Misawa Noboru, Matsumoto Masaru, Tsuda Momoko, Tamura Shigeki, Yoshihara Tsutomu, Ashikari Keiichi, Kessoku Takaomi, Ohkubo Hidenori, Higurashi Takuma, Sanada Hiromi, Kato Mototsugu, Nakajima Atsushi
Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
School of Nursing, Ishikawa Prefectural Nursing University, Kahoku, Japan.
J Anus Rectum Colon. 2024 Apr 25;8(2):126-131. doi: 10.23922/jarc.2023-058. eCollection 2024.
Chronic constipation is a common gastrointestinal disorder, and management is crucial. Computed tomography (CT) is useful for evaluating rectal fecal mass but limited owing to radiation exposure, cost, and inaccessibility at certain facilities. Ultrasonography (US) avoids these pitfalls, but it is unknown whether it accurately assesses rectal feces. In this study, we evaluated the diagnostic performance of US compared with CT as the gold standard for assessing rectal feces.
We prospectively evaluated rectal fecal mass retention using US performed within 1 h of CT to assess the degree of agreement between methodologies. Rectal stool findings were evaluated on three levels: no stool (R1), presence of stool (R2), and hard stool filling (R3).
The sample included 100 patients (55 men, 45 women), of whom 47 were constipated. The kappa coefficients for rectal content detection were excellent between US and CT ( <0.001). Eighty-two cases (R1: 46 cases; R2: 28 cases; R3: 8 cases) were matched with CT and US findings, and 18 were not. Cases that did not match had low urine or high gas volumes. CT and US findings showed high agreement in constipation (kappa coefficient 0.674, <0.001) and non-constipation groups (kappa coefficient 0.677, <0.001). All cases with R3 on CT were found in the constipation group, while more than half of the cases with R1 on CT were in the non-constipation group.
CT and US showed high agreement in evaluating rectal fecal mass retention, indicating that US can substitute CT.
慢性便秘是一种常见的胃肠道疾病，其治疗至关重要。计算机断层扫描（CT）有助于评估直肠粪便量，但由于辐射暴露、成本以及某些设备无法使用等因素而受到限制。超声检查（US）可避免这些缺陷，但尚不清楚其是否能准确评估直肠粪便情况。在本研究中，我们将US与作为评估直肠粪便金标准的CT进行比较，评估了US的诊断性能。
我们前瞻性地使用在CT检查后1小时内进行的US评估直肠粪便潴留情况，以评估两种方法之间的一致性程度。直肠粪便检查结果分为三个等级：无粪便（R1）、有粪便（R2）和硬粪便充盈（R3）。
样本包括100例患者（55例男性，45例女性），其中47例为便秘患者。US和CT之间直肠内容物检测的kappa系数极佳（<0.001）。82例（R1：46例；R2：28例；R3：8例）的CT和US检查结果相符，18例不符。不相符的病例尿液量少或气体量多。CT和US检查结果在便秘组（kappa系数0.674，<0.001）和非便秘组（kappa系数0.677，<0.001）中显示出高度一致性。CT上R3级的所有病例均在便秘组中，而CT上R1级的病例一半以上在非便秘组中。
CT和US在评估直肠粪便潴留方面显示出高度一致性，表明US可替代CT。
