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Staniorski CJ, Paul A, Chaudhry R. Prospective assessment of entrance skin dose and targets for radiation reduction during abdominal plain films in pediatric urology patients. J Pediatr Urol 2024:S1477-5131(24)00139-6. [PMID: 38453616 DOI: 10.1016/j.jpurol.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Abdominal radiographs are frequently used for evaluation of bowel and bladder dysfunction in pediatric urology. However, the dose of radiation delivered with each study is estimated from machine settings as opposed to measurement of the true entrance skin dose. In addition, the correlation of radiographic constipation with patient symptoms has been questioned. OBJECTIVE To evaluate the practices for obtaining abdominal radiographs and the true entrance skin dose of radiation for each examination in order to identify targets for radiation reduction. STUDY DESIGN Pediatric urology patients were prospectively enrolled from June 2022 through June 2023. Dosimeters were attached to the navel to collect entrance skin doses from single view abdominal x-ray. Estimated doses were compared to measured entrance skin dose as well as patient characteristics. Exam parameters were evaluated to identify targets for radiation reduction. RESULTS A total of 75 patients were recruited for this study with a median age of 10.0 years (IQR 6-14). Most evaluations were done to assess for bowel and bladder dysfunction (68 exams, 91%). The protocol for exams was not standardized resulting in 27% of patients undergoing a medium or high dose strength and 55% undergoing 1 or more image. The median estimated dose was 0.63 mGy (IQR 0.3-1.2 mGy). The median measured dose was 0.77 mGy (IQR 0.31-2.01 mGy) which was significantly different than the estimations (p < 0.001). The estimated dose, measured dose and estimate error were all found to be positively correlated with patient characteristics including age and body mass index (See Figure). Increasing age and body mass index also showed a higher likelihood of increased dose strength and image acquisition. DISCUSSION The measured entrance skin dose of radiation is significantly higher than prior estimates. The measured dose but also the estimate error increased with patient age and size which is likely related to higher settings used for image acquisition as patients age. Standardized protocols using low dose settings and limiting image acquisition to the pelvis may reduce radiation exposure in children with bowel and bladder dysfunction while providing adequate diagnostic data. CONCLUSION Radiation dose for abdominal radiographs is higher than previously estimated. Older and larger children received higher doses which may be mediated by increased dose strength and image acquisition. Standardization of protocols could lower radiation exposure.
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Affiliation(s)
| | | | - Rajeev Chaudhry
- Department of Urology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
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Alzyoud K, Al-Murshedi S, England A. Effective dose and image quality for different patient sizes during AP upper abdominal radiography: A phantom study. Appl Radiat Isot 2023; 202:111060. [PMID: 37806283 DOI: 10.1016/j.apradiso.2023.111060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/17/2023] [Accepted: 09/28/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Undertaking medical imaging examinations on obese patients can present practical challenges. Choosing optimal imaging protocols can be difficult, especially when promoting the ALARA principle. The aim of this study was to assess the effects of increasing body part thickness on image quality (IQ) and effective dose (ED) during upper abdominal radiography. A secondary aim was to determine the optimum exposure settings for larger sized patients. METHODS Underweight, standard, overweight and obese abdomen sizes were simulated using an anthropomorphic upper abdomen phantom, without and with additional fat layers (6, 10 and 16 cm). Phantoms were imaged using a variety of tube potentials (70-110 kVp), automatic exposure control (AEC) and a source-to-image distance of 120 cm. IQ was assessed visually using a relative visual grading analysis (VGA) method. Radiation dose was evaluated by calculating the ED using the Monte Carlo PCXMC 2.0 computer program. RESULTS IQ values showed a statistical reduction (p = 0.006) with increasing phantom size across all examined tube potentials. The highest IQ scores (3.3, 2.8, 2.5 and 2.2, respectively) were obtained at 70/75 kVp for all phantom thicknesses. As tube potential increased the IQ was also shown to decrease. ED showed a statistically significant increase (p < 0.001) with increasing phantom thicknesses. CONCLUSION Higher EDs were evident when applying lower tube potentials. Using an AEC with high tube potentials (105/110 kVp) can lead to a considerable decrease in ED with acceptable IQ when undertaking upper abdomen radiography on patients with large body part thicknesses. IMPLICATION FOR PRACTICE Applying higher values of tube potentials for patients who have a thicker abdomen can lead to decreased ED.
