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.

目的：研究對比灌腸對嬰兒先天性巨結腸診斷的準確性。方法：在兩年時間內共收集了23張疑似先天性巨結腸嬰兒的對比灌腸影像。其中11例經組織病理學確診為先天性巨結腸，而另12例病理證實非先天性巨結腸。影像資料分別被3位兒童影像醫生獨立閱片，事先他們並不知道最終病理結果。醫師審閱了所有影像資料中先天性巨結腸的影像學特徵，包括移行段、腸段痙攣、直腸-乙狀結腸指數倒置情況並給出意見。最後，通過影像學特點做出是否診斷為先天性巨結腸的最終判斷。結果：移行段判斷的平均假陽性和假陰性率分別為23.1% 和 40.6%。腸段痙攣判斷的假陽性和假陰性率分別為15.3% 和59.1%。直腸-乙狀結腸指數倒置判斷的假陽性和假陰性率分別為18.1% 和57.6%。而根據影像學資料綜合診斷先天性巨結腸的假陽性率和假陰性率分別為18.8%和 44.3%。在這23個病例中，3位影像醫生對其中11個病例作出了一致和正確的判斷。結論：通過影像學表現診斷先天性巨結腸的假陽性率和假陰性率均較高。在不同影像醫生之間的個體判斷差異較大。先天性巨結腸的診斷不能單獨參照對比灌腸的影像學表現來斷症。