Multiplanar MDCT measurement of esophageal hiatus surface area: association with hiatal hernia and GERD.
Multiplanar MDCT measurement of esophageal hiatus surface area: association with hiatal hernia and GERD.
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DOI：
10.1007/s00464-015-4499-9
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发表时间：
2016-06
期刊：
影响因子：
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通讯作者：
COPDGene Investigators
中科院分区：
文献类型：
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作者：
Ouyang W;Dass C;Zhao H;Kim C;Criner G;COPDGene Investigators
准确测量食管裂孔的大小在临床上是很重要的，特别是当计划进行抗反流手术时。我们提出了一种新的方法，在体内测量食管裂孔表面积使用MDCT多平面重建。我们的目的是确定大食管裂孔面积是否与食管裂孔疝和胃食管反流病有关。我们回顾性分析了前瞻性入选COPDGene®项目的受试者。我们创建了两个试验组，一个在胸部CT上有食管裂孔疝，另一个在没有疝病史的情况下有GERD。形成匹配的对照组。我们进行了CT后处理，以确定食管裂孔的双斜平面，在该平面上手动跟踪裂孔表面积。48例疝受试者的平均裂孔面积大于匹配的对照组（6.9 cm 2 vs. 2.5 cm 2，p<0.0001），并且更可能患有GERD（42% vs. 10%，p<0.0005）。混合型（III型）疝患者的裂孔比滑动型（I型）疝患者大，滑动型疝患者的裂孔比无疝患者大（p<0.0001）。与匹配的对照组相比，55例疝阴性GERD受试者的平均食管裂孔面积并不显著更大（3.0 cm 2 vs. 2.5 cm 2，p=0.12）。由两名放射科医生获得的20个测量值显示相关性为0.93，平均差异为0.5 cm 2（p=0.20）。我们设计了一种方法来测量在体内食管裂孔表面积使用MDCT重建，并建立了正常的大小范围内的第一次。该方法有可能在术前指导抗反流手术技术的决策，并在术后评估手术结果。疝的存在与大食管裂孔和GERD相关。然而，食管裂孔面积不能识别那些没有食管裂孔疝的GERD患者。
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 if 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 post-processing to define the double oblique plane of the esophageal hiatus, on which the hiatal surface area is manually traced. 48 subjects with hernia had larger mean hiatus areas than matched controls (6.9 cm2 vs. 2.5 cm2, 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). 55 hernia-negative subjects with GERD did not have significantly larger mean hiatal areas compared to matched controls (3.0 cm2 vs. 2.5 cm2, p=0.12). 20 measurements obtained by two radiologists showed correlation of 0.93, with mean difference of 0.5 cm2 (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 pre-operatively, and assess surgical result post-operatively. Presence of hernia correlated with large hiatuses and GERD. However, hiatal area failed to identify those with GERD in the absence of hiatal hernia.