van Gruting Isabelle M A, Stankiewicz Aleksandra, Kluivers Kirsten, De Bin Riccardo, Blake Helena, Sultan Abdul H, Thakar Ranee
Departments of Obstetrics and Gynaecology and Radiology, Croydon University Hospital, Croydon, United Kingdom; and the Departments of Obstetrics and Gynaecology and Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands.
Obstet Gynecol. 2017 Nov;130(5):1017-1024. doi: 10.1097/AOG.0000000000002245.
To establish the diagnostic test accuracy of evacuation proctography, magnetic resonance imaging (MRI), transperineal ultrasonography, and endovaginal ultrasonography for detecting posterior pelvic floor disorders (rectocele, enterocele, intussusception, and anismus) in women with obstructed defecation syndrome and secondarily to identify the most patient-friendly imaging technique.
In this prospective cohort study, 131 women with symptoms of obstructed defecation syndrome underwent evacuation proctogram, MRI, and transperineal and endovaginal ultrasonography. Images were analyzed by two blinded observers. In the absence of a reference standard, latent class analysis was used to assess diagnostic test accuracy of multiple tests with area under the curve (AUC) as the primary outcome measure. Secondary outcome measures were interobserver agreement calculated as Cohen's κ and patient acceptability using a visual analog scale.
No significant differences in diagnostic accuracy were found among the imaging techniques for all the target conditions. Estimates of diagnostic test accuracy were highest for rectocele using MRI (AUC 0.79) or transperineal ultrasonography (AUC 0.85), for enterocele using transperineal (AUC 0.73) or endovaginal ultrasonography (AUC 0.87), for intussusception using evacuation proctography (AUC 0.76) or endovaginal ultrasonography (AUC 0.77), and for anismus using endovaginal (AUC 0.95) or transperineal ultrasonography (AUC 0.78). Interobserver agreement for the diagnosis of rectocele (κ 0.53-0.72), enterocele (κ 0.54-0.94) and anismus (κ 0.43-0.81) was moderate to excellent, but poor to fair for intussusception (κ -0.03 to 0.37) with all techniques. Patient acceptability was better for transperineal and endovaginal ultrasonography as compared with MRI and evacuation proctography (P<.001).
Evacuation proctography, MRI, and transperineal and endovaginal ultrasonography were shown to have similar diagnostic test accuracy. Evacuation proctography is not the best available imaging technique. There is no one optimal test for the diagnosis of all posterior pelvic floor disorders. Because transperineal and endovaginal ultrasonography have good test accuracy and patient acceptability, we suggest these could be used for initial assessment of obstructed defecation syndrome.
ClinicalTrials.gov, NCT02239302.
确定排粪造影、磁共振成像（MRI）、经会阴超声检查和经阴道超声检查在诊断排便障碍综合征女性后盆腔底疾病（直肠膨出、肠膨出、套叠和盆底失弛缓综合征）中的诊断试验准确性，并进而确定对患者最友好的成像技术。
在这项前瞻性队列研究中，131名有排便障碍综合征症状的女性接受了排粪造影、MRI、经会阴和经阴道超声检查。图像由两名不知情的观察者进行分析。在缺乏参考标准的情况下，采用潜在类别分析以曲线下面积（AUC）作为主要结局指标来评估多项检查的诊断试验准确性。次要结局指标是用Cohen's κ计算的观察者间一致性以及使用视觉模拟量表评估的患者可接受性。
对于所有目标疾病，各成像技术在诊断准确性方面未发现显著差异。对于直肠膨出，MRI（AUC 0.79）或经会阴超声检查（AUC 0.85）的诊断试验准确性估计最高；对于肠膨出，经会阴超声检查（AUC 0.73）或经阴道超声检查（AUC 0.87）的诊断试验准确性估计最高；对于套叠，排粪造影（AUC 0.76）或经阴道超声检查（AUC 0.77）的诊断试验准确性估计最高；对于盆底失弛缓综合征，经阴道超声检查（AUC 0.95）或经会阴超声检查（AUC 0.78）的诊断试验准确性估计最高。所有技术对直肠膨出（κ 0.53 - 0.72）、肠膨出（κ 0.54 - 0.94）和盆底失弛缓综合征（κ 0.43 - 0.81）诊断的观察者间一致性为中等至优秀，但对套叠诊断的观察者间一致性较差至一般（κ -0.03至0.37）。与MRI和排粪造影相比，经会阴和经阴道超声检查的患者可接受性更好（P<0.001）。
排粪造影、MRI以及经会阴和经阴道超声检查显示出相似的诊断试验准确性。排粪造影并非最佳的可用成像技术。对于所有后盆腔底疾病的诊断，不存在一种最佳检查方法。由于经会阴和经阴道超声检查具有良好的检查准确性和患者可接受性，我们建议可将其用于排便障碍综合征的初步评估。
ClinicalTrials.gov，NCT02239302
