对比灌肠下结肠黏膜形态对先天性巨结肠症的诊断准确性。

Accuracy of colonic mucosal patterns at contrast enema for diagnosis of Hirschsprung disease.

机构信息

Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.

Division of Paediatric Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.

出版信息

Pediatr Radiol. 2020 May;50(6):810-816. doi: 10.1007/s00247-020-04631-2. Epub 2020 Feb 12.

DOI:10.1007/s00247-020-04631-2

PMID:32052081

Abstract

BACKGROUND

Various patterns of colonic mucosal irregularity have been recorded on contrast enema, each with individually very low sensitivity, but high specificity.

OBJECTIVE

To assess the accuracy of the radiologic features of Hirschsprung disease utilising a unifying stratification of any form of colonic mucosal irregularity on contrast enema.

MATERIALS AND METHODS

We conducted a retrospective study of children with suspected Hirschsprung disease managed at a tertiary South African hospital from January 2009 through April 2015. Three observers independently reviewed abdominal radiographs and contrast enemas. The enema analysis included a unifying category of any form of colonic mucosal irregularity. Radiologic features were compared with rectal biopsy results. We used descriptive statistics and the Fisher exact test to compare the radiologic features of children with and without Hirschsprung disease.

RESULTS

Ninety-two children with median age of 37 days (range 3 days to 11 years) were included; 50 had biopsy-proven Hirschsprung disease. On enema, any mucosal irregularity, a transition zone and recto-sigmoid ratio inversion were associated with Hirschsprung disease (all P<0.01). Mucosal irregularity showed 96% sensitivity (95% confidence interval [CI] 86.3-99.5) and 71.4% specificity (CI 55.4-84.3); a transition zone showed 86% sensitivity (CI 73.3-94.2) and 90.5% specificity (CI 77.4-97.3); and recto-sigmoid ratio inversion showed 78% sensitivity (CI 64.0-88.5) and 83.3% specificity (CI 68.3-93.0).

CONCLUSION

Colonic mucosal irregularity on contrast enema has high sensitivity and moderate specificity for Hirschsprung disease.

摘要

背景

对比灌肠时记录到各种结肠黏膜不规则模式，每种模式的敏感性都非常低，但特异性都很高。

目的

利用对比灌肠时任何形式的结肠黏膜不规则的统一分层来评估先天性巨结肠病的放射学特征的准确性。

材料和方法

我们对 2009 年 1 月至 2015 年 4 月在南非一家三级医院就诊的疑似先天性巨结肠病患儿进行了回顾性研究。三位观察者独立地对腹部 X 线片和对比灌肠进行了复查。灌肠分析包括任何形式的结肠黏膜不规则的统一分类。放射学特征与直肠活检结果进行了比较。我们使用描述性统计和 Fisher 确切检验比较了有和没有先天性巨结肠病的患儿的放射学特征。

结果

92 名患儿的中位年龄为 37 天（范围 3 天至 11 岁）；50 名患儿经活检证实患有先天性巨结肠病。在灌肠时，任何黏膜不规则、移行区和直肠-乙状结肠比值倒置与先天性巨结肠病有关（均 P<0.01）。黏膜不规则的敏感性为 96%（95%置信区间 86.3%至 99.5%），特异性为 71.4%（置信区间 55.4%至 84.3%）；移行区的敏感性为 86%（置信区间 73.3%至 94.2%），特异性为 90.5%（置信区间 77.4%至 97.3%）；直肠-乙状结肠比值倒置的敏感性为 78%（置信区间 64.0%至 88.5%），特异性为 83.3%（置信区间 68.3%至 93.0%）。