Venkatakrishna Shyam Sunder B, Elsingergy Mohamed, Calle-Toro Juan S, Dennis Rebecca, Otero Hansel J, Andronikou Savvas
Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
Children (Basel). 2024 Jan 24;11(2):151. doi: 10.3390/children11020151.
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.
We aimed to evaluate the quality, findings including the prevalence of the "descending staircase" configuration and its correspondence to a diagnosis of duodenum redundum.
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.
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.
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.
诊断肠旋转不良的标准成像技术仍然是上消化道造影（UGIS）。侧位片对诊断很重要，因此侧位片应质量足够，放射科医生必须了解十二指肠的正常表现以及变异表现，因为误诊可能导致不必要的手术。
我们旨在评估质量、包括“下降阶梯”形态的发生率及其与十二指肠冗长症诊断的相关性等发现。
这是一项回顾性研究，在美国一家大型三级儿童医院进行。由一名儿科放射科医生对2018年1月至12月期间年龄≤18岁儿童的UGI透视检查进行回顾性分析。首先，独立评估侧位片图像/电影环，然后是前后位（AP）片。对被认定侧位片质量足够的研究进行十二指肠形态评估并记录为：正常、异常或正常变异。此外，下降阶梯形态的存在与AP片诊断十二指肠冗长症相关。
共有26名年龄在0至16岁的儿童（26%）（男性16名；女性10名）在UGI检查期间有质量足够的侧位片可供纳入分析。在这26名儿童中，18名（69%）报告为正常，7名（27%）报告有下降阶梯形态，1名（4%）报告为异常。AP片显示2例异常研究（1例旋转不良和1例非旋转）、6例十二指肠冗长症和18例正常检查。侧位片上一例十二指肠异常在AP片上被确认为非旋转；AP片异常的第二名患者侧位片表现正常。
共有26%的UGI研究有质量足够的侧位片可供解读。其中，近四分之一（23%）在AP片上显示与十二指肠冗长症诊断相符的下降阶梯征。如果仅使用侧位片，会有一名患者漏诊。
