic signs of peritoneal carcinomatosis. Eur J Cancer 1991; 27: 720–723.
    [CROSSREF]
  4. Rioux M, Michaud C: Sonographic detection of peritoneal carcinomatosis: a prospective study of 37 cases. Abdom Imaging 1995; 20: 47–51.
    [CROSSREF]
  5. Shen-Gunther J, Mannel RS: Ascites as a predictor of ovarian malignancy. Gynecol Oncol 2002; 87: 77–83.
    [CROSSREF]
  6. deSouza NM, O’Neill R, McIndoe GA, Dina R, Soutter WP: Borderline tumors of the ovary: CT and MRI features and tumor markers in differentiation from stage I disease. AJR Am J Roentgenol 2005; 184: 999–1003.
    [CROSSREF]
  7. Topal NB, Gurel S, Ercan I, Savci G: The role of ultrasonography and computed tomography in determining the etiology of ascites. Saudi Med J 2007; 28: 1822–1826.
    [CROSSREF]
  8. Timmerman D, Testa AC, Bourne T, Ameye L, Jurkovic D, Van Holsbeke C et al.: Simple ultrasound-based rules for the diagnosis of ovarian cancer. Ultrasound Obstet Gynecol 2008; 31: 681–690.
    [CROSSREF]
  9. Allah MH, Salama ZA, El-Hindawy A, Al Kady N: Role of peritoneal ultrasonography and ultrasound-guided fine needle aspiration cytology/ biopsy of extravisceral masses in the diagnosis of ascites of undetermined origin. Arab J Gastroenterol 2012; 13: 116–124.
    [CROSSREF]
  10. Maeda H, Kobayashi M, Sakamato J: Evaluation and treatment of malignant ascites secondary to gastric cancer. World J Gastroenterol 2015; 21: 10936–10947.
    [CROSSREF]
  11. Hanbidge AE, Lynch D, Wilson SR: US of the peritoneum. Radiographics 2003; 23: 663–685.
    [CROSSREF]
  12. Nichols JE, Steinkampf MP: Detection of free peritoneal fluid by transvaginal sonography. J Clin Ultrasound 1993; 21: 171–174.
    [CROSSREF]
  13. Brown SE, Dubbins PA: Detection of free intraperitoneal fluid in healthy young men. J Ultrasound Med 2012; 31: 1527–1530.
    [CROSSREF]
  14. Chidambaram VA, Venkatanarasimha N: Detection of intraperitoneal free fluid in healthy young men: “innocent bystander versus benign imposter”. J Ultrasound Med 2013; 32: 549.
    [CROSSREF]
  15. Yoshikawa T, Hayashi N, Maeda E, Matsuda I, Sasaki H, Ohtsu H et al.: Peritoneal fluid accumulation in healthy men and postmenopausal women: evaluation on pelvic MRI. AJR Am J Roentgenol 2013; 200: 1181–1185.
    [CROSSREF]
  16. Rana SS, Bhasin DK, Srinivasan R, Singh K: Endoscopic ultrasound-guided fine needle aspiration of peritoneal nodules in patients with ascites of unknown cause. Endoscopy 2011; 43: 1010–1013.
    [CROSSREF]
  17. Repiso A, López-Padro R, Arribas C, Arranzana A, Abad S, Rodriquez-Merlo R et al.: [Significance of free fluid detected by echoendoscopy in patients with gastric cancer]. Gastroenterol Hepatol 2012; 35: 691–696.
    [CROSSREF]
  18. Montgomery MM, Leitman IM: Endoscopic ultrasound and paracentesis in the evaluation of small volume ascites in patients with intra-abdominal malignances. World J Gastroenterol 2014; 20: 10219–10222.
    [CROSSREF]
  19. Tsujimoto F, Miyamoto Y, Tada S: Differentiation of benign from malignant ascites by sonographic evaluation of gallbladder wall. Radiology 1985; 157: 503–504.
    [CROSSREF]
  20. Martin-Bonmati L, Andres JC, Aguado C: Sonographic relationship between gallbladder wall thickness and the etiology ascites. J Clin Ultrasound 1989; 17: 497–501.
    [CROSSREF]
  21. Mahammad A, Ghasemi-Rad M, Mahammadifar M: Differentiation of benign from malignant induced ascites by measuring gallbladder wall thickness. Maedica (Buchar) 2011; 6: 282–286.
    [CROSSREF]
  22. Kim KW, Shinagare AB, Krajewski KM, Pyo J, Tirumani SH, Jagannathan JP et al.: Fluid retention associated with imatnib treatment in patients with gastrointestinal stromal tumor: quantitative radiologic assessment and implications for management. Korean J Radiol 2015; 16: 304–313.
    [CROSSREF]
  23. Keraliya AR, Rosenthal MH, Krajewski KM, Jagannathan JP, Shinagara AB, Tirumi SH et al.: Imaging of fluid in caner patients treated with systemic therapy: chemotherapy, molecular targeted therapy, and hematopoietic stem cell transplantation. AJR Am J Roentgenol 2015; 205: 709–719.
    [CROSSREF]
  24. Que Y, Tao C, Wang Y, Wang X, Zhao W, Ou G et al.: Nodules in the thickened greater omentum. A good indicator of lesions? J Ultrasound Med 2009; 28: 745–748.
    [CROSSREF]
  25. Wand J, Gao L, Tang S, Li T, Lei Y, Xie H et al.: A retrospective analysis on the diagnostic value of ultrasound-guided percutaneous biopsy for peritoneal lesions. World J Surg Oncol 2013; 11: 251.
    [CROSSREF]

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