Diagnostic performance of CT with Valsalva maneuver for the diagnosis and characterization of inguinal hernias,Hernia

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Diagnostic performance of CT with Valsalva maneuver for the diagnosis and characterization of inguinal hernias
Hernia ( IF 2.6 ) Pub Date : 2023-07-06 , DOI: 10.1007/s10029-023-02830-y
S Ghafoor ₁ , A Tognella ₁ , D Stocker ₁ , A M Hötker ₁ , M Kaniewska ₁ , T Sartoretti ₁ , A Euler ₁ , R Vonlanthen ₂ , M Bueter ₂ , H Alkadhi ₁

Affiliation

Purpose

Inguinal hernias are mainly diagnosed clinically, but imaging can aid in equivocal cases or for treatment planning. The purpose of this study was to evaluate the diagnostic performance of CT with Valsalva maneuver for the diagnosis and characterization of inguinal hernias.

Methods

This single-center retrospective study reviewed all consecutive Valsalva-CT studies between 2018 and 2019. A composite clinical reference standard including surgery was used. Three blinded, independent readers (readers 1–3) reviewed the CT images and scored the presence and type of inguinal hernia. A fourth reader measured hernia size. Interreader agreement was quantified with Krippendorff’s α coefficients. Sensitivity, specificity, and accuracy of Valsalva-CT for the detection of inguinal hernias was computed for each reader.

Results

The final study population included 351 patients (99 women) with median age 52.2 years (interquartile range (IQR), 47.2, 68.9). A total of 381 inguinal hernias were present in 221 patients. Sensitivity, specificity, and accuracy were 85.8%, 98.1%, and 91.5% for reader 1, 72.7%, 92.5%, and 81.8% for reader 2, and 68.2%, 96.3%, and 81.1% for reader 3. Hernia neck size was significantly larger in cases correctly detected by all three readers (19.0 mm, IQR 13, 25), compared to those missed by all readers (7.0 mm, IQR, 5, 9; p < 0.001). Interreader agreement was substantial (α = 0.723) for the diagnosis of hernia and moderate (α = 0.522) for the type of hernia.

Conclusion

Valsalva-CT shows very high specificity and high accuracy for the diagnosis of inguinal hernia. Sensitivity is only moderate which is associated with missed smaller hernias.

中文翻译：

CT 结合 Valsalva 动作对腹股沟疝的诊断和表征的诊断性能

目的

腹股沟疝气主要通过临床诊断，但影像学检查可以帮助诊断模棱两可的病例或制定治疗计划。本研究的目的是评估 CT 结合 Valsalva 动作对腹股沟疝的诊断和表征的诊断性能。

方法

这项单中心回顾性研究回顾了 2018 年至 2019 年间所有连续的 Valsalva-CT 研究。使用了包括手术在内的复合临床参考标准。三名盲法独立读者（读者 1-3）审查了 CT 图像，并对腹股沟疝的存在和类型进行评分。第四位读者测量了疝气的大小。读者间一致性通过 Krippendorff 的 α 系数进行量化。计算每位读者的 Valsalva-CT 检测腹股沟疝气的敏感性、特异性和准确性。

结果

最终研究人群包括 351 名患者（99 名女性），中位年龄 52.2 岁（四分位距 (IQR)，47.2，68.9）。221 名患者共有 381 处腹股沟疝。读数器 1 的敏感性、特异性和准确性分别为 85.8%、98.1% 和 91.5%，读数器 2 的敏感性、特异性和准确性分别为 72.7%、92.5% 和 81.8%，读数器 3 的敏感性、特异性和准确性分别为 68.2%、96.3% 和 81.1%。疝颈大小与所有读取器漏检的情况（7.0 毫米，IQR，5、9；p < 0.001）相比，所有三个读取器正确检测到的情况（19.0 毫米，IQR 13、25）明显更大。读者间对于疝气的诊断的一致性很高（α = 0.723），对于疝气的类型的一致性中等（α = 0.522）。