■先天性巨结肠病(HSD)仍然是小儿肠梗阻的常见原因。钡对比剂灌肠(BE)是评估临床疑似病例的主要成像方式。这里,我们的目的是与金标准全厚度直肠活检(FTRB)相比,评估BE在临床疑似HSD患儿中的诊断准确性.
■我们在两家三级教学医院招募并连续招募临床怀疑患有HSD的儿童。参与者接受了BE成像,两名放射科医生独立解释了这些发现。参与者进一步接受儿科外科医生的FTRB作为验证性测试。灵敏度,特异性,阳性预测值(PPV),负预测值(NPV),以FTRB为标准,在Stata14.2版上计算了接收器工作特性(ROC)和曲线下面积(AUC)。
■我们登记了55个案例,其中49人完成评估,并纳入最终分析。中位年龄为9.4个月(四分位距:2-24],男女比例为4.4:1。敏感性,特异性,PPV,BE的净现值为0.95(95%置信区间[CI][0.81-0.99]),0.73(95%CI[0.39-0.94]),0.92(95%CI[0.82-0.97]),和0.80(95%CI[0.50-0.94]),分别。在AUC上,与验证性FTRB相比,BE的诊断准确率为0.84(95%CI[0.69-0.98]).与婴儿(ROC:0.83)或1岁以上的婴儿(ROC:0.798)相比,新生儿(ROC:1.00)的诊断准确性更高。HSD提示的BE发现与FTRB上缺乏神经节细胞有关(χ2=23.301,p<0.001)。倒置的直肠乙状结肠比率和过渡区在检测0.92(95%CI[0.74-0.98])和0.81(95%CI[0.63-0.92])的HSD时更敏感,分别。
■BE在HSD患儿的诊断中足够准确,提示BE可能用于在缺乏确证活检的环境中告知手术管理.然而,在解释阴性BE发现时,有必要进行临床判断.
UNASSIGNED: Hirschsprung\'s disease (HSD) remains a common cause of pediatric intestinal obstruction. Barium contrast enema (BE) is the primary imaging modality for the evaluation of clinically suspected cases. Here, we aimed to assess the diagnostic accuracy of BE in children with clinically suspected HSD when compared to a gold standard full-thickness rectal biopsy (FTRB).
UNASSIGNED: We recruited and consecutively enrolled children with clinically suspected HSD at two tertiary teaching hospitals. Participants underwent BE imaging and two radiologists interpreted the findings independently. Participants further underwent FTRB by pediatric surgeons as the confirmatory test. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristics (ROC) with the area under the curve (AUC) were calculated on Stata version 14.2, taking FTRB as the standard.
UNASSIGNED: We enrolled 55 cases, of which 49 completed the evaluation and were included in the final analysis. The median age was 9.4 months (interquartile range: 2-24], with a male-to-female ratio of 4.4:1. The sensitivity, specificity, PPV, and NPV of BE were 0.95 (95% confidence interval [CI] [0.81-0.99]), 0.73 (95% CI [0.39-0.94]), 0.92 (95% CI [0.82-0.97]), and 0.80 (95% CI [0.50-0.94]), respectively. On AUC, the diagnostic accuracy of BE compared to the confirmatory FTRB was 0.84 (95% CI [0.69-0.98]). The diagnostic accuracy was higher in neonates (ROC: 1.00) when compared to infants (ROC: 0.83) or those above 1 year of age (ROC: 0.798). HSD-suggestive BE findings were associated with absence of ganglion cells on FTRB (χ 2 = 23.301, p < 0.001). Inverted rectosigmoid ratio and transition zone were more sensitive in detecting HSD of 0.92 (95% CI [0.74-0.98]) and 0.81 (95% CI [0.63-0.92]), respectively.
UNASSIGNED: BE is sufficiently accurate in the diagnosis of children with HSD, suggesting BE would likely be used to inform surgical management in settings where confirmatory biopsy is lacking. However, clinical judgment is warranted in interpreting negative BE findings.