Comparison of diagnostic capability and subtypes classification for inguinal hernias between upright and supine ADCTs

PURPOSE: The purpose of this study was to directly compare diagnostic capability of inguinal herniation between upright area-detector CT (ADCT) and conventional supine ADCT under the Valsalva maneuver. MATERIALS AND METHODS: This retrospective study included 209 patients with 360 inguinal herniations and 123 patients without inguinal hernias. All patients underwent supine and upright ADCT for the evaluation of abdominal wall hernias within one week between May 2023 and March 2024. From this cohort, a total of 120 of 360 inguinal hernias and 120 of 304 non-inguinal hernias were computationally selected, and the probability of hernia was visually assessed by two board-certified general and abdominal radiologists with 5-point scales to assess subtypes of herniation. The final score for each hernia was determined as consensus of two investigators. To determine the capability of diagnosis for inguinal herniation in selected lesion groups, diagnostic performance was compared between upright and supine ADCTs using an ROC analysis. Then, sensitivity (SE), specificity (SP), and accuracy (AC) for differentiation of inguinal from non-inguinal hernias were compared between the two methods using McNemar's test. RESULTS: The area under the curve (AUC) of upright ADCT (AUC = 0.96) was significantly larger than that of supine ADCT (AUC = 0.93, p < 0.0001). Sensitivity (SE) and accuracy (AC) of upright ADCT (SE: 87.5 %, AC: 93.8 %) were significantly higher than those of supine ADCT (SE: 73.3 %, p < 0.0001; AC: 86.7 %, p < 0.0001). CONCLUSION: Upright ADCT has better potential for the diagnosis and subtype classification of inguinal herniation than conventional supine ADCT when applied under the Valsalva maneuver.