Evaluation of gastroeosophagial junction in hiatal herniation with MDCT

Purpose: In this retrospective study, our aim is to evaluate the relation between crural thickness, His angle, hiatus area and hiatal hernia, in patients who underwent thoracal or abdominal CT and had endoscopic diagnosis of hiatal hernia. Material-metod: Between February 2010 and February 2016, patients who had both upper gastrintestinal system endoscopy and enhanced or non-enhanced thoracal or abdominal CT containing gastroeosophagial junction were searched from HIS and RIS. Patients whose endoscopy were performed by the same clinician were selected from this group. CT examinations were evaluated by two radiologists who had four and ten years experience. The readers who had no information about the endoscopy reports measured crural thickness, His angle and hiatus area independently. Measurements of two readers for patient and control groups and interobserver variability were analysed statistically Results: Eighty six (42 in patient group, 44 in control group) of 93 patients who had endoscopy and CT were included in this study.There was no significant difference in right and left crural thicknesses at celiac and L1 vertebrae levels between measurements' of two readers in patient and control groups (First reader; celiac level; right:p=0,481, left:p=0,893, L1 vertebrae level; right p=0,289, left: p=0,941; second reader; celiac level; right:p=0,089, left: p=0,463, L1 vertebrae level; right:p=0,082, left: p=0,830). There was significant difference in His angle and hiatus area between two goups respectively (first reader; p=0,007, p<0,0001, second reader; p=0,021, p=0,014). There was high positive correlation in crural thicknesses at celiac level between two readers (patient group; right: r =0,811, left: r =0,824; control group; right: r =0,781, left: r =0,718), while there was moderate positive correlation in crural thicknesses at L1 vertebrae level (patient group; right: r =0,665, left: r =0,744; control group; right: r =0,578, left: r =0,570). In both groups, there was weak positive correlation for His angle between two readers (patient group; r v =0,427; control group; r =0,336). There was weak positive correlation in patient group (r=309) and high positive correlation in control group (r=704) for hiatus area between two readers. Conclution: In our study, hiatus area and His angle of hiatal hernia patients were found to be significantly different compared to control group. Although there was significant difference between patient and control groups in His angle, there was only weak positive correlation between two readers. No significant difference was detected in crural thickness between two groups. Keywords: Hiatal hernia, hiatus area, diaphragmatic crus, computed tomography, His angle, endoscopy