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.
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).
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.
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.
DaviesS.J.Longitudinal relationship between solute transport and ultrafiltration capacity in peritoneal dialysis patients.Kidney Int2004; 66: 2437–45.
2.
DobbieJ.W., AndersonJ.D., HindC.Long-term effects of peritoneal dialysis on peritoneal morphology.Perit Dial Int1994; 14(Suppl 3): S16–20.
3.
MateijsenM.A., van der WalA.C., HendriksP.M., ZweersM.M., MulderJ., StruijkD.G.Vascular and interstitial changes in the peritoneum of CAPD patients with peritoneal sclerosis.Perit Dial Int1999; 19: 517–25.
4.
SelgasR., Fernandez-ReyesM.J., BosqueE., BajoM.A., BorregoF., JimenezC.Functional longevity of the human peritoneum: how long is continuous peritoneal dialysis possible? Results of a prospective medium long-term study.Am J Kidney Dis1994; 23: 64–73.
5.
GhandiV.C., HumayunH.M., IngT.S., DaugirdasJ.T., JablokowV.R., IwatsukiS.Sclerotic thickening of the peritoneal membrane in maintenance peritoneal dialysis patients.Arch Intern Med1980; 140: 1201–3.
KawanishiH., KawaguchiY., FukuiH., HaraS., ImadaA., KuboH.Encapsulating peritoneal sclerosis in Japan: a prospective, controlled, multicenter study.Am J Kidney Dis2004; 44: 729–37.
8.
RigbyR.J., HawleyC.M.Sclerosing peritonitis: the experience in Australia.Nephrol Dial Transplant1998; 13: 154–9.
9.
NomotoY., KawaguchiY., KuboH., HiranoH., SakaiS., KurokawaK.Sclerosing encapsulating peritonitis in patients undergoing continuous ambulatory peritoneal dialysis: a report of the Japanese Sclerosing Encapsulating Peritonitis Study Group.Am J Kidney Dis1996; 28: 420–7.
AfthentopoulosI.E., PassadakisP., OreopoulosD.G., BargmanJ.Sclerosing peritonitis in continuous ambulatory peritoneal dialysis patients: one center's experience and review of the literature.Adv Ren Replace Ther1998; 5: 157–67.
12.
SummersA.M., ClancyM.J., SyedF., HarwoodN., BrenchleyP.E., AugustineT.Single-center experience of encapsulating peritoneal sclerosis in patients on peritoneal dialysis for end-stage renal failure.Kidney Int2005; 68: 2381–8.
13.
HendriksP.M., Ho-dac-PannekeetM.M., van GulikT.M., StruijkD.G., PhoaS.S., SieL.Peritoneal sclerosis in chronic peritoneal dialysis patients: analysis of clinical presentation, risk factors, and peritoneal transport kinetics.Perit Dial Int1997; 17: 136–43.
14.
FierenM.W., BetjesM.G., KorteM.R., BoerW.H.Posttransplant encapsulating peritoneal sclerosis: a worrying new trend?Perit Dial Int2007; 27: 619–24.
15.
KawaguchiY., KawanishiH., MujaisS., TopleyN., OreopoulosD.G.Encapsulating peritoneal sclerosis: definition, etiology, diagnosis, and treatment. For the International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis.Perit Dial Int2000; 20(Suppl 4): S43–55.
16.
HollmanA.S., McMillanM.A., BriggsJ.D., JunorB.J., MorleyP.Ultrasound changes in sclerosing peritonitis following continuous ambulatory peritoneal dialysis.Clin Radiol1991; 43: 176–9.
17.
KorzetsA., KorzetsZ., PeerG., PapoJ., SternD., BernheimJ.Sclerosing peritonitis. Possible early diagnosis by computerized tomography of the abdomen.Am J Nephrol1988; 8: 143–6.
LoughreyG.J., HawnaurJ.M., SambrookP.Case report: computed tomographic appearance of sclerosing peritonitis with gross peritoneal calcification.Clin Radiol1997; 52: 557–8.
22.
SlimR., TohmeC., YaghiC., HoneinK., SayeghR.Sclerosing encapsulating peritonitis: a diagnostic dilemma.J Am Coll Surg2005; 200: 974–5.
23.
SyedM.A., KhaleelZ.L., AveryG.R.Peritoneal calcification in dialysis patients—CT appearance of sclerosing peritonitis.Eur J Radiol Extra2006; 57: 19–21.
24.
KrestinG.P., KaclG., HauserM., KeuschG., BurgerH.R., HoffmannR.Imaging diagnosis of sclerosing peritonitis and relation of radiologic signs to the extent of the disease.Abdom Imaging1995; 20: 414–20.
25.
Stafford-JohnsonD.B., WilsonT.E., FrancisI.R., SwartzR.CT appearance of sclerosing peritonitis in patients on chronic ambulatory peritoneal dialysis.J Comput Assist Tomogr1998; 22: 295–9.
26.
TarziR.M., LimA., MoserS., AhmadS., GeorgeA., BalasubramaniamG.Assessing the validity of an abdominal CT scoring system in the diagnosis of encapsulating peritoneal sclerosis.Clin J Am Soc Nephrol2008; 3: 1702–10.
27.
JunorB.J., McMillanM.A.Immunosuppression in sclerosing peritonitis.Adv Perit Dial1993; 9: 187–9.
28.
MoriY., MatsuoS., SutohH., ToriyamaT., KawaharaH., HottaN.A case of a dialysis patient with sclerosing peritonitis successfully treated with corticosteroid therapy alone.Am J Kidney Dis1997; 30: 275–8.
AllariaP.M., GiangrandeA., GandiniE., PisoniI.B.Continuous ambulatory peritoneal dialysis and sclerosing encapsulating peritonitis: tamoxifen as a new therapeutic agent?J Nephrol1999; 12: 395–7.
31.
Del PesoG., BajoM.A., GilF., AguileraA., RosS., CosteroO.Clinical experience with tamoxifen in peritoneal fibrosing syndromes.Adv Perit Dial2003; 19: 32–5.
32.
EltoumM.A., WrightS., AtchleyJ., MasonJ.C.Four consecutive cases of peritoneal dialysis-related encapsulating peritoneal sclerosis treated successfully with tamoxifen.Perit Dial Int2006; 26: 203–6.
