背景:诊断肠旋转不良的标准成像技术仍然是上消化道序列(UGIS)。侧视图对于做出诊断是重要的。为此,侧视图应具有足够的质量,放射科医生必须知道正常的外观以及十二指肠变异的外观,因为误诊可能导致不必要的手术。
目的:我们旨在评估质量,发现包括“下降楼梯”配置的患病率及其与十二指肠红肿诊断的对应关系。
方法:这是一项回顾性研究,在美国一家大型三级儿童医院进行。儿科放射科医师对2018年1月至12月年龄≤18岁儿童的UGI透视检查进行了回顾性审查。首先,独立评估侧视图像/电影循环,其次是前后(AP)视图。被指定为具有足够的侧视图的研究对十二指肠的构型进行了评估,并记录为:正常,异常,或正常变异。此外,对于十二指肠红肿的诊断,降梯构型的存在与AP视图相关.
结果:共有26名年龄在0至16岁的儿童(男性:16岁;女性:10岁)在UGI考试中有足够的侧视纳入。在26,18(69%)报告为正常,7(27%)报告为下降楼梯,1(4%)报告为异常。AP视图显示2项异常研究(1项旋转不良和1项非旋转),十二指肠红肿6例,正常检查18例。一个异常的十二指肠外侧在AP视图上被确认为非旋转;第二位具有异常AP视图的患者在侧视图上具有正常外观。
结论:总共26%的UGI研究有足够的横向解释。其中,近四分之一(23%)的患者在AP视图中表现出与十二指肠红肿诊断相对应的下降阶梯体征。如果侧视图是单独使用的,一个病人会漏诊.
BACKGROUND: The standard imaging technique for the diagnosis of intestinal malrotation remains the upper gastro-intestinal series (UGIS). The lateral view is promoted as important for making a diagnosis. For this, the lateral view should be of adequate quality, and radiologists must know the normal appearance as well as the appearance of duodenal variants, as misdiagnosis may lead to unnecessary surgery.
OBJECTIVE: We aimed to evaluate the quality, findings including the prevalence of the \"descending staircase\" configuration and its correspondence to a diagnosis of duodenum redundum.
METHODS: This was a retrospective study and was conducted in a large tertiary children\'s hospital in the United States. A retrospective review of UGI fluoroscopy exams in children aged ≤ 18 years between January and December 2018 was performed by a pediatric radiologist. First, the lateral view images/cine-loops were assessed independently, followed by the anteroposterior (AP) view. The studies which were designated to have an adequate lateral view were evaluated for configuration of the duodenum and recorded as: normal, abnormal, or normal variant. Also, the presence of a descending staircase configuration was correlated with an AP view for a diagnosis of duodenum redundum.
RESULTS: A total of 26 children (26%) (males:16; females:10) with age range 0 to 16 years had adequate lateral views during UGI exams for inclusion. Of the 26, 18 (69%) were reported as normal, 7 (27%) were reported as having a descending staircase and 1 (4%) was reported as abnormal. The AP view demonstrated 2 abnormal studies (1 malrotation and 1 non-rotation), 6 duodenum redundum and 18 normal exams. The one abnormal lateral duodenum was confirmed as a non-rotation on AP view; the second patient with an abnormal AP view had a normal appearance on the lateral view.
CONCLUSIONS: A total of 26% of UGI studies had adequate lateral views for interpretation. Of these, nearly a quarter (23%) demonstrated the descending stair-case sign corresponding to a diagnosis of duodenum redundum on the AP view. If the lateral view had been used alone, there would have been a missed diagnosis in one patient.