Diagnostic and Interventional Radiology
Abdominal Radiology - Original Article
CT colonography has low sensitivity but high specificity in the detection of internal hemorrhoids

CT colonography has low sensitivity but high specificity in the detection of internal hemorrhoids

1.

Department of Radiology, First School of Medicine Charles University and General University Hospital in Prague, Prague, Czech Republic

2.

Fourth Department of Medicine, First School of Medicine Charles University and General University Hospital in Prague, Prague, Czech Republic

Diagn Interv Radiol 2020; 26: 82-86
DOI: 10.5152/dir.2019.19098
Read: 207 Downloads: 160 Published: 03 September 2019

PURPOSE

We aimed to evaluate the diagnostic performance of computed tomography colonography (CTC) in the detection of internal hemorrhoids.

 

METHODS

Three gastroenterologists systematically reported on the presence of internal hemorrhoids in patients with incomplete colonoscopy, for whom they considered a subsequent CTC. For 44 patients with internal hemorrhoids revealed by optical colonoscopy, an age- and gender-matched cohort of 66 patients with normal findings in the rectum was selected. Endoluminal and transaxial CTC views of the rectum were evaluated for the presence of internal hemorrhoids, the anal verge prominence, asymmetry, and cushion-like appearance on a Likert scale by two experienced radiologists and two gastroenterologists.

 

RESULTS

The sensitivity, specificity, and AUC for identification of internal hemorrhoids were 0.61 (95% CI, 0.53–0.68), 0.69 (95% CI, 0.63–0.75) and 0.66 (95% CI, 0.62–0.70), respectively. The radiologists showed a better specificity, the gastroenterologists a slightly better sensitivity. When only the rating “very likely” was considered as positive, the specificity rose to 0.89 (95% CI, 0.81–0.94) with a sensitivity of 0.50 (95% CI, 0.38–0.62). The interobserver agreement was fair. The best predictor of the presence of hemorrhoids was a prominent anal verge in the supine position (OR=1.789, 95% CI, 1.267–2.525). The difference between supine and prone positions in the evaluated features in patients with internal hemorrhoids was not significant.

 

CONCLUSION

CTC has low sensitivity but high specificity in the detection of internal hemorrhoids, if the rater is confident in detecting them. Internal hemorrhoids do not substantially change their shape between prone and supine positions.
 

You may cite this article as: Lambert L, Jahoda J, Grusova G, Hrabak P, Novotny A, Burgetova A. CT colonography has low sensitivity but high specificity in the detection of internal hemorrhoids. Diagn Interv Radiol 2020; 26:82–86.

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