OBJECTIVES Peritoneal carcinomatosis (PC) is a prognostically relevant metastatic disease which may be difficult to depict in postoperative patients, particularly in early stages. This study aimed to determine whether PC could be diagnosed more accurately when using a combination of spectral detector CT (SDCT)-derived conventional images (CI) and iodine overlay images (IO) compared with CI only. METHODS Thirty patients with PC and 30 patients with benign peritoneal alterations (BPA) who underwent portal-venous abdominal SDCT were included. Four radiologists determined the presence/absence of PC for each patient and assessed lesion conspicuity, diagnostic certainty, and image quality using 5-point Likert scales. Subjective assessment was conducted in two sessions comprising solely CI and CI/IO between which a latency of 6 weeks was set. Iodine uptake and HU attenuation were determined ROI-based to analyze quantitative differentiation of PC/BPA. RESULTS Specificity for PC was significantly higher when using CI/IO compared with using CI only (0.86 vs. 0.78, p ≤ 0.05), while sensitivity was comparable (0.79 vs. 0.81, p = 1). In postoperative patients, the increase in specificity was the highest (0.93 vs. 0.80, p ≤ 0.05). Lesion conspicuity was rated higher in CI/IO (4 (3-5)) compared with that in CI only (3 (3-4); p ≤ 0.05). Diagnostic certainty was comparable (both 4 (3-5); p = 0.5). CI/IO received the highest rating for overall image quality and assessability (CI/IO 5 (4-5) vs. CI 4 (4-4) vs. IO 4 (3-4); p ≤ 0.05). Area under the receiver operating characteristics curve (AUC) for quantitative differentiation between PC and BPA was higher for iodine (AUCIodine = 0.95, AUCHU = 0.90). CONCLUSIONS Compared with CI, combination of CI/IO improves specificity in the assessment of peritoneal carcinomatosis at comparable sensitivity, particularly in postoperative patients. KEY POINTS • Combination of iodine overlays and conventional images improves specificity when assessing patients with peritoneal carcinomatosis at comparable sensitivity. • Particularly in postsurgical patients, iodine overlays could help to avoid false-positive diagnosis of peritoneal disease. • Iodine overlays alone provided inferior image quality and assessability than conventional images, while the combination of both received the highest ratings. Iodine overlays should therefore be used in addition to and not as a substitute for conventional images.

中文翻译：

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碘覆盖层可改善腹膜癌变与良性腹膜病变之间的区别。

目的腹膜癌（PC）是一种与预后相关的转移性疾病，在术后患者中尤其是早期阶段可能难以描绘。这项研究旨在确定与仅使用CI相比，结合使用光谱检测器CT（SDCT）衍生的常规图像（CI）和碘覆盖图像（IO）可以更准确地诊断PC。方法包括30例行门静脉腹部SDCT的PC患者和30例良性腹膜改变（BPA）患者。四位放射科医生确定了每位患者是否存在PC，并使用5点Likert量表评估了病变的明显性，诊断确定性和图像质量。在仅由CI和CI / IO组成的两个会话中进行了主观评估，这两个会话之间的等待时间设置为6周。碘的吸收和HU衰减的确定是基于ROI的，以分析PC / BPA的定量差异。结果与仅使用CI相比，使用CI / IO时PC的特异性显着更高（0.86 vs. 0.78，p≤0.05），而敏感性相当（0.79 vs. 0.81，p = 1）。在术后患者中，特异性的增加最高（0.93比0.80，p≤0.05）。与仅在CI中（3（3-4）； p≤0.05）相比，CI / IO（4（3-5））中的病变明显程度更高。诊断确定性是可比较的（均为4（3-5）； p = 0.5）。CI / IO在整体图像质量和可评估性方面得分最高（CI / IO 5（4-5）对CI 4（4-4）对IO 4（3-4）； p≤0.05）。碘的接收器工作特性曲线（AUC）下用于PC和BPA定量区分的面积更大（AUCIodine = 0.95，AUCHU = 0。90）。结论与CI相比，CI / IO的组合在敏感性相当的情况下提高了腹膜癌评估的特异性，特别是在术后患者中。要点•在以相当的灵敏度评估腹膜癌患者时，碘覆盖层和常规图像的结合可以提高特异性。•特别是在术后患者中，碘覆盖可以帮助避免腹膜疾病的假阳性诊断。•仅碘覆盖层可提供比传统图像低的图像质量和可评估性，而两者的组合获得最高评分。因此，除常规图像外，还应使用碘覆盖层，而不应使用碘覆盖层。CI / IO的组合提高了腹膜癌评估的特异性，灵敏度相当，尤其是术后患者。要点•在以相当的灵敏度评估腹膜癌患者时，碘覆盖层和常规图像的结合可以提高特异性。•特别是在术后患者中，碘覆盖可以帮助避免腹膜疾病的假阳性诊断。•仅碘覆盖层可提供比传统图像低的图像质量和可评估性，而两者的组合获得最高评分。因此，除常规图像外，还应使用碘覆盖层，而不应使用碘覆盖层。CI / IO的组合提高了腹膜癌评估的特异性，灵敏度相当，尤其是术后患者。要点•在以相当的灵敏度评估腹膜癌患者时，碘覆盖层和常规图像的结合可以提高特异性。•特别是在术后患者中，碘覆盖可以帮助避免腹膜疾病的假阳性诊断。•仅碘覆盖层可提供比传统图像低的图像质量和可评估性，而两者的组合获得最高评分。因此，除常规图像外，还应使用碘覆盖层，而不应使用碘覆盖层。要点•在以相当的灵敏度评估腹膜癌患者时，碘覆盖层和常规图像的结合可以提高特异性。•特别是在术后患者中，碘覆盖可以帮助避免腹膜疾病的假阳性诊断。•仅碘覆盖层可提供比传统图像低的图像质量和可评估性，而两者的组合获得最高评分。因此，除了常规图像外，还应使用碘覆盖层，而不应使用碘覆盖层。要点•在以相当的灵敏度评估腹膜癌患者时，碘覆盖层和常规图像的结合可以提高特异性。•特别是在术后患者中，碘覆盖可以帮助避免腹膜疾病的假阳性诊断。•仅碘覆盖层可提供比传统图像低的图像质量和可评估性，而两者的组合获得最高评分。因此，除了常规图像外，还应使用碘覆盖层，而不应使用碘覆盖层。•仅碘覆盖层可提供比传统图像低的图像质量和可评估性，而两者的组合获得最高评分。因此，除常规图像外，还应使用碘覆盖层，而不应使用碘覆盖层。•仅碘覆盖层可提供比传统图像低的图像质量和可评估性，而两者的组合获得最高评分。因此，除了常规图像外，还应使用碘覆盖层，而不应使用碘覆盖层。