PMY Tang, MWY Leung, NSY Chao, KKW Liu, TW Fan

Abstract

Objective: To determine the accuracy of contrast enema (CE) in diagnosis of Hirschsprung's disease (HD) in infants. Methods: A total of 23 CE films of infants with suspected HD were collected in a period of two years. Of those, 11 cases had histological confirmed diagnosis of HD, and 12 cases had HD excluded. The radiographs were reviewed independently by three pediatric radiologists without knowing the histological diagnosis. Radiological signs of HD, including transition zone, spastic colon and reversed recto-sigmoid index were commented by the radiologists in all radiographs. Also, they need to commit the overall impression for or against the radiological diagnosis of HD in each case at the end of examination. Results: For transition zone sign, the mean false positive and false negative rates were 23.1% and 40.6% respectively. For spastic colon sign, the false positive and false negative rates were 15.3% and 59.1% respectively. Reversed recto-sigmoid index gave false positive and false negatives rates of 18.1% and 57.6% respectively. For overall impression of radiological diagnosis of HD, the false positive and false negative rates were 18.8% and 44.3% respectively. Among all three radiologists, concordant and correct radiological diagnosis occurred in 11 out of 23 cases (47.8%). Conclusions: Radiological signs shown in CE have high false positive and high negative rates in diagnosis of HD. There is significant discordance among different radiologists in reading CE radiographs. Diagnosis of HD should not be relied on CE alone.