MRI Pelvis No specific data are available relative to the sensitivity, specificity, or accuracy of MRI in the diagnosis of deep pelvic hernias. However, case reports demonstrate efficacy, particularly in patients with orthopedic instrumentation limiting CT imaging [54]. There are no specific data differentiating diagnostic efficacy of IV contrast versus noncontrast examination. However, the modality would be able to depict the anatomy, and theoretically, visualize a hernia. The specific performance attributes are unknown. Radiography Abdomen and Pelvis There is no relevant literature regarding the use of KUB in the evaluation of deep pelvic hernia. However, there may be utility if there is a concern for bowel obstruction. US Pelvis There is no relevant literature regarding the use of US of the pelvis in the evaluation of deep pelvic hernia. Variant 4: Suspected diaphragmatic hernia including traumatic, Bochdalek, or Morgagni. Initial imaging. Diaphragmatic hernias are rare and diagnosis may be difficult despite high -resolution multiplanar imaging techniques. Congenital, traumatic, and iatrogenic etiologies are evaluated primarily with CT and MRI. Congenital, Bochdalek and Morgagni hernias are most often diagnosed in the prenatal or neonatal period because o f abnormalities detected on obstetric US. Diagnosis of traumatic diaphragmatic rupture with herniation of abdominal contents into the thorax is often delayed because of subtle initial imaging findings and late herniation of abdominal contents into the thorax. Congenital diaphragmatic hernias are rare, occurring in approximately 1 per 2,000 pregnancies with 5% Morgagni and 90% Bochdalek hernias [55]. Most are diagnosed on prenatal imaging and present in the neonatal period with cardiorespiratory compromise and are surgically corrected. Bochdalek hernias are the result of improper fusion of the septum transversarium and pleuroperitoneal fo lds and are present in 1:2 ,200 to 12 ,500 live births [56,57] .
Hernia. MRI Pelvis No specific data are available relative to the sensitivity, specificity, or accuracy of MRI in the diagnosis of deep pelvic hernias. However, case reports demonstrate efficacy, particularly in patients with orthopedic instrumentation limiting CT imaging [54]. There are no specific data differentiating diagnostic efficacy of IV contrast versus noncontrast examination. However, the modality would be able to depict the anatomy, and theoretically, visualize a hernia. The specific performance attributes are unknown. Radiography Abdomen and Pelvis There is no relevant literature regarding the use of KUB in the evaluation of deep pelvic hernia. However, there may be utility if there is a concern for bowel obstruction. US Pelvis There is no relevant literature regarding the use of US of the pelvis in the evaluation of deep pelvic hernia. Variant 4: Suspected diaphragmatic hernia including traumatic, Bochdalek, or Morgagni. Initial imaging. Diaphragmatic hernias are rare and diagnosis may be difficult despite high -resolution multiplanar imaging techniques. Congenital, traumatic, and iatrogenic etiologies are evaluated primarily with CT and MRI. Congenital, Bochdalek and Morgagni hernias are most often diagnosed in the prenatal or neonatal period because o f abnormalities detected on obstetric US. Diagnosis of traumatic diaphragmatic rupture with herniation of abdominal contents into the thorax is often delayed because of subtle initial imaging findings and late herniation of abdominal contents into the thorax. Congenital diaphragmatic hernias are rare, occurring in approximately 1 per 2,000 pregnancies with 5% Morgagni and 90% Bochdalek hernias [55]. Most are diagnosed on prenatal imaging and present in the neonatal period with cardiorespiratory compromise and are surgically corrected. Bochdalek hernias are the result of improper fusion of the septum transversarium and pleuroperitoneal fo lds and are present in 1:2 ,200 to 12 ,500 live births [56,57] .