In vivo measurement of esophageal hiatus surface area using MDCT: description of the methodology and clinical validation

  • Ambria S. MotenEmail author
  • Wei Ouyang
  • Sana Hava
  • Huaqing Zhao
  • Dina Caroline
  • Abbas Abbas
  • Chandra Dass
Hollow Organ GI



Accurate estimation of esophageal hiatus surface area (HSA) prior to surgical repair of hiatal hernia is difficult. The ability to do so may assist with following progression of hiatal hernias, choosing the optimal surgical approach and post-surgical evaluation. We developed a method for measurement of HSA using multi-planar reconstruction (MPR) of multi-detector computed tomography (MDCT) scans and sought to validate our method using intra-operative HSA measurements.


Patients with thoracic or abdominal CT scans who were scheduled to undergo hiatal hernia repair were identified. A radiologist performed MPR of each MDCT scan to obtain the measured HSA (mHSA). Estimated HSA (eHSA) was obtained using intra-operative measurements of crura length and distance between crural edges. The association between eHSA and the corresponding mHSA was assessed using Pearson correlation. The intra-class correlation coefficient was calculated to assess both intra-observer and inter-observer agreement for the MDCT–MPR technique.


Of 30 subjects included, 16 (53.3%) were female and the median age was 68.5 years. All patients underwent robotic-assisted laparoscopic hiatal hernia repair. The median HSA was 8.1 cm2 based on intra-operative measurements and 9.9 cm2 based on CT measurements. The correlation coefficient for eHSA and corresponding mHSA was 0.83 (p < 0.001). The intra-class correlation coefficient was 0.97 (p < 0.001) for intra-observer agreement and 0.97 (p < 0.001) for inter-observer agreement.


We developed a MDCT–MPR technique that measures HSA in vivo. This technique is reproducible and can be used for pre-operative planning and post-operative follow-up of patients with symptomatic hiatal hernia.


CT Multi-detector CT Multi-planar reconstruction Esophageal hiatus Hiatal surface area Hiatal hernia 


Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Temple University Institutional Review Board; protocol # 24196) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

261_2019_2279_MOESM1_ESM.docx (1.6 mb)
Supplementary material 1 (DOCX 1618 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Ambria S. Moten
    • 1
    Email author
  • Wei Ouyang
    • 2
  • Sana Hava
    • 2
  • Huaqing Zhao
    • 3
  • Dina Caroline
    • 2
  • Abbas Abbas
    • 4
  • Chandra Dass
    • 2
  1. 1.Department of SurgeryTemple University HospitalPhiladelphiaUSA
  2. 2.Department of Clinical RadiologyLewis Katz School of Medicine at Temple UniversityPhiladelphiaUSA
  3. 3.Department of Clinical SciencesLewis Katz School of Medicine at Temple UniversityPhiladelphiaUSA
  4. 4.Department of Thoracic Medicine and SurgeryLewis Katz School of Medicine at Temple UniversityPhiladelphiaUSA

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