ArticleHernia : the journal of hernias and abdominal wall surgery2025
Evaluation of radiologists' accuracy and interrater reliability when interpreting CT scans after ventral hernia repair.
Article in Hernia : the journal of hernias and abdominal wall surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAccurate interpretation of computed tomography (CT) prior to ventral hernia repair (VHR) is critical for operative planning, particularly in recurrent cases where prior mesh type and placement influence surgical approach. While radiologists possess specialized expertise in imaging interpretation, their performance in identifying post-VHR mesh characteristics remains unstudied. This study assesses the diagnostic performance of radiologists in identifying mesh plane and type on CT following VHR.
methodsForty body radiologists from 16 centers evaluated 18 de-identified CT scans, including 12 post-VHR cases and 6 controls. After receiving standardized training on mesh characteristics and surgical planes, radiologists were tasked with identifying both the VHR mesh plane and the mesh type. The study assessed correct identification rates, interrater reliability, and repeatability.
resultsRadiologists demonstrated overall accuracy rates of 39.2% for mesh plane identification and 43.5% for mesh type identification. Accuracy was highest for intraperitoneal approaches (53.8%) and heavy-weight mesh (52.5%), with significantly lower accuracy (16.9-22.5%) for other surgical planes and mesh types (30.6%). Interrater reliability was poor (Gwet's AC1 = 0.127), with significant between-radiologist variability. Self-reported confidence levels correlated positively with accuracy rates, with high-confidence radiologists showing significantly better performance (OR 4.55, p < 0.001). Years of clinical experience did not predict diagnostic accuracy.
conclusionsRadiologists demonstrated limited ability to accurately interpret post-VHR CT scans, even after targeted instruction. These diagnostic challenges mirror findings among abdominal wall reconstruction surgeons, suggesting inherent limitations in CT-based assessment rather than discipline-specific deficits. Multidisciplinary collaboration, standardized operative documentation, and dedicated abdominal wall imaging protocol and training are essential to improve diagnostic accuracy and optimize surgical planning.
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