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Radiologist Performance in the Diagnosis of Internal Hernia by Using Specific CT Findings with Emphasis on Transmesenteric Hernia¹

¹ From the Departments of Radiology (A.B., M.P.F., G.B., M.S.P., J.H.O.) and Biostatistics (W.L.), University of Pittsburgh Medical Center, 200 Lothrop St, Rm 4660 CHP MT, Pittsburgh, PA 15213-2582. Received December 7, 2000; revision requested January 11, 2001; final revision received May 23; accepted June 6. Address correspondence to M.P.F. (e-mail: federle@pitt.edu).

PURPOSE: To evaluate the performance of radiologists in the diagnosis of internal hernia with specific computed tomographic (CT) findings.

MATERIALS AND METHODS: Abdominal CT scans obtained in 42 patients were retrospectively reviewed by three radiologists. The case group consisted of 18 patients with internal hernias (two paraduodenal, 16 transmesenteric); the comparison group was 24 patients with no internal hernia. Images were reviewed in a random and blinded fashion. Individual and group performance was evaluated with receiver operating characteristic (ROC) analysis, and interobserver agreement was measured with Cronbach coefficient . Individual CT signs relevant as predictors of transmesenteric hernia were identified with logistic regression analysis and ranked by their odds ratio and P values.

RESULTS: Both paraduodenal hernias were diagnosed by all readers on the basis of CT signs, including a retrogastric saclike mass of small-bowel loops. Diagnosis of transmesenteric hernia was more difficult and variable, with an average accuracy of area under the ROC curve (A_z) of 77%, sensitivity of 63%, and specificity of 76%. CT signs of transmesenteric hernia were recognized consistently (Cronbach coefficient 0.80) and included a cluster of dilated small-bowel segments and stretching and displacement of mesenteric vessels. Coexisting volvulus and ischemia were diagnosed with low sensitivity (46% and 43%, respectively) but high specificity (96% and 98%, respectively).

CONCLUSION: Diagnosis of internal hernia with CT remains difficult. Special attention should be given to the clustering of bowel loops, the mesenteric vessels, and signs of small-bowel obstruction.

Index terms: Diagnostic radiology, observer performance • Intestines, CT, 74.12112, 74.12115 • Intestines, hernia, 74.158 • Mesentery, 792.158 • Mesentery, CT, 792.12112, 792.12115

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