Department of Obstetrics and Gynaecology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, the Netherlands.
Int J Colorectal Dis. 2013 Mar;28(3):359-63. doi: 10.1007/s00384-012-1567-7. Epub 2012 Sep 2.
This study concerns the level of agreement between transperineal ultrasound and evacuation proctography for diagnosing enteroceles and intussusceptions.
In a prospective observational study, 50 consecutive women who were planned to have an evacuation proctography underwent transperineal ultrasound too. Sensitivity, specificity, positive (PPV) and negative predictive value, as well as the positive and negative likelihood ratio of transperineal ultrasound were assessed in comparison to evacuation proctography. To determine the interobserver agreement of transperineal ultrasound, the quadratic weighted kappa was calculated. Furthermore, receiver operating characteristic curves were generated to show the diagnostic capability of transperineal ultrasound.
For diagnosing intussusceptions (PPV 1.00), a positive finding on transperineal ultrasound was predictive of an abnormal evacuation proctography. Sensitivity of transperineal ultrasound was poor for intussusceptions (0.25). For diagnosing enteroceles, the positive likelihood ratio was 2.10 and the negative likelihood ratio, 0.85. There are many false-positive findings of enteroceles on ultrasonography (PPV 0.29). The interobserver agreement of the two ultrasonographers assessed as the quadratic weighted kappa of diagnosing enteroceles was 0.44 and that of diagnosing intussusceptions was 0.23.
An intussusception on ultrasound is predictive of an abnormal evacuation proctography. For diagnosing enteroceles, the diagnostic quality of transperineal ultrasound was limited compared to evacuation proctography.
本研究旨在探讨经会阴超声与排粪造影在诊断肠膨出和套叠中的一致性。
在一项前瞻性观察性研究中，对 50 例计划进行排粪造影的连续女性患者也进行了经会阴超声检查。与排粪造影相比，评估了经会阴超声的敏感性、特异性、阳性预测值（PPV）和阴性预测值，以及阳性和阴性似然比。为了确定经会阴超声的观察者间一致性，计算了二次加权 kappa。此外，生成了受试者工作特征曲线以显示经会阴超声的诊断能力。
对于诊断套叠（PPV 为 1.00），经会阴超声的阳性发现预测了排粪造影的异常。经会阴超声对套叠的敏感性较差（0.25）。对于诊断肠膨出，阳性似然比为 2.10，阴性似然比为 0.85。超声有许多假阳性的肠膨出发现（PPV 为 0.29）。两位超声医师评估的诊断肠膨出的二次加权 kappa 观察者间一致性为 0.44，诊断套叠的观察者间一致性为 0.23。
超声上的套叠可预测排粪造影异常。与排粪造影相比，经会阴超声诊断肠膨出的质量有限。
