Cowlam S, Vinayagam R, Khan U, Marsden S, Minty I, Moncur P, Bain I, Yiannakou Y J
Sunderland Royal Hospital, Sunderland, UK.
Clin Radiol. 2008 Dec;63(12):1326-31. doi: 10.1016/j.crad.2008.06.011. Epub 2008 Aug 28.
To compare faecal loading on plain radiography versus radio-opaque marker transit studies in the assessment of constipation.
The study group was a convenience sample of patients attending the Durham Constipation Clinic. All patients underwent transit studies according to an established protocol, and severity of constipation was assessed contemporaneously using a validated questionnaire (PAC-SYM). Transit studies were performed using radio-opaque markers that were ingested over 3 consecutive days, with a radiograph taken on the fourth day. Digital images of the radiograph were digitally altered to remove all traces of the transit markers without affecting the underlying pattern of faecal loading. Four observers assessed faecal loading independently; two clinicians (C1 and C2) and two radiologists (R1 and R2). C1 and R1 used a previously described formal scoring method of assessing faecal loading, whereas C2 and R2 assessed the images as if they were in a clinic or reporting session, grading the faecal loading as mild, moderate, or severe.
One hundred patients were recruited out of 186 presenting in a 2-year period. All patients completed assessments. The correlation between observers was only fair to moderate (r ranging from 0.34-0.51). There were some surprisingly marked disagreements in 10-18% of assessments. The correlation between faecal loading and transit was weak for all observers (r ranging from 0.261-0.311). Symptom severity did not correlate with faecal loading.
These results suggest that there is considerable inter-observer variation in the radiological assessment of faecal loading, irrespective of the training or method used by the observer, and that there is very poor correlation with colonic transit. The diagnosis of constipation, and the assessment of severity, is best performed clinically.
比较在便秘评估中，普通X线片上的粪便积聚情况与不透X线标志物转运研究的结果。
研究组为达勒姆便秘诊所的便利样本患者。所有患者均按照既定方案进行转运研究，并同时使用经过验证的问卷（PAC-SYM）评估便秘的严重程度。转运研究使用连续3天摄入的不透X线标志物，第4天拍摄X线片。对X线片的数字图像进行数字处理，以去除转运标志物的所有痕迹，同时不影响粪便积聚的基本模式。四名观察者独立评估粪便积聚情况；两名临床医生（C1和C2）和两名放射科医生（R1和R2）。C1和R1使用先前描述的评估粪便积聚的正式评分方法，而C2和R2则像在诊所或报告会议中那样评估图像，将粪便积聚程度分为轻度、中度或重度。
在2年期间就诊的186名患者中招募了100名患者。所有患者均完成评估。观察者之间的相关性仅为中等（r值范围为0.34 - 0.51）。在10% - 18%的评估中存在一些惊人的显著差异。所有观察者的粪便积聚与转运之间的相关性都很弱（r值范围为0.261 - 0.311）。症状严重程度与粪便积聚无关。
这些结果表明，无论观察者的培训或使用的方法如何，在粪便积聚的放射学评估中观察者之间存在相当大的差异，并且与结肠转运的相关性非常差。便秘的诊断和严重程度评估最好在临床上进行。
