El-Ali Alexander Maad, Schiess Desi M, Van Tassel Dane, Le Cacheux Catalina, Lala Shailee V, Riemann Monique, Tutman Jeffrey, Sher Andrew C, Sammer Marla B K, Navarro Oscar M, Nguyen HaiThuy N, Silva Cicero T
Division of Pediatric Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 First Avenue, New York, NY, 10016, USA.
Department of Radiology, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA.
Pediatr Radiol. 2025 May;55(5):925-935. doi: 10.1007/s00247-024-06141-x. Epub 2025 Feb 4.
Ultrasound (US) is increasingly used as the first-line imaging modality for the diagnosis of midgut volvulus, but may be non-diagnostic in some cases.
To determine the frequency and factors associated with non-diagnostic US for each midgut volvulus and malrotation in a multi-institutional sample.
We conducted a retrospective multi-institutional study of children (age 0-18 years) who underwent US to evaluate for midgut volvulus and malrotation between January 1, 2018, and June 30, 2021, and had an available reference standard of one of the following: upper GI series, CT/MRI, surgery, or, for volvulus, clinical follow-up at 30 days or greater. Blinded review of US images was performed by a single radiologist at each institution. When available, radiographs acquired ≤3 h from the US were reviewed for bowel gas pattern. After blinded review, original ultrasound reports were classified as diagnostic or non-diagnostic for midgut volvulus and malrotation. Stepwise logistic regression identified the most important predictors of non-diagnostic US.
In total, 637 patients were imaged for midgut volvulus and 311 for malrotation. Based on original report review, non-diagnostic proportions of examinations for volvulus and malrotation were 13.5% (86/637) and 25.7% (80/311), respectively. Based on blinded review, non-diagnostic proportions of examinations for volvulus and malrotation were 17.3% (110/637) and 37.6% (117/311), respectively. Of the patients with US considered non-diagnostic for volvulus by original reports, 2.3% (2/86) were subsequently found to have volvulus. Among patients with non-diagnostic US for volvulus by blinded review (n=110), none was found to have volvulus. Gaseous dilation with elongation of bowel on radiography was the single best predictor of a non-diagnostic US in blinded interpretation for volvulus and malrotation (OR=8.2 and 9.2; 95%CI 3.7-19.8 and 1.7-89.4, respectively) and in original radiology reports for volvulus (OR=4.5; 95%CI 2.2-9.5).
A small fraction of a multi-institutional sample of US for midgut volvulus was non-diagnostic; however, assessment of malrotation without volvulus is associated with a higher frequency of non-diagnostic examinations. Dilated bowel gas pattern on radiography is the strongest predictor for a non-diagnostic US, although it does not necessarily preclude a diagnostic exam.
超声（US）越来越多地被用作诊断中肠扭转的一线成像方式，但在某些情况下可能无法做出诊断。
确定多机构样本中每种中肠扭转和旋转不良的超声诊断不确定频率及相关因素。
我们对2018年1月1日至2021年6月30日期间接受超声检查以评估中肠扭转和旋转不良的0至18岁儿童进行了一项回顾性多机构研究，这些儿童具有以下可用参考标准之一：上消化道造影、CT/MRI、手术，或者对于扭转，30天或更长时间的临床随访。每个机构由一名放射科医生对超声图像进行盲法审查。如有可用，对在超声检查后3小时内获取的X线片进行肠气模式审查。盲法审查后，将原始超声报告分类为中肠扭转和旋转不良的诊断性或非诊断性报告。逐步逻辑回归确定了超声诊断不确定的最重要预测因素。
共有637例患者接受了中肠扭转成像检查，311例接受了旋转不良成像检查。根据原始报告审查，扭转和旋转不良检查的非诊断比例分别为13.5%（86/637）和25.7%（80/311）。根据盲法审查，扭转和旋转不良检查的非诊断比例分别为17.3%（110/637）和37.6%（117/311）。在原始报告中被认为超声诊断不确定的扭转患者中，2.3%（2/86）随后被发现患有扭转。在盲法审查中超声诊断不确定的扭转患者（n = 110）中，未发现有扭转患者。X线片上肠管气体扩张并延长是盲法解读中扭转和旋转不良超声诊断不确定的最佳单一预测因素（OR = 8.2和9.2；95%CI分别为3.7 - 19.8和1.7 - 89.4），也是原始放射学报告中扭转的最佳单一预测因素（OR = 4.5；95%CI为2.2 - 9.5）。
多机构样本中用于中肠扭转的超声检查有一小部分无法做出诊断；然而，对无扭转的旋转不良评估的非诊断性检查频率更高。X线片上肠管气体扩张模式是超声诊断不确定的最强预测因素，尽管这不一定排除诊断性检查。
