El-Ali Alexander Maad, Ocal Selin, Hartwell C Austen, Goldberg Judith D, Li Xiaochun, Prestano Jaimelee, Kamity Ranjith, Martin Laura, Strubel Naomi, Lala Shailee
Division of Pediatric Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 First Avenue, New York, NY, 10016, USA.
NYU Grossman School of Medicine, Long Island Campus, 660 First Avenue, New York, NY, 10016, USA.
Pediatr Radiol. 2023 Oct;53(11):2199-2207. doi: 10.1007/s00247-023-05727-1. Epub 2023 Aug 17.
Few reports explore the frequency and factors associated with diagnostic ultrasound (US) for midgut volvulus.
To evaluate predictive factors for diagnostic US for midgut volvulus and clinical outcomes of patients with non-diagnostic US.
This retrospective study included infants imaged for midgut volvulus with US. Exams were rated as diagnostic (midgut volvulus present or absent) or non-diagnostic by a pediatric radiologist, and in cases of disagreement with the original report, an additional pediatric radiologist was the tie-breaker. For each exam, the following were recorded: age, weight, respiratory support, exam indication, sonographer experience, and gaseous dilated bowel loops on radiography. Logistic regression models with "stepwise" variable selection were used to investigate the association of diagnostic US for midgut volvulus with each of the independent variables.
One hundred nineteen patients were imaged. US was diagnostic in 74% (88/119) of patients. In subsets of patients presenting with bilious emesis or age <28 days, US was diagnostic in 92% (22/24) and 90% (53/59), respectively. Logistic regression suggested that symptom type (bilious vs other) was the best predictor of diagnostic US (type 3 P=0.02). Out of 26 patients with available radiographs, US was diagnostic in 92% (12/13) of patients without bowel dilation on radiographs compared to 62% (8/13) of patients with bowel dilation (P=0.16). Weight, respiratory support, and sonographer experience did not differ between groups. Two sick neonates, ages 2 days and 30 days, in whom the primary clinical concern was dropping hematocrit and sepsis, respectively, had non-diagnostic ultrasounds in the setting of bowel dilation on radiography. Both were found to have midgut volvulus at surgery and both expired.
US was most frequently diagnostic in patients with bilious emesis or age less than 28 days. Non-diagnostic US for midgut volvulus must prompt a predetermined follow-up strategy, such as an additional imaging study (e.g., upper GI series), particularly in a sick child, as non-diagnostic US may miss midgut volvulus.
很少有报告探讨诊断性超声（US）用于诊断中肠扭转的频率及相关因素。
评估诊断性超声用于诊断中肠扭转的预测因素以及超声检查未明确诊断的患者的临床结局。
这项回顾性研究纳入了接受超声检查以诊断中肠扭转的婴儿。检查结果由一名儿科放射科医生评定为诊断性（存在或不存在中肠扭转）或非诊断性，若与原始报告存在分歧，则由另一名儿科放射科医生进行最终裁决。对于每次检查，记录以下信息：年龄、体重、呼吸支持情况、检查指征、超声检查人员经验以及X线片上气体扩张的肠袢情况。采用具有“逐步”变量选择的逻辑回归模型来研究诊断性超声用于诊断中肠扭转与各独立变量之间的关联。
对119例患者进行了超声检查。74%（88/119）的患者超声检查具有诊断意义。在以胆汁性呕吐就诊或年龄小于28天的患者亚组中，超声检查具有诊断意义的比例分别为92%（22/24）和90%（53/59）。逻辑回归分析表明，症状类型（胆汁性呕吐与其他症状）是诊断性超声检查的最佳预测因素（3型P = 0.02）。在26例有X线片的患者中，X线片上无肠扩张的患者中92%（12/13）超声检查具有诊断意义，而有肠扩张的患者中这一比例为62%（8/13）（P = 0.16）。两组患者在体重、呼吸支持情况及超声检查人员经验方面无差异。两名患病新生儿，年龄分别为2天和30天，主要临床问题分别是血细胞比容下降和败血症，在X线片显示肠扩张的情况下超声检查未明确诊断。二者均在手术中发现有中肠扭转，且均死亡。
超声检查对胆汁性呕吐患者或年龄小于28天的患者最常具有诊断意义。对于中肠扭转超声检查未明确诊断的情况，必须启动预先确定的后续检查策略，如额外的影像学检查（如上消化道造影），尤其是对于患病儿童，因为超声检查未明确诊断可能会漏诊中肠扭转。
