Department of Surgery.
Department of Pathology, Botucatu Medical School, Unesp - São Paulo State University, Botucatu.
J Pediatr Gastroenterol Nutr. 2019 Apr;68(4):e62-e66. doi: 10.1097/MPG.0000000000002242.
To analyse the diagnostic capacity of barium enema (BE) in the diagnostic investigation for Hirschsprung's disease (HD) was analyzed for transition zone (TZ) identification and rectosigmoid index (RSI) ≤1.0 determination.
BE images were analyzed retrospectively by 2 examiners and the results were compared with the histopathology of rectal biopsies.
TZ identification and RSI ≤1.0 were assessed separately and combined in 43 patients. Twelve (27.9%) patients had the diagnosis of HD based on rectal biopsies. TZ identification presented better diagnostic capacity for the 2 examiners than RSI ≤1.0. However, interexaminer agreement was higher for RSI ≤1.0 than for TZ identification. The combination of TZ identification and RSI ≤1.0 increased the sensitivity (83.3%-92.3%) and the negative predictive value (90.4%-92.3%).
Therefore, the high diagnostic sensitivity of TZ identification combined to RSI ≤1.0 reinforces the usefulness of these BE parameters in the screening for Hirschsprung's disease.
分析钡灌肠（BE）在先天性巨结肠（HD）诊断中的诊断能力，用于分析移行区（TZ）的识别和直肠乙状结肠指数（RSI）≤1.0 的确定。
通过 2 名检查者对 BE 图像进行回顾性分析，并将结果与直肠活检的组织病理学进行比较。
在 43 名患者中，单独评估了 TZ 识别和 RSI≤1.0，并将其组合。12 名（27.9%）患者根据直肠活检诊断为 HD。与 RSI≤1.0 相比，TZ 识别对 2 名检查者的诊断能力更好。然而，RSI≤1.0 的检查者间一致性高于 TZ 识别。TZ 识别与 RSI≤1.0 的组合提高了敏感性（83.3%-92.3%）和阴性预测值（90.4%-92.3%）。
因此，TZ 识别与 RSI≤1.0 的高诊断敏感性证实了这些 BE 参数在先天性巨结肠筛查中的有用性。