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Affiliation(s)
- Kholoud Alzyoud
- Department of Medical Imaging, Faculty of Applied Health Science, The Hashemite University, P.O. Box 330127, Zarqa, 13133, Jordan.
| | - Sadeq Al-Murshedi
- AL-Zahraa University for Women, College of Health and Medical Technology, Karbala, Iraq
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Rukwong P, Wangviwat N, Phewplung T, Sintusek P. Cohort analysis of pediatric intussusception score to diagnose intussusception. World J Clin Cases 2023; 11:5014-5022. [PMID: 37583866 PMCID: PMC10424024 DOI: 10.12998/wjcc.v11.i21.5014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Intussusception is a primary cause of intestinal obstruction in young children. Delayed diagnosis is associated with increased morbidity. Ultrasonography (USG) is the gold standard for diagnosis, but it is operator dependent and often unavailable in limited resource areas. AIM To study the clinical characteristics of intussusception including management and evaluation of the diagnostic accuracy of abdominal radiography (AR) and the promising parameters found in the pediatric intussusception score (PIS). METHODS Children with suspected intussusception in our center from 2006 to 2018 were recruited. Clinical manifestations, investigations, and treatment outcomes were recorded. AR images were interpreted by a pediatric radiologist. Diagnosis of intussusception was composed of compatible USG and response with reduction. The diagnostic value of the proposed PIS was evaluated. RESULTS Ninety-seven children were diagnosed with intussusception (2.06 ± 2.67 years, 62.9% male), of whom 74% were < 2 years old and 37.1% were referrals. The common manifestations of intussusception were irritability or abdominal pain (86.7%) and vomiting (59.2%). Children aged 6 mo to 2 years, pallor, palpable abdominal mass, and positive AR were the parameters that could discriminate intussusception from other mimics (P < 0.05). Referral case was the only significant parameter for failure to reduce intussusception (P < 0.05). AR to diagnose intussusception had a sensitivity of 59.2%. The proposed PIS, a combination of clinical irritability or abdominal pain, children aged 6 mo to 2 years, and compatible AR, had a sensitivity of 85.7%. CONCLUSION AR alone provides poor screening for intussusception. The proposed PIS in combination with common manifestations and AR data was shown to increase the diagnostic sensitivity, leading to timely clinical management.
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Affiliation(s)
- Punwadee Rukwong
- Department of Pediatrics, Phrapokklao Hospital, Chantaburi 22000, Meuang, Thailand
| | - Nathawit Wangviwat
- Division of Laboratory Medicine, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Teerasak Phewplung
- Department of Radiology, Chulalongkorn University, Bangkok 10330, Thailand
| | - Palittiya Sintusek
- Thai Pediatric Gastroenterology, Hepatology and Immunology Research Unit, Division of Gastroenterology, Department of Pediatrics, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand
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Park S, Ye JC, Lee ES, Cho G, Yoon JW, Choi JH, Joo I, Lee YJ. Deep Learning-Enabled Detection of Pneumoperitoneum in Supine and Erect Abdominal Radiography: Modeling Using Transfer Learning and Semi-Supervised Learning. Korean J Radiol 2023; 24:541-552. [PMID: 37271208 DOI: 10.3348/kjr.2022.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVE Detection of pneumoperitoneum using abdominal radiography, particularly in the supine position, is often challenging. This study aimed to develop and externally validate a deep learning model for the detection of pneumoperitoneum using supine and erect abdominal radiography. MATERIALS AND METHODS A model that can utilize "pneumoperitoneum" and "non-pneumoperitoneum" classes was developed through knowledge distillation. To train the proposed model with limited training data and weak labels, it was trained using a recently proposed semi-supervised learning method called distillation for self-supervised and self-train learning (DISTL), which leverages the Vision Transformer. The proposed model was first pre-trained with chest radiographs to utilize common knowledge between modalities, fine-tuned, and self-trained on labeled and unlabeled abdominal radiographs. The proposed model was