[A comparative study of CT and barium enema examination in diagnosis of peritoneal metastasis from gastric carcinoma].

Objective: To compare the results of CT and barium enema examination in the diagnosis of peritoneal metastasis from gastric carcinoma.

Materials: Peritoneal metastases were pathologically confirmed in nine patients with gastric carcinoma who had had abdominal CT and barium enema examinations prior to surgery.

Methods and results: Five patients were reported to have colonic wall rigidity on preoperative barium enema examination. Review of the images indicated that six cases showed rigidity. On the other hand, no CT findings suggestive of peritoneal metastasis were reported in eight patients without ascites. No patients were indicated to have intraperitoneal nodules. For the retrospective evaluation, we changed the diagnostic procedure: the CT window setting was changed in wide window width (from 250 Hounsfield units (HU) to 400HU)and low window level (50-60HU to 0 HU), and reading mode was changed to a cine paging mode with a picture archiving and communication system (PACS) instead of hard-copy review. It followed that intraperitoneal nodules suggestive of peritoneal metastasis were detected in eight patients.

Conclusion: On conventional image reading, barium enema examination is of greater assistance than CT examination for detecting peritoneal metastasis from gastric carcinoma. However, the new CT reading method with PACS is more sensitive than barium enema examination for diagnosing peritoneal metastasis.