多模态影像学对儿童不明原因下消化道出血诊断的价值

The diagnostic value of multimodal imaging in children with obscure gastrointestinal bleeding

目的:探讨多模态影像学对儿童不明原因下消化道出血的诊断价值,旨在提高影像学诊断儿童下消化道出血的效能。方法:回顾性分析2017年1月—2021年12月我院以不明原因血便为主要症状入院的238例患儿的临床资料,患儿最终诊断由病理结果或临床诊断确定,依据最终诊断结果对比各种影像学成像差异,重点评估超声诊断下消化道出血的效果。结果:238例患儿中梅克尔憩室105例,结肠息肉98例,炎性肠病23例,其他病因8例,后续检查阴性结果4例。超声诊断总体准确率为87.4%(208/238),灵敏度为89.7%,特异度为66.7%;梅克尔憩室超声诊断的准确率为86.7%(91/105),灵敏度为90.1%,特异度为100%,核素显像诊断的准确率为88.5%(69/78),灵敏度为90.7%,特异度为50.0%,两者差异无统计学意义(χ^(2)=0.131,P=0.717);结肠息肉超声诊断准确率为93.9%(92/98),灵敏度为95.8%,特异度为50%,CT结肠造影诊断准确率为81.4%(48/59),灵敏度为85.7%,特异度为66.7%,两者差异有统计学意义(χ^(2)=5.980,P=0.014);炎性肠病超声诊断的准确率为78.3%(18/23),灵敏度为85.7%,特异度为50%,MR小肠造影诊断准确率为91.3%(21/23),灵敏度为95.5%,特异度为100%,两种差异无统计学意义(χ^(2)=1.516,P=0.218)。结论:多模态影像学检查是安全、准确诊断儿童下消化道出血的方法,其中超声检查对梅克尔憩室、肠息肉及炎性肠病具有较高的灵敏度及特异度。

Objective:To investigate the diagnostic value of multimodal imaging in children presenting with obscure gas-trointestinal bleeding,in order to improve the diagnotic efficiency of ultrasound.Methods:From January 2017 to December 2021,a single-centre study was performed on 238 children referred to the medical imaging department for obscure gastrointesti-nal bleeding retrospectively.Each child underwent ultrasound and radiological examination after admitting to hospital.The final diagnosis was confirmed by pathology or clinical follow-up.The diagnostic performance of ultrasound was analyzed according to the final diagnosis.Results:A total of 238 eligible children were enrolled in the study.The final diagnoses were Meckel’s di-verticulum in 105 children(44.1%),intestinal polyp in 98 children(41.2%)and inflammatory bowel disease in 23 children(9.7%).There were eight cases of other causes and four cases of negative result of follow-up.The diagnostic accuracy,sensitivity and specificity of ultrasound were 87.4%,89.7%and 66.7%,respectively.The diagnostic accuracy,sensitivity and specificity of ultra-sound in Meckel’s diverticulum were 86.7%(91/105),90.1%and 100%,respectively.The diagnostic accuracy,sensitivity and specificity of ultrasound in ectopic gastric mucosa was 88.5%(69/78),90.7%and 50.0%,respectively.The difference was not sta-tistically significant(χ^(2)=0.131,P=0.717).The diagnostic accuracy,sensitivity and specificity of ultrasound in intestinal polyp were 93.9%(92/98),95.8%and 50%,respectively.While the diagnostic accuracy,sensitivity and specificity of CT in colography were 81.4%(48/59),85.7%and 66.7%,respectively.The difference was statistically significant(χ^(2)=5.980,P=0.014).The diagnostic accu-racy,sensitivity and specificity of ultrasound in inflammatory bowel disease were 78.3%(18/23),85.7%and 50%,respectively.While the diagnostic accuracy,sensitivity and specificity of magnetic resonance imaging in enterography was 91.3%(21/23),95.5%and 100%,respectively.The difference was not statistically significant(χ^(2)=1.516,P=0.218).Conclusion:It was safe and accurate imaging modality of multimodal imaging in the evaluation of paediatric obscure gastrointestinal bleeding.Especially,the diagnos-tic sensitivity and specificity of ultrasound in Meckel’s diverticulum,intestinal polyp and inflammatory bowel disease were high.