trained using data from supine and erect abdominal radiographs. In total, 191212 chest radiographs (CheXpert data) were used for pre-training, and 5518 labeled and 16671 unlabeled abdominal radiographs were used for fine-tuning and self-supervised learning, respectively. The proposed model was internally validated on 389 abdominal radiographs and externally validated on 475 and 798 abdominal radiographs from the two institutions. We evaluated the performance in diagnosing pneumoperitoneum using the area under the receiver operating characteristic curve (AUC) and compared it with that of radiologists. RESULTS In the internal validation, the proposed model had an AUC, sensitivity, and specificity of 0.881, 85.4%, and 73.3% and 0.968, 91.1, and 95.0 for supine and erect positions, respectively. In the external validation at the two institutions, the AUCs were 0.835 and 0.852 for the supine position and 0.909 and 0.944 for the erect position. In the reader study, the readers' performances improved with the assistance of the proposed model. CONCLUSION The proposed model trained with the DISTL method can accurately detect pneumoperitoneum on abdominal radiography in both the supine and erect positions.
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Affiliation(s)
- Sangjoon Park
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Jong Chul Ye
- Kim Jaechul Graduate School of AI, Korea Advanced Institute of Science and Technology, Daejeon, Korea.
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
- Biomedical Research Institute, Chung-Ang University Hospital, Seoul, Korea.
| | - Gyeongme Cho
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Woo Yoon
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Joo Hyeok Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Yoon Jin Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
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Morrell DJ, DeLong CG, Horne CM, Pauli EM. Radiographic identification of thoracoabdominal hernias. Hernia 2021; 26:287-295. [PMID: 34125302 DOI: 10.1007/s10029-021-02437-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Hernias spanning both chest and abdominal walls are uncommon and associated with chest wall trauma, coughing and obesity. This study describes the radiographic appearance of these hernias to guide proper identification and operative planning. Proposed standardized reporting patterns are also presented. METHODS The cross sectional imaging of patients presenting with thoracoabdominal hernias was reviewed. Radiographic reports were supplemented by surgeon imaging review and operative findings during repair. Defect dimensions, hernia content, level of herniation, presence of osseous or cartilaginous disruption of the chest wall and degree of rib displacement were collected. Disruption of myofascial planes was also noted. RESULTS Six patients were identified. All hernias occurred below the 9th rib and were associated with complete intercostal muscle disruption. The transversus abdominis was disrupted in all hernias and the internal oblique was disrupted in five of the hernias. The majority (83%) had caudal rib displacement (median 6.8 cm compared to contralateral side). Median hernia width was 10.35 cm (1.6-19.1 cm) and median length was 10.2 cm (1.8-14.3 cm). Five patients had associated bone/cartilage injuries: two with 11th rib fractures, two with combined bone and cartilaginous fractures and one with a surgical rib resection. CONCLUSION The typical injury pattern of thoracoabdominal hernias includes disruption of the intercostal muscles, transversus abdominis, and commonly the internal oblique with an intact external oblique. Inferior rib displacement by hernia contents and unopposed pull of the abdominal musculature is common. Osseous or cartilaginous disruption always occurs unless the defect is bounded on at least one side by a floating rib.
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Affiliation(s)
- David J Morrell
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, H149, Hershey, PA, 17033-0850, USA
| | - Colin G DeLong
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, H149, Hershey, PA, 17033-0850, USA
| | - Charlotte M Horne
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, H149, Hershey, PA, 17033-0850, USA
| | - Eric M Pauli
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, H149, Hershey, PA, 17033-0850, USA.
