Jaffe Tracy A, O'Connell Martin J, Harris John P, Paulson Erik K, Delong David M
Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA.
AJR Am J Roentgenol. 2005 Mar;184(3):847-51. doi: 10.2214/ajr.184.3.01840847.
Our objective was to evaluate the role of Valsalva's maneuver during MDCT for the diagnosis and characterization of abdominal wall hernias.
From September 2002 to May 2003, 100 consecutive patients (37 men and 63 women; mean age, 53 years) with suspected anterior abdominal wall hernias underwent 4-, 8-, or 16-MDCT with and without Valsalva's maneuver. Patients received both oral and IV contrast material. On a workstation, three independent reviewers evaluated each scan obtained during rest and during Valsalva's maneuver for the following parameters: anteroposterior (AP) diameter of the abdomen; presence, location, and contents of the hernia; and transverse diameter of the fascial defect. The scans were compared to assess for changes in hernia size and contents and to determine whether the hernia would have been overlooked without Valsalva's maneuver. Fisher's exact test, the McNemar test, and Cohen's kappa coefficient were used to assess for significant differences.
The three reviewers identified a mean of 72 abdominal wall hernias (72%). The reviewers agreed (kappa = 0.723) with respect to the presence of a hernia. AP diameters increased an average of 1.33 cm during Valsalva's maneuver (p < 0.001). The transverse diameter of the fascial defect increased an average of 0.66 cm and the AP diameter of the hernia sac increased an average of 0.79 cm during Valsalva's maneuver (p < 0.001). Fifty percent of the hernias became more apparent with Valsalva's maneuver. Ten percent of the hernias could be detected only on the scan obtained during Valsalva's maneuver. Conversely, in no patients was the hernia detected only on the rest scan.
As opposed to scans obtained at rest, scans obtained during Valsalva's maneuver aid in the detection and characterization of suspected abdominal wall hernias. A single scan obtained during Valsalva's maneuver is sufficient to detect 100% of anterior abdominal wall hernias identified on CT.
我们的目的是评估瓦氏动作在多层螺旋CT（MDCT）检查中对腹壁疝的诊断及特征描述的作用。
2002年9月至2003年5月，100例连续的疑似前腹壁疝患者（37例男性，63例女性；平均年龄53岁）接受了4排、8排或16排MDCT检查，检查时分别进行了瓦氏动作及未进行瓦氏动作。患者同时接受了口服和静脉造影剂。在工作站上，三名独立的阅片者对静息期及瓦氏动作期获得的每幅扫描图像评估以下参数：腹部前后径；疝的存在、位置及内容物；筋膜缺损的横径。对扫描图像进行比较，以评估疝大小及内容物的变化，并确定若不进行瓦氏动作，疝是否会被漏诊。采用Fisher确切概率检验、McNemar检验及Cohen κ系数评估显著差异。
三名阅片者共识别出72例腹壁疝（72%）。阅片者在疝的存在方面达成一致（κ = 0.723）。在瓦氏动作期间，腹部前后径平均增加1.33 cm（p < 0.001）。在瓦氏动作期间，筋膜缺损的横径平均增加0.66 cm，疝囊的前后径平均增加0.79 cm（p < 0.001）。50%的疝在瓦氏动作时变得更明显。10%的疝仅在瓦氏动作期获得的扫描图像上才能被检测到。相反，没有患者的疝仅在静息期扫描图像上被检测到。
与静息期获得的扫描图像相比，瓦氏动作期获得的扫描图像有助于检测和描述疑似腹壁疝。在瓦氏动作期获得的单次扫描图像足以检测出CT上识别出的100%的前腹壁疝。
