- 期刊
Differential Diagnosis between Intussusception and Gastroenteritis by Plain Film
小兒腸套疊及胃腸炎的X光素片鑑別診斷
摘要
背景：針對放射學表徵的敏感度、特異性和組合來重新探討小兒腸套疊的X光素片診斷。 方法：我們收集66個腸套疊和81個腸胃炎的病例。病人的X光素片經由隨機混合後，針對九個放射學表徵（F1：大腸氣稀少，F2：大腸中糞便稀少，F3：在或季肋部有充氣的小腸圈，F4：小腸阻塞，F5：難以決定盲腸的位置，F6：腹腔積氣，F7：可辨識的腫塊病竈，F8：標靶特徵，F9：彎月特徵），由三位放射科醫師共同閱片，並分析各個表徵的敏感度、特異性和所有的組合。 結果：沒有任何片子有F6的放射學表徵，其他八個表徵由出現頻率的大至小按序列出爲：F1、F5、F7、F3、F4、F9和F8，這八個放射學表徵的敏感度和特異性都呈反比並俱有有意義的p-值（F8：小於0.005；其他七個表徵小於0.001）此外，63個(95%)腸套疊的X光片至少顯示了三個以上的放射學表徵，假如腸套疊的X光素片診斷標准必須至少有三個以上的放射學表徵，那麽就有60個(74%)腸胃炎的病例可被排除掉。 結論：將小腸阻塞的表徵對右季肋處充氣小腸圈的幹擾作用以及瑞氏研究裡只被單一放射科醫師認同的資料去除後，我們的閱片結果與其他研究相符合。X光素片診斷對小兒腸套疊的篩檢可扮演積極的角色。當放射學表徵的組合取代了單一表徵的重要性時，其統計效力也隨著增高。
並列摘要
BACKGROUND. The objective of this study is to reassess the validity of plain film diagnosis for pediatric intussusception with consideration of the combinations of radiologic findings. METHODS. Sixty-six cases of intussusception and 81 controls of gastroenteritis were collected. Their films were read blindly by three radiologists together, with emphasis on nine radiologic findings: sparse colon gas (F1), sparse fecaloid content in colon (F2), gas-filled small bowel loops in right hypochondrium (F3), small bowel obstruction (F4), difficulty in assessing cecum position (F5), pneumoperitoneum (F6), discernible mass lesion (F7), target sign (F8) and crescent sign (F9). The sensitivity and specificity of individual findings and combinations of findings were analyzed. RESULTS. No cases showed F6. Listed in decreasing order of sensitivity, the other eight findings were F], F5, F2, F7, F3, F4, F9 and F8. The sensitivity and specificity of these eight findings were inversely proportional with significant p-values (F8: ＜0.005, the other seven findings: ＜0.001). Sixty- three films (95%) in case group displayed combination of at least three radiologic findings. If the diagnostic criteria must consist of at least three radiologic findings, 60 cases (74%) of control group can be excluded. CONCLUSIONS. After eliminating the confounding effect of small bowel obstruction on the percentage of gas-filled small bowel loops in right hypochondrium and excluding the data agreed by only one radiologist from the study by Ratcltffe et al., the results of plain film findings were consistent with those of previous reports. The plain abdominal film can play an active role in the diagnosis of pediatric intussusception. Its validity increases when combinations of radiologic findings rather than individual signs are emphasized.