How Useful is Contrast Enema in the Diagnosis of Hirschsprung’s Disease? Five-year Experience from a Local Referral Centre
AWY Wong, DSF Tsang, WWM Lam
Hong Kong J Radiol 2014;17:30-5
DOI: 10.12809/hkjr1413206
Objective: To review the diagnostic performance of contrast enema examinations for the investigation of Hirschsprung’s disease, determine the usefulness of delayed 24-hour X-rays, and validate water-soluble contrast enemas for the investigation for patients with suspected Hirschsprung’s disease.
Methods: This was a retrospective study of all neonates and infants referred for radiological evaluation of symptoms and signs suspicious of Hirschsprung’s disease in Queen Mary Hospital, Hong Kong from January 2007 to December 2011. Patients were included in this study when all radiographs were available and Hirschsprung’s disease had been confirmed or excluded by rectal biopsy or by a combination of enema results, manometry, and close clinical follow-up. Radiographs and reports were reviewed with a checklist of radiological criteria described in the literature, including transitional zone, rectosigmoid index (maximum width of rectum divided by maximum width of sigmoid; abnormal if <1), irregular contractions, mucosal irregularity, spasm, serrations and retention of contrast agent on delayed radiographs. The sensitivity, specificity, positive and negative predictive values of each of these criteria were calculated and considered in the context of recommendations described in the literature.
Results: A total of 136 such patients were evaluated during the study period, of whom 86 had barium enemas and 57 had water-soluble contrast enemas. Among all the patients reviewed, the sensitivity, specificity, positive and negative predictive values for all enema examinations (excluding delayed films) in the diagnosis of Hirschsprung’s disease were 69%, 89%, 44% and 96%, respectively. While the corresponding values of all enema examinations (including delayed films) were 100%, 78%, 36% and 100%, respectively. Similar results were noted in patients having barium enemas and water-soluble contrast enema examinations. For patients having barium enemas or water-soluble contrast enemas, with the inclusion of delayed films there was a significant increase in sensitivity compared to sensitivity derived without recourse to delayed films, whilst there was only a slight reduction in specificity.
Conclusion: Recourse to water-soluble contrast enemas with the addition of a 24-hour delayed film was useful in the diagnosis of Hirschsprung’s disease.
中文摘要
灌腸診斷先天性巨結腸症有用嗎？一所本地轉介中心的五年經驗
黃慧妍、曾承峰、林慧文
目的：探討灌腸檢查對先天性巨結腸症的診斷性能和24小時延遲X光片的診斷效用，並驗證水溶性對比劑灌腸對先天性巨結腸症疑似病例的研究。
方法：本研究回顧2007年1月至2011年12月期間具有疑似先天性巨結腸症狀及指徵而被轉介至瑪麗醫院作放射性檢查的新生兒和嬰兒病例。病人被納入本研究時，均已有X光片，其先天性巨結腸症已由直腸活檢或灌腸結合測壓及臨床監察的方法證實或排除。根據文獻描述的放射學標準目錄而回顧X光片及其報告，包括過渡區、直腸乙狀結腸指數（直腸的最寬徑除以乙狀結腸的最寬徑，<1為異常）、不規則宮縮、粘膜不規則、痙攣、鋸齒狀和延遲X光片上對比劑滯留。為每項標準分別計算其敏感性、特異性，以及陽性和陰性預測值，並與文獻上的數據作比較。
結果：136例中，有86例進行鋇劑灌腸，57例進行水溶性對比劑灌腸。回顧病例中，灌腸檢查（不包括延遲X光片）對先天性巨結腸症診斷的敏感性、特異性，以及陽性和陰性預測值分別為69%、89%、44%和96%。把延遲X光片結果納入統計之內，相應值為100%、78%、36%和100%。接受鋇劑灌腸和水溶性對比劑灌腸檢查的兩組患者均有類似的結果。同樣地兩組患者中，與不包括延遲X光片的數據比較，包括延遲X光片的數據顯示其敏感性明顯上升，而特異性則輕微下降。
結論：水溶性對比劑灌腸檢查結合24小時延遲X光片對診斷先天性巨結腸症有用。