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Wang X, Zheng F, Xiao R, Liu Z, Li Y, Li J, Zhang X, Hao X, Zhang X, Guo J, Zhang Y, Xue H, Jin Z. Comparison of image quality and lesion diagnosis in abdominopelvic unenhanced CT between reduced-dose CT using deep learning post-processing and standard-dose CT using iterative reconstruction: A prospective study. Eur J Radiol 2021; 139:109735. [PMID: 33932717 DOI: 10.1016/j.ejrad.2021.109735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/06/2021] [Accepted: 04/19/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare image quality and lesion diagnosis between reduced-dose abdominopelvic unenhanced computed tomography (CT) using deep learning (DL) post-processing and standard-dose CT using iterative reconstruction (IR). METHOD Totally 251 patients underwent two consecutive abdominopelvic unenhanced CT scans of the same range, including standard and reduced doses, respectively. In group A, standard-dose data were reconstructed by (blend 30 %) IR. In group B, reduced-dose data were reconstructed by filtered back projection reconstruction to obtain group B1 images, and post-processed using the DL algorithm (NeuAI denosing, Neusoft medical, Shenyang, China) with 50 % and 100 % weights to obtain group B2 and B3 images, respectively. Then, CT values of the liver, the second lumbar vertebral centrum, the erector spinae and abdominal subcutaneous fat were measured. CT values, noise levels, signal-to-noise ratios (SNRs), contrast-to-noise ratios (CNRs), radiation doses and subjective scores of image quality were compared. Subjective evaluations of low-density liver lesions were compared by diagnostic results from enhanced CT or Magnetic Resonance Imaging. RESULTS Groups B3 and B1 showed the lowest and highest noise levels, respectively (P < 0.001). The SNR and CNR in group B3 were highest (P < 0.001). The radiation dose in group B was reduced by 71.5 % on average compared to group A. Subjective scores in groups A and B2 were highest (P < 0.001). Diagnostic sensitivity and confidence for liver metastases in groups A and B2 were highest (P < 0.001). CONCLUSIONS Reduced-dose abdominopelvic unenhanced CT combined with DL post-processing could ensure image quality and satisfy diagnostic needs.
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Affiliation(s)
- Xiao Wang
- From the Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Fuling Zheng
- From the Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ran Xiao
- From the Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhuoheng Liu
- From CT Business Unit, Neusoft Medical System Company, Shenyang, China
| | - Yutong Li
- From CT Business Unit, Neusoft Medical System Company, Shenyang, China
| | - Juan Li
- From the Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xi Zhang
- From the Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xuemin Hao
- From the Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xinhu Zhang
- From the Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jiawu Guo
- From the Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yan Zhang
- From the Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Huadan Xue
- From the Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
| | - Zhengyu Jin
- From the Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Kang S, Park H, Hong J. Clinical and Radiologic Characteristics of Caudal Regression Syndrome in a 3-Year-Old Boy: Lessons from Overlooked Plain Radiographs. Pediatr Gastroenterol Hepatol Nutr 2021; 24:238-243. [PMID: 33833979 PMCID: PMC8007840 DOI: 10.5223/pghn.2021.24.2.238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/20/2020] [Accepted: 10/05/2020] [Indexed: 12/04/2022] Open
Abstract
Caudal regression syndrome (CRS) is a rare neural tube defect that affects the terminal spinal segment, manifesting as neurological deficits and structural anomalies in the lower body. We report a case of a 31-month-old boy presenting with constipation who had long been considered to have functional constipation but was finally confirmed to have CRS. Small, flat buttocks with bilateral buttock dimples and a short intergluteal cleft were identified on close examination. Plain radiographs of the abdomen, retrospectively reviewed, revealed the absence of the distal sacrum and the coccyx. During the 5-year follow-up period, we could find his long-term clinical course showing bowel and bladder dysfunction without progressive neurologic deficits. We present this case to highlight the fact that a precise physical examination, along with a close evaluation of plain radiographs encompassing the sacrum, is necessary with a strong suspicion of spinal dysraphism when confronting a child with chronic constipation despite the absence of neurologic deficits or gross structural anomalies.
