Ott D J, Abernethy W B, Chen M Y, Wu W C, Gelfand D W
Department of Radiology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27103.
AJR Am J Roentgenol. 1990 Nov;155(5):983-5. doi: 10.2214/ajr.155.5.2120968.
The role of radiologic evaluation of esophageal motility in patients with chest pain has been studied rarely. Consequently, we compared the results of radiologic and manometric examinations of the esophagus in 170 patients (106 women, 64 men; mean age, 53 years) with chest pain. Manometry, used as the standard, was normal in 114 (67%) patients, and showed the following abnormal diagnoses in the remaining 56 (33%): nonspecific esophageal motility disorder in 27 (48%), nutcracker esophagus in 16 (29%), diffuse esophageal spasm in 11 (20%), and achalasia in two (4%). Radiologic specificity was 93% (106/114) and overall sensitivity only 36% (20/56). Sensitivity increased to 50% by excluding those with nutcracker esophagus, a purely manometric diagnosis. Of the 20 patients in whom nonspecific esophageal motility disorder and diffuse esophageal spasm were undetected on radiologic examination, minimal manometric criteria for diagnosis were available in 18. Our results show that radiologic recognition of normal esophageal peristalsis is excellent. However, the vast majority of patients with chest pain do not appear to have abnormal esophageal motility on radiologic evaluation.
胸痛患者食管动力的放射学评估作用鲜有研究。因此，我们比较了170例胸痛患者（106例女性，64例男性；平均年龄53岁）食管的放射学检查和测压检查结果。以测压检查作为标准，114例（67%）患者结果正常，其余56例（33%）显示以下异常诊断：27例（48%）为非特异性食管动力障碍，16例（29%）为胡桃夹食管，11例（20%）为弥漫性食管痉挛，2例（4%）为贲门失弛缓症。放射学检查的特异性为93%（106/114），总体敏感性仅为36%（20/56）。排除胡桃夹食管（一种纯粹基于测压诊断的疾病）患者后，敏感性增至50%。在放射学检查未发现非特异性食管动力障碍和弥漫性食管痉挛的20例患者中，18例有最低限度的测压诊断标准。我们的结果表明，放射学对正常食管蠕动的识别效果极佳。然而，绝大多数胸痛患者在放射学评估中似乎没有食管动力异常。
