Alehossein Mehdi, Roohi Ahad, Pourgholami Masoud, Mollaeian Mansour, Salamati Payman
Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran ; Department of Radiology, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran.
Iran J Radiol. 2015 Apr 22;12(2):e12451. doi: 10.5812/iranjradiol.12451. eCollection 2015 Apr.
In 1996, Donovan and colleagues represented a scoring system for better prediction of Hirschsprung disease (HD).
Our objective was to devise another scoring system that uses a checklist of radiologic and clinical signs to determine the probability of HD in suspicious patients.
In a diagnostic accuracy study, 55 children with clinical manifestations of HD that referred to a training hospital from 1998 to 2011 were assessed. A checklist was used to evaluate the items proposed by contrast enema (CE), based on six subscales, including transitional zone, rectosigmoid index (RSI), irregular contractions in aganglionic region, cobblestone appearance, filling defect due to fecaloid materials and lack of meconium defecation during the first 48 hours after birth. The patients were classified as high score and low score. Sensitivity, specificity, positive predictive value and negative predictive value of our scoring system were calculated for identifying HD, in comparison with pathologically proved or ruled out HD.
Of the 55 patients, 36 (65.4%) cases had HD and 19 (34.6%) cases were without HD. In the HD group, 32 patients showed high scores and four patients had low scores. The sensitivity and specificity of our diagnostic scoring system were 88.9% (95% CI: 78.6% - 99.1%) and 84.2% (95% CI: 68.7% - 100%), respectively. Moreover, positive predictive value (PPV) and negative predictive value (NPV) were 91.4% (95% CI: 82.1% - 100%) and 80% (95% CI: 62.5% - 97.5%), respectively.
Our new scoring system of CE is a useful diagnostic method in HD. If a patient's score is high, that patient is highly suspicious to HD and reversely, when one's score is low, the patient presents a reduced probability to be diagnosed with HD.
1996年，多诺万及其同事提出了一种评分系统，用于更好地预测先天性巨结肠（HD）。
我们的目标是设计另一种评分系统，该系统使用放射学和临床体征清单来确定可疑患者患HD的概率。
在一项诊断准确性研究中，对1998年至2011年转诊至一家培训医院的55例有HD临床表现的儿童进行了评估。使用一份清单，根据六个子量表评估由结肠造影（CE）提出的项目，包括移行区、直肠乙状结肠指数（RSI）、无神经节区域的不规则收缩、鹅卵石外观、粪便样物质导致的充盈缺损以及出生后48小时内无胎粪排出。将患者分为高分和低分。与经病理证实或排除HD的情况相比，计算我们的评分系统用于识别HD的敏感性、特异性、阳性预测值和阴性预测值。
55例患者中，36例（65.4%）患有HD，19例（34.6%）未患HD。在HD组中，32例患者得高分，4例患者得低分。我们的诊断评分系统的敏感性和特异性分别为88.9%（95%CI：78.6% - 99.1%）和84.2%（95%CI：68.7% - 100%）。此外，阳性预测值（PPV）和阴性预测值（NPV）分别为91.4%（95%CI：82.1% - 100%）和80%（95%CI：62.5% - 97.5%）。
我们新的CE评分系统是HD的一种有用诊断方法。如果患者得分高，则该患者患HD的可能性很大；反之，当得分低时，患者被诊断为HD的概率降低。
