Centre for Medical Imaging and Physiology, Skåne University Hospital, Clinical Sciences Lund, Lund University, 221 85, Lund, Sweden.
Pediatr Radiol. 2013 Aug;43(8):950-7. doi: 10.1007/s00247-013-2622-4. Epub 2013 Mar 6.
Patients with Hirschsprung disease lack the normal rectoanal inhibitory reflex, which can be studied with anorectal manometry or US.
To see whether the rectoanal inhibitory reflex could be visualised with a modified contrast enema, thereby increasing the diagnostic accuracy of the contrast enema and reducing the number of rectal biopsies.
Fifty-nine boys and 42 girls (median age, 12 months) with suspected Hirschsprung disease were examined with a modified contrast enema, supplemented with two injections of cold, water-soluble contrast medium, to induce the reflex. Two paediatric radiologists evaluated the anonymised examinations in consensus. The contrast enema findings were correlated with the results of rectal biopsy or clinical follow-up.
Five boys and one girl (median age, 7.5 days) were diagnosed with Hirschsprung disease. The negative predictive value of the rectoanal inhibitory reflex was 100%. A contrast enema with signs of Hirschsprung disease in combination with an absent rectoanal inhibitory reflex had the specificity of 98% and sensitivity of 100% for Hirschsprung disease.
The modified contrast enema improves the radiological diagnosis of Hirschsprung disease. By demonstrating the rectoanal inhibitory reflex in children without Hirschsprung disease, we can reduce the proportion of unnecessary rectal biopsies.
先天性巨结肠病患者缺乏正常的直肠肛门抑制反射，可以通过直肠肛门测压或超声检查进行研究。
观察改良对比灌肠是否能显示直肠肛门抑制反射，从而提高对比灌肠的诊断准确性，减少直肠活检的数量。
对 59 名男孩和 42 名女孩（中位年龄 12 个月）进行改良对比灌肠检查，补充两次冷、水溶性对比剂注射以诱导反射。两名儿科放射科医生对匿名检查进行了共识评估。对比灌肠结果与直肠活检或临床随访结果相关。
5 名男孩和 1 名女孩（中位年龄 7.5 天）被诊断为先天性巨结肠病。直肠肛门抑制反射的阴性预测值为 100%。具有先天性巨结肠病征象的对比灌肠加上不存在直肠肛门抑制反射的检查对先天性巨结肠病的特异性为 98%，敏感性为 100%。
改良对比灌肠可提高先天性巨结肠病的放射学诊断。通过在无先天性巨结肠病的儿童中显示直肠肛门抑制反射，我们可以减少不必要的直肠活检的比例。
