超声诊断儿童中肠旋转不良和肠扭转的临床表现:一项多机构回顾性研究。

IF 6.1 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
American Journal of Roentgenology Pub Date : 2025-09-01 Epub Date: 2025-06-11 DOI:10.2214/AJR.25.32660
HaiThuy N Nguyen, Alexander M El-Ali, Dane Van Tassel, Catalina Le Cacheux, Andrew C Sher, Afsaneh Amirabadi, Marla B K Sammer, Xiaofan Huang, Monique Riemann, Kevin Wong, Jeffrey Tutman, Desi M Schiess, Oscar M Navarro, Cicero T Silva
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引用次数: 0

摘要

背景:超声(US)对中肠旋转不良和肠扭转的诊断表现各不相同。目的:本研究的目的是评估超声对中肠旋转不良和肠扭转的诊断效果,并评估每种诊断的单个超声征象。方法:这项多中心、回顾性、横断面研究纳入了0-18岁的儿童,这些儿童在2018年至2021年期间接受了US作为评估疑似中肠旋转不良或扭转的第一影像学检查。临床资料从病历中提取。盲法评价者测量近端十二指肠,评估旋转不良和扭转以及特定超声征象。排除非诊断性和模棱两可的研究。旋转不良的参考标准包括手术、上胃肠道(UGI)系列、CT或MRI。扭转参考标准包括相同的,加上临床随访(至少28天)。计算敏感性、特异性和准确性来评估诊断性能;采用Wilcoxon秩和检验比较中位数。结果:旋转不良分析384例;中位年龄32天(IQR, 5-182天)。肠扭转分析包括900例检查;中位年龄为60天(IQR, 9-573天)。美国对旋转不良的敏感性和特异性在原始报告中分别为93% (95% CI, 81-98%)和96% (95% CI, 92-98%),在盲法研究综述中分别为97% (95% CI, 87-100%)和99% (95% CI, 97-100%)。美国对扭转的敏感性和特异性在原始报告中分别为97% (95% CI, 85-100%)和98% (95% CI, 96-99%),在盲法研究综述中分别为97% (95% CI, 86-100%)和99% (95% CI, 98-100%)。最准确的超声征象是十二指肠第三段腹膜内位置旋转不良(准确率为98%)和旋涡征象扭转(准确率为99%)。扭转患儿的十二指肠近端中径较大(13 mm [IQR, 7-18 mm] vs 6 mm [IQR, 4-8 mm], p < 0.001)。结论:超声对诊断中肠旋转不良和肠扭转均有良好的影像学表现。临床影响:US可作为诊断中肠旋转不良和肠扭转的一线影像学方式,UGI系列留待非诊断性或模棱两可的检查。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Diagnostic Performance of Ultrasound for Diagnosing Midgut Malrotation and Volvulus in Children: A Multiinstitutional Retrospective Review.

BACKGROUND. The reported diagnostic performance of ultrasound (US) for midgut malrotation and volvulus varies. OBJECTIVE. The purpose of this study was to evaluate the diagnostic performance of US for midgut malrotation and volvulus separately and to assess individual sonographic signs for each diagnosis. METHODS. This multicenter, retrospective, cross-sectional study included children (who were defined as individuals 0-18 years old) who had US performed as the first imaging test for evaluation of suspected midgut malrotation or volvulus from January 1, 2018, to June 30, 2021. Clinical data were extracted from medical records. Blinded reviewers measured the proximal duodenum and assessed for malrotation and volvulus as well as for specific sonographic signs. Nondiagnostic and equivocal studies were excluded. The reference standards used for malrotation included surgery, upper gastrointestinal (UGI) series, and CT and/or MRI. Volvulus reference standards included the same plus clinical follow-up (minimum, 28 days). Sensitivity, specificity, and accuracy were calculated to evaluate diagnostic performance; the Wilcoxon rank sum test was used to compare median values. RESULTS. Malrotation analysis included 384 examinations; median patient age was 32 days (IQR, 5-182 days). Volvulus analysis included 900 examinations; median patient age was 60 days (IQR, 9-573 days). The sensitivity and specificity of US for malrotation were 93% (95% CI, 81-98%) and 96% (95% CI, 92-98%) by original report and 97% (95% CI, 87-100%) and 99% (95% CI, 97-100%) by blinded research review. The sensitivity and specificity of US for volvulus were 97% (95% CI, 85-100%) and 98% (95% CI, 96-99%) by original report and 97% (95% CI, 86-100%) and 99% (95% CI, 98-100%) by blinded research review. The most accurate sonographic signs were the intraperitoneal position of the third portion of the duodenum for malrotation (accuracy = 98%) and the whirlpool sign for volvulus (accuracy = 99%). The median proximal duodenal diameter was greater in children with volvulus (13 mm [IQR, 7-18 mm] versus 6 mm [IQR, 4-8 mm], p < .001). CONCLUSION. The performance of US for diagnosing both midgut malrotation and volvulus is excellent in the setting of a diagnostic imaging study. CLINICAL IMPACT. US can be used as the first-line imaging modality for diagnosing midgut malrotation and volvulus, with UGI series reserved for nondiagnostic or equivocal examinations.

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来源期刊
CiteScore
12.80
自引率
4.00%
发文量
920
审稿时长
3 months
期刊介绍: Founded in 1907, the monthly American Journal of Roentgenology (AJR) is the world’s longest continuously published general radiology journal. AJR is recognized as among the specialty’s leading peer-reviewed journals and has a worldwide circulation of close to 25,000. The journal publishes clinically-oriented articles across all radiology subspecialties, seeking relevance to radiologists’ daily practice. The journal publishes hundreds of articles annually with a diverse range of formats, including original research, reviews, clinical perspectives, editorials, and other short reports. The journal engages its audience through a spectrum of social media and digital communication activities.
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