Baucom Rebeccah B, Beck William C, Holzman Michael D, Sharp Kenneth W, Nealon William H, Poulose Benjamin K
Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Am Surg. 2014 Jul;80(7):720-2.
Patients with incisional hernias or abdominal pain are frequently referred with abdominal computed tomography (CT) scans. The purpose of this study was to determine the sensitivity and specificity of a CT radiology report for the detection of incisional hernias. General surgery patients with a history of an abdominal operation and a recent viewable abdominal CT scan were enrolled prospectively. Patients with a stoma, fistula, or soft tissue infection were excluded. The results of the radiology reports were compared with blinded, surgeon-interpreted CT for each patient. Testing characteristics including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. One hundred eighty-one patients were enrolled with a mean age of 54 years. Sixty-eight per cent were women. Hernia prevalence was 55 per cent, and mean hernia width was 5.2 cm. The radiology report had a sensitivity and specificity of 79 per cent and 94 per cent, respectively, for hernia diagnosis. The PPV and NPV were 94 and 79 per cent, respectively. Reliance on the CT report alone underestimates the presence of incisional hernia. Referring physicians should not use CT as a screening modality for detection of hernias. Referral to a surgeon for evaluation before imaging may provide more accurate diagnosis and potentially decrease the cost of caring for this population.
患有切口疝或腹痛的患者经常会接受腹部计算机断层扫描（CT）检查。本研究的目的是确定CT放射学报告对检测切口疝的敏感性和特异性。前瞻性纳入有腹部手术史且近期有可查看腹部CT扫描的普通外科患者。排除有造口、瘘管或软组织感染的患者。将放射学报告的结果与每位患者经外科医生盲法解读的CT结果进行比较。计算包括敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）在内的检测特征。共纳入181例患者，平均年龄54岁。68%为女性。疝患病率为55%，平均疝宽度为5.2厘米。放射学报告对疝诊断的敏感性和特异性分别为79%和94%。PPV和NPV分别为94%和79%。仅依靠CT报告低估了切口疝的存在。转诊医生不应将CT用作检测疝的筛查方式。在进行影像学检查前转诊给外科医生进行评估可能会提供更准确的诊断，并有可能降低该人群的护理成本。
