BACKGROUND Various patterns of colonic mucosal irregularity have been recorded on contrast enema, each with individually very low sensitivity, but high specificity. OBJECTIVE To assess the accuracy of the radiologic features of Hirschsprung disease utilising a unifying stratification of any form of colonic mucosal irregularity on contrast enema. MATERIALS AND METHODS We conducted a retrospective study of children with suspected Hirschsprung disease managed at a tertiary South African hospital from January 2009 through April 2015. Three observers independently reviewed abdominal radiographs and contrast enemas. The enema analysis included a unifying category of any form of colonic mucosal irregularity. Radiologic features were compared with rectal biopsy results. We used descriptive statistics and the Fisher exact test to compare the radiologic features of children with and without Hirschsprung disease. RESULTS Ninety-two children with median age of 37 days (range 3 days to 11 years) were included; 50 had biopsy-proven Hirschsprung disease. On enema, any mucosal irregularity, a transition zone and recto-sigmoid ratio inversion were associated with Hirschsprung disease (all P<0.01). Mucosal irregularity showed 96% sensitivity (95% confidence interval [CI] 86.3-99.5) and 71.4% specificity (CI 55.4-84.3); a transition zone showed 86% sensitivity (CI 73.3-94.2) and 90.5% specificity (CI 77.4-97.3); and recto-sigmoid ratio inversion showed 78% sensitivity (CI 64.0-88.5) and 83.3% specificity (CI 68.3-93.0). CONCLUSION Colonic mucosal irregularity on contrast enema has high sensitivity and moderate specificity for Hirschsprung disease.

中文翻译：

---

造影剂灌肠时结肠粘膜模式的准确性，可用于诊断Hirschsprung疾病。

背景技术已经在对比剂灌肠上记录了结肠粘膜不规则的各种模式，每种模式各自的敏感性非常低，但是特异性很高。目的通过对造影剂灌肠采用任何形式的结肠粘膜不规则性的统一分层来评估Hirschsprung疾病的放射学特征的准确性。材料与方法我们对2009年1月至2015年4月间在南非一家三级医院接受治疗的疑似患有克氏菌病的儿童进行了回顾性研究。三名观察员独立检查了腹部X光片和造影剂。灌肠分析包括任何形式的结肠粘膜不规则的统一类别。将放射学特征与直肠活检结果进行比较。我们使用描述性统计数据和Fisher精确检验来比较患有和不患有Hirschsprung疾病的儿童的放射学特征。结果纳入了92名中位年龄为37天（范围为3天至11岁）的儿童。50例经活检证实为Hirschsprung病。灌肠时，任何粘膜不规则，过渡区和直肠乙状结肠比例倒置均与Hirschsprung病有关（均P <0.01）。粘膜不规则显示出96％的敏感性（95％置信区间[CI] 86.3-99.5）和71.4％的特异性（CI 55.4-84.3）；过渡区显示出86％的敏感性（CI 73.3-94.2）和90.5％的特异性（CI 77.4-97.3）；乙状结肠比例反转显示敏感性为78％（CI 64.0-88.5），特异性为83.3％（CI 68.3-93.0）。