Department of General Surgery, Beijing Children's Hospital, National Center of Children's Health, Capital Medical University, Beijing, China.
Department of Radiology, Beijing Children's Hospital, National Center of Children's Health, Capital Medical University, Beijing, China.
BMC Pediatr. 2020 Oct 31;20(1):499. doi: 10.1186/s12887-020-02403-3.
Preoperative diagnosis of total colonic aganglionosis is important for the rational choice of treatment. The present study aimed to evaluate the diagnostic performance of radiographic signs on preoperative barium enema in patients with total colonic aganglionosis.
Forty-four patients [41 (3-659) days] with total colonic aganglionosis, including 17 neonatal patients, who received preoperative barium enema at Beijing Children's Hospital, from January 2007 to December 2019 were included. All radiographs were retrospectively restudied by 2 pediatric radiologists to ascertain radiographic signs including rectosigmoid index, transition zone, irregular contraction, gas-filled small bowel, microcolon, question-mark-shaped colon and ileocecal valve reflux. Kappa test was performed to assess the accuracy and consistency of the radiographic signs.
The 2 radiologists showed slight agreement for gas-filled small bowel, microcolon and rectosigmoid index, fair agreement for transition zone and irregular contraction, and moderate agreement for question-mark-shaped colon and ileocecal valve reflux (Kappa values, 0.043, 0.075, 0.103, 0.244, 0.397, 0.458 and 0.545, respectively). In neonatal patients, the 2 radiologists showed moderate agreement for ileocecal valve reflux and substantial agreement for question-mark-shaped colon (Kappa values, 0.469 and 0.667, respectively). In non-neonatal patients, the 2 radiologists showed substantial agreement for ileocecal valve reflux (Kappa value, 0.628). In 36 patients with total colonic aganglionosis extending to the ileum, the accuracies of question-mark-shaped colon, ileocecal valve reflux and the combination of both were 47%, 53%, and 75%, respectively, in one radiologist and 53%, 50% and 72%, respectively, in the other radiologist.
Ileocecal valve reflux is a relatively reliable radiographic sign for diagnosing total colonic aganglionosis and could improve the diagnostic accuracy upon combination with question-mark-shaped colon.
术前诊断全结肠无神经节细胞症对于合理选择治疗方法非常重要。本研究旨在评估全结肠无神经节细胞症患者术前钡灌肠的放射学征象的诊断性能。
本研究纳入了 2007 年 1 月至 2019 年 12 月期间在北京儿童医院接受术前钡灌肠检查的 44 例（3-659 天）全结肠无神经节细胞症患者，包括 17 例新生儿患者。由 2 名儿科放射科医生对所有 X 线片进行回顾性研究，以确定包括直肠乙状结肠指数、移行区、不规则收缩、充气小肠、小结肠、问号状结肠和回盲瓣反流在内的放射学征象。采用 Kappa 检验评估放射学征象的准确性和一致性。
2 位放射科医生在充气小肠、小结肠和直肠乙状结肠指数方面显示出轻微的一致性，在移行区和不规则收缩方面显示出一般的一致性，在问号状结肠和回盲瓣反流方面显示出中等的一致性（Kappa 值分别为 0.043、0.075、0.103、0.244、0.397、0.458 和 0.545）。在新生儿患者中，2 位放射科医生在回盲瓣反流方面显示出中等的一致性，在问号状结肠方面显示出高度的一致性（Kappa 值分别为 0.469 和 0.667）。在非新生儿患者中，2 位放射科医生在回盲瓣反流方面显示出高度的一致性（Kappa 值为 0.628）。在 36 例全结肠无神经节细胞症延伸至回肠的患者中，1 位放射科医生对问号状结肠、回盲瓣反流和两者联合的准确率分别为 47%、53%和 75%，另一位放射科医生的准确率分别为 53%、50%和 72%。
回盲瓣反流是诊断全结肠无神经节细胞症相对可靠的放射学征象，与问号状结肠联合使用可提高诊断准确性。
