Related Experiment Video
Updated: Dec 27, 2025
Flexible Colonoscopy in Mice to Evaluate the Severity of Colitis and Colorectal Tumors Using a Validated Endoscopic Scoring System
Published on: October 16, 2013
CT colonography has low sensitivity but high specificity in the detection of internal hemorrhoids
Lukas Lambert1, Jiri Jahoda1, Gabriela Grusova2
1Department of Radiology, First School of Medicine Charles University and General University Hospital in Prague, Prague, Czech Republic.
Insights
Computed tomography colonography (CTC) shows low sensitivity but high specificity for detecting internal hemorrhoids. A prominent anal verge in the supine position is the best predictor of hemorrhoids.
Area of Science:
- Gastroenterology
- Radiology
- Medical Imaging
Background:
- Internal hemorrhoids are a common condition affecting the rectum.
- Accurate diagnosis is crucial for effective management.
- Computed tomography colonography (CTC) is an imaging modality with potential for evaluating rectal pathology.
Purpose of the Study:
- To assess the diagnostic performance of computed tomography colonography (CTC) in identifying internal hemorrhoids.
- To compare the diagnostic accuracy between radiologists and gastroenterologists using CTC for hemorrhoid detection.
Main Methods:
- Retrospective analysis of CTC scans from patients with and without confirmed internal hemorrhoids.
- Evaluation of endoluminal and transaxial CTC views for specific hemorrhoid indicators by radiologists and gastroenterologists.
- Comparison of diagnostic performance metrics including sensitivity, specificity, and AUC.
Main Results:
- CTC demonstrated low sensitivity (0.61) but high specificity (0.69) for internal hemorrhoid detection.
- Specificity increased to 0.89 when only highly confident ratings were considered.
- A prominent anal verge in the supine position was the strongest predictor of hemorrhoids (OR=1.789).
Conclusions:
- CTC offers high specificity but limited sensitivity for diagnosing internal hemorrhoids.
- Radiologist and gastroenterologist performance varied, with radiologists showing higher specificity.
- The supine position and anal verge prominence are key indicators in CTC assessment of internal hemorrhoids.
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.
More Related Videos
05:45Diagnosis of Hirschsprung's Disease by Immunostaining Rectal Suction Biopsies for Calretinin, S100 Protein and Protein Gene Product 9.5
Published on: April 26, 2019
03:43Structured Approach to Colonoscopy Technique Optimization: A Single-Center Experience with Novice Endoscopists
Published on: July 11, 2025
Related Concept Videos
01:25Assessment of the Rectum and Anus
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...
01:26Imaging Studies III: Gastrointestinal Motility Studies and Virtual Colonoscopy
Radionuclide Testing
Radionuclide testing is a sophisticated medical technique for assessing gastrointestinal motility. It focuses on gastric emptying and colonic transit time. Radioactive markers track the movement of food through the digestive system, providing insights into gastrointestinal disorders.
In gastric emptying studies, a meal's liquid and...
01:25Endoscopic Procedures II: Colonoscopy
01:30Irritable Bowel Syndrome II: Clinical Features and Diagnostic Evaluation
Irritable Bowel Syndrome (IBS) is classified into subtypes based on the predominant bowel habits as determined by the Bristol Stool Form Scale (BSFS). The subtypes are:
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:30Serum Laboratory Studies, Stool Test, Breath Test