Hwang T J, Servaes S, Mattei P, Anupindi S A
Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Clin Radiol. 2017 Jun;72(6):519.e11-519.e19. doi: 10.1016/j.crad.2017.01.007. Epub 2017 Mar 9.
To evaluate the diagnostic performance of contrast enemas (CEs) for the diagnosis of Hirschsprung's disease (HD).
CE studies performed as part of an HD workup in patients 1-18 years of age over a 10-year period were identified. All abnormal CE studies and an equal number of age-matched controls were included in the final study group. Two radiologists independently and blindly reviewed all CE studies for quality (scale of 0-3) and the presence of large colon calibre, colon redundancy, transition zone, rectosigmoid ratio, and abnormal contractions. Readers also determined whether a rectal biopsy would be recommended to confirm an HD diagnosis. Discrepancies were resolved in consensus. Findings were correlated with surgery and biopsy data.
Out of 834 CE studies, 38 abnormal CE studies were identified (mean age 5.9 years) and included 38 matched controls. Seventeen of 76 patients were recommended for rectal biopsy, of which five were confirmed to have HD. Twelve of 70 (17.1%) were false positives, and were clinically confirmed not to have HD. The proportion of HD in the present population was 6/834 (0.72%). Of the 17 recommended for biopsy, CE studies showed 17/17 (100%) with an abnormal rectosigmoid ratio, 16/17 (94.1%) with redundant colon, and 15/17 (88%) with large colon. Of patients not recommended for biopsy, one was diagnosed with HD, (false negative, 16.7%). The diagnostic performance of CE was 83.3% sensitivity and 82.9% specificity.
Few children >1 year of age were found to have HD and the diagnostic performance of the CE is moderately high. The CE examination is a valuable non-invasive imaging study to help exclude older children who may not have HD, thereby obviating the need for invasive rectal biopsy and surgery.
评估结肠灌肠造影（CE）对先天性巨结肠（HD）的诊断效能。
确定在10年期间对1至18岁患者进行的作为HD检查一部分的CE研究。所有异常的CE研究以及数量相等的年龄匹配对照被纳入最终研究组。两名放射科医生独立且盲法审查所有CE研究的质量（0 - 3级）以及是否存在结肠扩张、结肠冗长、移行区、直肠乙状结肠比例和异常收缩。阅片者还确定是否建议进行直肠活检以确诊HD。分歧通过协商解决。研究结果与手术及活检数据相关。
在834例CE研究中，识别出38例异常CE研究（平均年龄5.9岁），并纳入38例匹配对照。76例患者中有17例被建议进行直肠活检，其中5例确诊为HD。70例中有12例（17.1%）为假阳性，临床确诊无HD。本研究人群中HD的比例为6/834（0.72%）。在17例被建议进行活检的患者中，CE研究显示直肠乙状结肠比例异常者17/17（100%），结肠冗长16/17（94.1%），结肠扩张15/17（88%）。未被建议进行活检的患者中，1例被诊断为HD（假阴性，16.7%）。CE的诊断效能为敏感性83.3%，特异性82.9%。
发现1岁以上儿童中HD患者较少，CE的诊断效能中等偏高。CE检查是一项有价值的非侵入性影像学检查，有助于排除可能无HD的大龄儿童，从而避免进行侵入性直肠活检和手术。
