Comparison of CT and PET for Detecting Peritoneal Metastasis on the Preoperative Evaluation for Gastric Carcinoma

Objective: The aim of our study was to compare the accuracy of CT and $^{18}F-FDG$ PET for detecting peritoneal metastasis in patients with gastric carcinoma. Materials and Methods: One-hundred-twelve patients who underwent a histologic confirmative exam or treatment (laparotomy, n=107; diagnostic laparoscopy, n=4; peritoneal washing cytology, n=1) were retrospectively enrolled. All the patients underwent CT and $^{18}F-FDG$ PET scanning for their preoperative evaluation. The sensitivities, specificities and accuracies of CT and $^{18}F-FDG$ PET imaging for the detection of peritoneal metastasis were calculated and then compared using Fisher's exact probability test (p<0.05), on the basis of the original preoperative reports. In addition, two board-certified radiologists and two board-certified nuclear medicine physicians independently reviewed the CT and PET scans, respectively. A receiver-operating characteristic curve analysis was performed to compare the diagnostic performance of CT and $^{18}F-FDG$ PET imaging for detecting peritoneal metastasis. Results: Based on the original preoperative reports, CT and $^{18}F-FDG$ PET showed sensitivities of 76.5% and 35.3% (p=0.037), specificities of 91.6% and 98.9% (p=0.035), respectively, and equal accuracies of 89.3% (p=1.0). The receptor operating characteristics curve analysis showed a significantly higher diagnostic performance for CT (Az=0.878) than for PET (Az=0.686) (p=0.004). The interobserver agreement for detecting peritoneal metastasis was good (${\kappa}$ value = 0.684) for CT and moderate (${\kappa}$ value = 0.460) for PET. Conclusion: For the detection of peritoneal metastasis, CT was more sensitive and showed a higher diagnostic performance than PET, although CT had a relatively lower specificity than did PET.