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Affiliation(s)
- Seongyeon Kang
- Department of Pediatrics, Kangwon National University Hospital, Chuncheon, Korea
| | - Heewon Park
- Department of Rehabilitation, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jeana Hong
- Department of Pediatrics, Kangwon National University Hospital, Chuncheon, Korea.,Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea
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Abstract
Due to their chemical properties, accidental or suicidal ingestion of batteries into the digestive system can cause fatal complications; Treatment should not be delayed and close monitoring is required. A 26-year-old male patient is treated by the psychiatry department with diagnoses of antisocial personality disorder and depressive adjustment disorder. He consulted with the complaint of ingesting cylindrical AA battery for suicidal purpose. In our case, the cylindrical AA battery in the duodenum was removed from the rectum at the end of the third day without any complications. However, the continuous movement of the cylindrical AA battery with lactulose treatment in the gastrointestinal tract and the support of this movement with abdominal radiographs can reduce the risk of fatal complications. When planning the battery treatment in the gastrointestinal tract, the location of the battery and whether it is mobile should be determined. While obstruction of oesophagus by batteries requires emergency surgical treatment, batteries that remained fixed in the stomach for longer than 48 hours need to be treated with surgical or endoscopic methods.
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Affiliation(s)
- Mehmet Nuri Kosar
- Mehmet Nuri Kosar Department of General Surgery, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ozkan Gorgulu
- Ozkan Gorgulu Department of Anesthesiology and Reanimation, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
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Abstract
The imaging evaluation of the abdomen is of crucial importance for every radiologist. In addition to ultrasound, conventional radiographs and contrast-enhanced computed tomography (CT) are the most common imaging procedures in the abdominal region. Numerous pathognomonic signs should be known in this context by every radiologist. Radiographs of the abdomen are an often used first step in radiologic imaging, while CT examinations are carried out for further differentiation, in oncological settings and in time-critical emergency situations. A fast and clear assignment of these signs to a specific disease is the basis for a correct diagnosis. This pictorial review describes the most common pathognomonic signs in abdominal imaging. The knowledge of these pictograms is therefore essential for radiologists interested in abdominal medicine and should also be addressed in training and further education.
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Affiliation(s)
- Christopher Kloth
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Daniel Vogele
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Horst Brunner
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Stefan Andreas Schmidt
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Fattori Alves AF, Menegatti Pavan AL, Giacomini G, Quini CC, Marrone Ribeiro S, Garcia Marquez R, Bentlin MR, Petean Trindade A, de Arruda Miranda JR, Rodrigues de Pina D. Radiographic predictors determined with an objective assessment tool for neonatal patients with necrotizing enterocolitis. J Pediatr (Rio J) 2019; 95:674-81. [PMID: 31679612 DOI: 10.1016/j.jped.2018.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The objective of this study was to develop and validate a computational tool to assist radiological decisions on necrotizing enterocolitis. METHODOLOGY Patients that exhibited clinical signs and radiographic evidence of Bell's stage 2 or higher were included in the study, resulting in 64 exams. The tool was used to classify localized bowel wall thickening and intestinal pneumatosis using full-width at half-maximum measurements and texture analyses based on wavelet energy decomposition. Radiological findings of suspicious bowel wall thickening and intestinal pneumatosis loops were confirmed by both patient surgery and histopathological analysis. Two experienced radiologists selected an involved bowel and a normal bowel in the same radiography. The full-width at half-maximum and wavelet-based texture feature were then calculated and compared using the Mann-Whitney U test. Specificity, sensibility, positive and negative predictive values were calculated. RESULTS The full-width at half-maximum results were significantly different between normal and distended loops (median of 10.30 and 15.13, respectively). Horizontal, vertical, and diagonal wavelet energy measurements were evaluated at eight levels of decomposition. Levels 7 and 8 in the horizontal direction presented significant differences. For level 7, median was 0.034 and 0.088 for normal and intestinal pneumatosis groups, respectively, and for level 8 median was 0.19 and 0.34, respectively. CONCLUSIONS The developed tool could detect differences in radiographic findings of bowel wall thickening and IP that are difficult to diagnose, demonstrating the its potential in clinical routine. The tool that was developed in the present study may help physicians to investigate suspicious bowel loops, thereby considerably improving diagnosis and clinical decisions.
