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Detection of groin hernia with physical examination, ultrasound, and MRI compared with laparoscopic findings.

van den Berg JC, de Valois JC, Go PM, Rosenbusch G. Invest Radiol 1999 Dec;34(12):739-43.

OBJECTIVE.
To determine the diagnostic accuracy of physical examination, ultrasound, and dynamic MRI in patients with inguinal hernia.

METHODS.
In 41 patients with clinically evident herniations, 82 groins were evaluated using a standard ultrasound and MRI protocol, the latter including T1- and T2-weighted sequences as well as two dynamic sequences. All ultrasound examinations and MRI scans were reviewed without knowledge of clinical findings. In all cases, correlation with findings at laparoscopic surgery was made.

RESULTS.
At surgery, 55 inguinal herniations were found. Physical examination revealed 42 herniations (one false-positive finding), whereas ultrasound made the diagnosis of a hernia in 56 cases (five false-positive and four false-negative findings). MRI diagnosed 53 herniations (one false-positive and three false-negative findings). Thus, sensitivity and specificity figures were 74.5% and 96.3% for physical examination, 92.7% and 81.5% for ultrasound, and 94.5% and 96.3% for MRI.

CONCLUSIONS.
In patients with clinically uncertain herniations, MRI is a valid diagnostic tool with a high positive predictive value.

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