CT demonstration of peritoneal metastases after intraperitoneal injection of contrast media

Twenty-four patients with gynecologic malignancies were studied by CT before and after intraperitoneal injection of contrast medium, and then underwent laparotomy. Approximately 3,000 ml of 2.4% solution of nonionic contrast medium was injected into the peritoneum. Fourteen patients had ascites; studies were true positive in all. In the ten patients without ascites, there were six true-negative, two true-positive, two false-negative, and no false-negative studies. The peritoneum was very well outlined and metastases smaller than 1 cm were visible. It was possible to distinguish loculated fluid collections and to determine the location of lesions with respect to the peritoneum (extraperitoneal vs. intraperitoneal). This information is necessary to plan endoperitoneal chemotherapy. Small metastases on the omentum and on the root of the mesentery were not seen, and the technique had poor specificity. It was very difficult to distinguish among scars, granulomas, and metastases