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Jang JS, Yang HJ, Koo HJ, Kim SH, Park CR, Yoon SH, Shin SY, Do KH. Image quality assessment with dose reduction using high kVp and additional filtration for abdominal digital radiography. Phys Med 2018; 50:46-51. [PMID: 29891093 DOI: 10.1016/j.ejmp.2018.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 05/04/2018] [Accepted: 05/06/2018] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Dose reduction using additional filters with high kilovoltage peak (kVp) for abdominal digital radiography has received much attention recently. We evaluated image quality with dose reduction in abdominal digital radiography by using high kVp and additional copper filters at a tertiary hospital. METHODS Between June 2016 and July 2016, 82 patients underwent abdominal digital radiography using 80 kVp in X-ray room 1 and 82 were imaged using 92 kVp with 0.1-mm copper filtration in X-ray room 2. The effective dose was calculated using a PC-based Monte Carlo program. Image quality of the abdominal radiography acquired in the two rooms was evaluated using a five-point ordinal scale, as well as the signal-to-noise and contrast-to-noise ratios. RESULTS The mean effective dose decreased by 25.8% and 25.7% for the supine and standing positions, respectively, when abdominal digital radiography using 92 kVp with 0.1-mm copper filtration was performed. In the 20 patients who performed abdominal digital radiography twice in each room, visual grading scores for visualisation of psoas outlines and kidney outlines are higher in room 1. However, there was no statistical significant difference of visual grading scores among the 124 patients who underwent only one abdominal radiography in the room 1 or 2 (P > 0.05). CONCLUSIONS Dose reduction for abdominal digital radiography can be achieved with comparable image quality by performing abdominal digital radiography using 92 kVp with 0.1-mm copper filtration, despite the higher AEC dose.
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Affiliation(s)
- Ji Sung Jang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea; Department of Medical Physics, Korea University, South Korea
| | - Hyung Jin Yang
- Department of Medical Physics, Korea University, South Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Sung Ho Kim
- Department of Medical Physics, Korea University, South Korea
| | - Chan Rok Park
- Department of Medical Physics, Korea University, South Korea
| | - Suk Hwan Yoon
- Department of Medical Physics, Korea University, South Korea
| | - So Youn Shin
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Kyung-Hyun Do
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea.
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Ahle M, Ringertz HG, Rubesova E. The role of imaging in the management of necrotising enterocolitis: a multispecialist survey and a review of the literature. Eur Radiol 2018; 28:3621-31. [PMID: 29582131 DOI: 10.1007/s00330-018-5362-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/26/2018] [Accepted: 01/30/2018] [Indexed: 01/04/2023]
Abstract
Objectives To investigate current practices and perceptions of imaging in necrotising enterocolitis (NEC) according to involved specialists, put them in the context of current literature, and identify needs for further investigation. Methods Two hundred two neonatologists, paediatric surgeons, and radiologists answered a web-based questionnaire about imaging in NEC at their hospitals. The results were descriptively analysed, using proportion estimates with 95% confidence intervals. Results There was over 90% agreement on the value of imaging for confirmation of the diagnosis, surveillance, and guidance in decisions on surgery as well as on abdominal radiography as the first-choice modality and the most important radiographic signs. More variation was observed regarding some indications for surgery and the use of some ultrasonographic signs. Fifty-eight per cent stated that ultrasound was used for NEC at their hospital. Examination frequency, often once daily or more but with considerable variations, and projections used in AR were usually decided individually rather than according to fixed schedules. Predicting the need of surgery was regarded more important than formal staging. Conclusion Despite great agreement on the purposes of imaging in NEC and the most important radiographic signs of the disease, there was considerable diversity in routines, especially regarding examination frequency and the use of ultrasound. Apart from continuing validation of ultrasound, important objectives for future studies include definition of the supplementary roles of both imaging modalities in relation to other diagnostic parameters and evaluation of various imaging routines in relation to timing of surgery, complications, and mortality rate. Key Points • Imaging is an indispensable tool in the management of necrotising enterocolitis • Predicting the need of surgery is regarded more important than formal staging • There is great consensus on important signs of NEC on abdominal radiography • There is more uncertainty regarding the role of ultrasound • Individualised management is preferred over standardised diagnostic algorithms Electronic supplementary material The online version of this article (10.1007/s00330-018-5362-x) contains supplementary material, which is available to authorized users.
