Kitami Masahiro
Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Ultrasound Q. 2019 Dec;35(4):385-391. doi: 10.1097/RUQ.0000000000000407.
This study aims to examine the utility of dynamic compression and other sonographic signs in diagnosing enteric duplication.
This study reviewed real-time sonographic findings from ultrasound examinations performed by the author between April 2015 and March 2017, including 4 consecutive cases of enteric duplication and 7 cases of other abdominal cysts (control group). The ability of dynamic compression to separate the lesion from the adjacent intestine was analyzed, as were other sonographic signs, including the 5-layer sign, peristalsis, and the split-wall sign.
The 5-layer sign and peristalsis were seen in only 1 of 4 cases of enteric duplication. The split-wall sign was positive in all 4 cases of enteric duplication. In a case of gastric duplication, the split-wall sign was not detected during the first examination. One case showed an atypical white split wall, and 3 cases showed a pseudo-split wall; however, this pseudo-split wall was differentiated from the true split-wall sign using dynamic compression. The dynamic compression technique correctly differentiated enteric duplication from other abdominal cysts in all but 2 cases (82%).
The 5-layer sign and peristalsis were not sensitive for enteric duplication. The split-wall sign may have the highest sensitivity and specificity for enteric duplication, but finding this sign is technically difficult and interpretation is complicated by atypical variations. Dynamic compression differentiated enteric duplication from other abdominal cysts with 82% accuracy, and this technique was simple to perform and easier to interpret than the split-wall sign.
本研究旨在探讨动态压迫及其他超声征象在诊断肠重复畸形中的应用价值。
本研究回顾了作者在2015年4月至2017年3月期间进行的超声检查的实时超声表现，包括4例连续的肠重复畸形病例和7例其他腹部囊肿病例（对照组）。分析了动态压迫将病变与相邻肠管分离的能力，以及其他超声征象，包括五层征、蠕动和分壁征。
4例肠重复畸形病例中仅有1例出现五层征和蠕动。4例肠重复畸形病例均出现分壁征阳性。在1例胃重复畸形病例中，首次检查时未检测到分壁征。1例表现为非典型白色分壁，3例表现为假分壁；然而，使用动态压迫可将这种假分壁与真正的分壁征区分开来。除2例（82%）外，动态压迫技术在所有病例中均能正确区分肠重复畸形与其他腹部囊肿。
五层征和蠕动对肠重复畸形不敏感。分壁征对肠重复畸形可能具有最高的敏感性和特异性，但发现该征象在技术上具有难度，且非典型变异会使解读变得复杂。动态压迫区分肠重复畸形与其他腹部囊肿的准确率为82%，且该技术操作简单，比分壁征更易于解读。
