MRI与超声在小儿先天性肛门闭锁诊断中的价值对比研究

Comparison Study of Magnetic Resonance Imaging and Ultrasound in the Diagnosis of Congenital Anal Atresia

摘要: 目的：探讨MRI与超声诊断小儿先天性肛门闭锁的临床应用价值。方法：回顾性分析潍坊市妇幼保健院2015年1月~2022年1月期间收治的45例经手术确诊的先天性肛门闭锁患儿的超声和磁共振成像(MRI)影像资料，比较两种检查手段对于小儿先天性肛门闭锁的诊断效果。利用ROC曲线，比较磁共振和超声对小儿先天性肛门闭锁的诊断效能。结果：45例手术确诊患儿中包括2例(4.44%)高位肛门闭锁、37例(82.22%)中位肛门闭锁、6例(13.33%)低位肛门闭锁。以手术结果为金标准，MRI诊断准确率、灵敏度、特异度、阳性预测值、阴性预测值分别为97.78%、97.44%、100.00%、100.00%、85.71%，均显著高于超声(分别为77.78%、84.62%、33.33%、89.19%、25.00%) (P < 0.05)。MRI诊断与手术结果的一致性较好(Kappa = 0.829, P < 0.05)，超声诊断和手术结果的一致性一般(Kappa = 0.413, P < 0.05)。ROC曲线显示：MRI诊断的AUC为0.917 (95% CI: 0.856~0.991)，明显高于超声诊断的0.719 (95% CI: 0.601~0.829)。结论：MRI对小儿先天性肛门闭锁的临床诊断价值优于超声，且能够较好地分辨患儿疾病分型。

Abstract: Objective: To analyze and compare the clinical value of magnetic resonance imaging (MRI) and ultrasound in the diagnosis of congenital anal atresia (CAA). Methods: The ultrasound and MRI data of forty-five cases were selected from Weifang Maternal Child Health Hospital from 2015 January to 2022 January who were operatively proved as CAA. With retrospectively analysis, the diagnosic value of MRI and ultrasound was analyzed. A receiver operating characteristic (ROC) analysis was used to evaluate the diagnosis performance of the two modalities. Results: Among the 45 confirmed cases of CAA, 2 cases (4.44%) were high anal atresia, 37 cases (82.22%) were medial atresia, 6 cases (13.33%) were low atresia, according to the surgery results. Using the results of surgery results as the gold standard, the accuracy rate of MRI in the diagnosis of CAA was 97.78%, the sensitivity was 97.44%, the specificity was 100.00%, the positive predictive value was 100.00%, and the negative predictive value was 85.71%, which are significantly higher than those of ultrasound (77.78%, 84.62%, 33.33%, 89.19%, 25.00%) (P < 0.05). MRI diagnosis Kappa value is 0.829, the consistency intensity is high (P < 0.05). Ultrasound diagnosis Kappa value is 0.413, the consistency intensity is general (P < 0.05). The area under ROC curve (AUC) of MRI diagnosis 0.917 (95% CI 0.856~0.991), and the differences were statistically significant when compare with the ultrasound diagnosis 0.719 (95% CI 0.601~0.829). Conclusion: MRI has higher clinical application value compare with ultrasound in CAA diagnosis and has certain predictive value for the type of CAA.