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Cappelletti S, Ciallella C. Commentary on false negative findings of plain radiographs in body packing. Clin Imaging 2017; 45:122-123. [PMID: 28528792 DOI: 10.1016/j.clinimag.2017.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/13/2017] [Indexed: 11/24/2022]
Abstract
The use of terms "body packing" and "body pushing", both encompassed in the idiomatic expression "body packing", is still misunderstood by clinicians. "Body packing" is a general term used to indicate the internal transportation of drug packages within the gastrointestinal tract; while "Body pushing" refers to the insertion of drugs in anatomical cavities or body orifices, such as the anus, the vagina, and the ears. With the present paper, we would like to analyze and clarify some issues concerning the confounding definitions of body packing and the main reasons why some drug packages may be undetected at plain abdominal radiography, providing important false negative findings, as in the case commented.
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Affiliation(s)
- Simone Cappelletti
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Sciences, "Sapienza" University of Rome, Rome, Italy; State Police Health Service Department, Ministry of Interior, Rome, Italy.
| | - Costantino Ciallella
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Sciences, "Sapienza" University of Rome, Rome, Italy
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Esterson YB, Patel V, Nicastro J, Friedman B. Plain radiography may underestimate the burden of body packer ingestion: A case report. Clin Imaging 2017; 44:57-60. [PMID: 28441549 DOI: 10.1016/j.clinimag.2017.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/19/2017] [Indexed: 01/08/2023]
Abstract
Body packing refers to the intracorporeal concealment of illicit drugs. Here we report the case of a 55-year-old body packer who presented with palpitations, visual hallucinations, and a sense of impending death. Abdominal radiography demonstrated five ovoid foreign bodies overlying the rectum. At subsequent gastrotomy and cecotomy, thirty-eight cocaine-containing packets were retrieved from the stomach and ascending colon as well as from the rectum. As the contraband market evolves new techniques to evade detection, evaluation of the burden of body packer ingestion has become increasingly challenging. As demonstrated in this case, plain radiography can grossly underestimate the burden of ingestion.
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Affiliation(s)
- Yonah B Esterson
- Department of Radiology, Northwell Health System, Hofstra Northwell School of Medicine, 270-05 76th Avenue, New Hyde Park, NY 11040, USA.
| | - Vihas Patel
- Department of Surgery, Northwell Health System, Hofstra Northwell School of Medicine, 270-05 76th Avenue, New Hyde Park, NY 11040, USA.
| | - Jeffrey Nicastro
- Department of Surgery, Northwell Health System, Hofstra Northwell School of Medicine, 270-05 76th Avenue, New Hyde Park, NY 11040, USA.
| | - Barak Friedman
- Department of Radiology, Northwell Health System, Hofstra Northwell School of Medicine, 270-05 76th Avenue, New Hyde Park, NY 11040, USA.
