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Objective <p>This study aimed to evaluate the diagnostic accuracy of contrast-enhanced CT in detecting peritoneal metastasis from colorectal cancer, using surgical and pathological findings as the reference standard, and to identify an optimal diagnostic threshold through receiver operating characteristic (ROC) analysis.</p> Background <p>Accurate preoperative detection of peritoneal metastasis in colorectal cancer patients is crucial for treatment planning and prognosis assessment. Contrast-enhanced computed tomography (CE-CT) is the most widely used imaging modality, but its diagnostic performance requires further validation.</p> Methods <p>This retrospective diagnostic accuracy study enrolled 150 consecutive colorectal cancer patients who underwent surgical treatment between January 1st, 2017, and July 31st, 2025. All patients underwent preoperative CE-CT, with surgical exploration and histopathological examination serving as the reference standard. Diagnostic performance metrics including sensitivity, specificity, and accuracy were calculated. ROC curve analysis was performed to determine optimal diagnostic thresholds.</p> Results <p>Among 150 patients (mean age 65.7 ± 11.0 years; 59.3% male), 66 (44.0%) had confirmed peritoneal metastasis. CE-CT demonstrated sensitivity of 73.0% (95% CI: 60.0–83.0%), specificity of 81.0% (95% CI: 71.0–89.0%), and overall accuracy of 77.3% (95% CI: 70.0–84.0%). ROC analysis revealed an AUC of 0.92 (95% CI: 0.88–0.96), with an optimal CT score threshold of 0.415, yielding sensitivity of 93.9% and specificity of 82.1%. Subgroup analysis showed significantly higher sensitivity for lesions ≥1&#xa0;cm (91.9%) compared to smaller lesions (72.7%, <i>p</i> = 0.012). Ascites severity and omental changes were significantly associated with peritoneal metastasis (<i>p</i> &lt; 0.001 and <i>p</i> = 0.045, respectively).</p> Conclusion <p>Contrast-enhanced CT demonstrates good diagnostic performance for detecting peritoneal metastasis in colorectal cancer patients, particularly for larger lesions and those with significant ascites. The optimal CT score threshold of 0.415 provides excellent sensitivity while maintaining reasonable specificity, suggesting potential clinical utility for preoperative assessment.</p>

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Diagnostic value of contrast-enhanced CT in detecting peritoneal metastasis from colorectal cancer: a comparative study with surgical and pathological findings

  • 期刊论文

  • 发表日期：

    2026年2月16日

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  • Wei Li,
  • Wei Wen,
  • Yusen Xiao

摘要

Objective

This study aimed to evaluate the diagnostic accuracy of contrast-enhanced CT in detecting peritoneal metastasis from colorectal cancer, using surgical and pathological findings as the reference standard, and to identify an optimal diagnostic threshold through receiver operating characteristic (ROC) analysis.

Background

Accurate preoperative detection of peritoneal metastasis in colorectal cancer patients is crucial for treatment planning and prognosis assessment. Contrast-enhanced computed tomography (CE-CT) is the most widely used imaging modality, but its diagnostic performance requires further validation.

Methods

This retrospective diagnostic accuracy study enrolled 150 consecutive colorectal cancer patients who underwent surgical treatment between January 1st, 2017, and July 31st, 2025. All patients underwent preoperative CE-CT, with surgical exploration and histopathological examination serving as the reference standard. Diagnostic performance metrics including sensitivity, specificity, and accuracy were calculated. ROC curve analysis was performed to determine optimal diagnostic thresholds.

Results

Among 150 patients (mean age 65.7 ± 11.0 years; 59.3% male), 66 (44.0%) had confirmed peritoneal metastasis. CE-CT demonstrated sensitivity of 73.0% (95% CI: 60.0–83.0%), specificity of 81.0% (95% CI: 71.0–89.0%), and overall accuracy of 77.3% (95% CI: 70.0–84.0%). ROC analysis revealed an AUC of 0.92 (95% CI: 0.88–0.96), with an optimal CT score threshold of 0.415, yielding sensitivity of 93.9% and specificity of 82.1%. Subgroup analysis showed significantly higher sensitivity for lesions ≥1 cm (91.9%) compared to smaller lesions (72.7%, p = 0.012). Ascites severity and omental changes were significantly associated with peritoneal metastasis (p < 0.001 and p = 0.045, respectively).

Conclusion

Contrast-enhanced CT demonstrates good diagnostic performance for detecting peritoneal metastasis in colorectal cancer patients, particularly for larger lesions and those with significant ascites. The optimal CT score threshold of 0.415 provides excellent sensitivity while maintaining reasonable specificity, suggesting potential clinical utility for preoperative assessment.