Journal article
Multiplanar MDCT measurement of esophageal hiatus surface area: association with hiatal hernia and GERD
Surgical endoscopy, Vol.30(6), pp.2465-2472
06/2016
DOI: 10.1007/s00464-015-4499-9
PMCID: PMC4767697
PMID: 26304104
Abstract
Accurate measurement of esophageal hiatus size is clinically important, especially when antireflux surgery is planned. We present a novel method for in vivo measurement of esophageal hiatal surface area using MDCT multiplanar reconstruction. We aimed to determine whether large hiatal area is associated with hiatal hernia and gastroesophageal reflux disease.
We retrospectively analyzed subjects prospectively enrolled in the COPDGene(®) project. We created two test groups, one with hiatal hernia on chest CT and one with GERD on medical treatment identified by history without hernia. Matched control groups were formed. We performed CT postprocessing to define the double-oblique plane of the esophageal hiatus, on which the hiatal surface area is manually traced.
Subjects with hernia (n = 48) had larger mean hiatus areas than matched controls (6.9 vs. 2.5 cm(2), p < 0.0001), and were more likely to have GERD (42 vs. 10 %, p < 0.0005). Subjects with mixed (type III) hernias had larger hiatuses compared to subjects with sliding (type I) hernias, who, in turn, had larger hiatuses than subjects without hernia (p < 0.0001). Hernia-negative subjects with GERD (n = 55) did not have significantly larger mean hiatal areas compared to matched controls (3.0 vs. 2.5 cm(2), p = 0.12). Twenty measurements obtained by two radiologists showed correlation of 0.93, with mean difference of 0.5 cm(2) (p = 0.20).
We devised a method to measure in vivo esophageal hiatal surface area using MDCT reconstruction and established the normal size range for the first time. This methodology has the potential to guide decision-making in antireflux surgery technique preoperatively, and assess surgical result postoperatively. The presence of hernia correlated with large hiatuses and GERD. However, hiatal area failed to identify those with GERD in the absence of hiatal hernia.
Details
- Title: Subtitle
- Multiplanar MDCT measurement of esophageal hiatus surface area: association with hiatal hernia and GERD
- Creators
- Wei Ouyang - Department of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA, 19140, USA. wei.ouyang.rad@gmail.comChandra Dass - Department of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA, 19140, USAHuaqing Zhao - Clinical Research Center, Temple University School of Medicine, Philadelphia, PA, USACynthia Kim - Department of Pulmonary and Critical Care Medicine, Temple University Hospital, Philadelphia, PA, USAGerard Criner - Department of Pulmonary and Critical Care Medicine, Temple University Hospital, Philadelphia, PA, USACOPDGene Investigators
- Contributors
- Eric A Hoffman (Contributor) - University of Iowa, Radiology
- Resource Type
- Journal article
- Publication Details
- Surgical endoscopy, Vol.30(6), pp.2465-2472
- Publisher
- Germany
- DOI
- 10.1007/s00464-015-4499-9
- PMID
- 26304104
- PMCID
- PMC4767697
- ISSN
- 0930-2794
- eISSN
- 1432-2218
- Grant note
- U01 HL089897 / NHLBI NIH HHS R01 HL089856 / NHLBI NIH HHS R01 HL089897 / NHLBI NIH HHS
- Language
- English
- Date published
- 06/2016
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Internal Medicine
- Record Identifier
- 9984051509702771
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