title: Does the radiographic transition zone correlate with the level of aganglionosis on the specimen in Hirschsprung's disease?
abstract: OBJECTIVE
  The correlation between radiographic transition zone on contrast enema in Hirschsprung's disease and the total length of aganglionosis is known to be inaccurate. The aim of our study was to analyse this correlation more precisely to improve preoperative planning of the corrective surgery.
  
  
  METHODS
  From 1998 to 2009, 79 patients were operated on for Hirschsprung's disease. All available preoperative contrast enemas (n = 61) had been single blind reviewed by the same radiologist who defined the radiographic transition zone when present in vertebral level. Four groups were determined (rectal, rectosigmoid, long segment, and absence of transition zone) and by Kappa coefficient of agreement correlated to the length of aganglionosis in the pathological report.
  
  
  RESULTS
  Radiological findings were concordant with the specimen in pathology in 8 cases of 19 in rectal form (42 %), in 20 cases of 35 in rectosigmoid form (57 %), in all 6 cases of long-segment form (100 %), in the 2 cases of total colonic form (100 %) with a global agreement of 58.1 %, κ = 0.39 CI [0.24; 0.57].
  
  
  CONCLUSIONS
  Correlation between level of radiographic transition zone on contrast enema and length of aganglionosis remains low. Systematic preoperative biopsy by coelioscopy or ombilical incision is mandatory.
authors.affiliation: Department of Pediatric Surgery and Urology, Hôpital Robert Debré, 48 Boulevard Serrurier, 75019, Paris, France. cessolivia@gmail.com
authors.forename: Cécile Olivia
authors.initials: CO
authors.lastname: Muller
authors.forename: Cécile
authors.initials: C
authors.lastname: Mignot
authors.forename: Nadia
authors.initials: N
authors.lastname: Belarbi
authors.forename: Dominique
authors.initials: D
authors.lastname: Berrebi
authors.forename: Arnaud
authors.initials: A
authors.lastname: Bonnard
mesh_terms: D005260:Female; D006627:Hirschsprung Disease / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011859:Radiography; D012189:Retrospective Studies