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Nazerian P, Tozzetti C, Vanni S, Bartolucci M, Gualtieri S, Trausi F, Vittorini M, Catini E, Cibinel GA, Grifoni S. Accuracy of abdominal ultrasound for the diagnosis of pneumoperitoneum in patients with acute abdominal pain: a pilot study. Crit Ultrasound J 2015; 7:15. [PMID: 26443344 PMCID: PMC4595408 DOI: 10.1186/s13089-015-0032-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pneumoperitoneum is a rare cause of abdominal pain characterized by a high mortality. Ultrasonography (US) can detect free intraperitoneal air; however, its accuracy remains unclear. The aims of this pilot study were to define the diagnostic performance and the reliability of abdominal US for the diagnosis of pneumoperitoneum. METHODS This was a prospective observational study. Four senior and two junior physicians were shown, in an unpaired randomized order, abdominal US videos from 11 patients with and 11 patients without pneumoperitoneum. Abdominal US videos were obtained from consecutive patients presenting to ED complaining abdominal pain with the diagnosis of pneumoperitoneum established by CT. Abdominal US was performed according to a standardized protocol that included the following scans: epigastrium, right and left hypochondrium, umbilical area and right hypochondrium with the patient lying on the left flank. We evaluated accuracy, intra- and inter-observer agreement of abdominal US when reviewed by senior physicians. Furthermore, we compared the accuracy of a "2 scan-fast exam" (epigastrium and right hypochondrium) vs the full US examination and the accuracy of physicians expert in US vs nonexpert ones. Finally, accuracy of US was compared with abdominal radiography in patients with available images. RESULTS Considering senior revision, accuracy of abdominal US was 88.6 % (95 % CI 79.4-92.4 %) with a sensitivity of 95.5 % (95 % CI 86.3-99.2 %) and a specificity of 81.8 % (95 % CI 72.6-85.5 %). Inter- and intra-observer agreement (k) were 0.64 and 0.95, respectively. Accuracy of a "2 scan-fast exam" (87.5 %, 95 % CI 77.9-92.4 %) was similar to global exam. Sensitivity of abdominal radiography (72.2 %, 95 % CI 54.8-85.7 %) was lower than that of abdominal US, while specificity (92.5 %, 95 % CI 79.5-98.3 %) was higher. Accuracy (68.2 %, 95 % CI 51.4-80.9 %) of junior reviewers evaluating US was lower than senior reviewers. CONCLUSIONS Senior physicians can recognize US signs of pneumoperitoneum with a good accuracy and reliability; sensitivity of US could be superior to abdominal radiography and a 2 fast-scan exam seems as accurate as full abdominal examination. US could be a useful bedside screening test for pneumoperitoneum. Trial registry ClinicalTrials.gov; No.: NCT02004925; URL: http://www.clinicaltrials.gov.
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Affiliation(s)
- Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, largo Brambilla 3, 50134, Florence, Italy.
| | - Camilla Tozzetti
- Department of Emergency Medicine, Careggi University Hospital, largo Brambilla 3, 50134, Florence, Italy
| | - Simone Vanni
- Department of Emergency Medicine, Careggi University Hospital, largo Brambilla 3, 50134, Florence, Italy
| | | | - Simona Gualtieri
- Department of Emergency Medicine, Careggi University Hospital, largo Brambilla 3, 50134, Florence, Italy
| | - Federica Trausi
- Department of Emergency Medicine, Careggi University Hospital, largo Brambilla 3, 50134, Florence, Italy
| | - Marco Vittorini
- Department of Emergency Medicine, Careggi University Hospital, largo Brambilla 3, 50134, Florence, Italy
| | - Elisabetta Catini
- Department of Emergency Medicine, Careggi University Hospital, largo Brambilla 3, 50134, Florence, Italy
| | | | - Stefano Grifoni
- Department of Emergency Medicine, Careggi University Hospital, largo Brambilla 3, 50134, Florence, Italy
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Keller J, Layer P. [Acute colonic pseudo-obstruction: Ogilvie syndrome]. Med Klin Intensivmed Notfmed 2015; 110:506-9. [PMID: 26400054 DOI: 10.1007/s00063-015-0081-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/17/2015] [Indexed: 01/29/2023]
Abstract
Acute colonic pseudo-obstruction (ACPO) is characterized by marked colonic dilatation which develops over several days. ACPO is due to a motility disorder and is not caused by colonic obstruction and occurs in patients with severe, often acute underlying diseases or postoperatively. It is associated with a 25-30% mortality overall that increases to up to 50% in patients who develop complications (e.g. colonic ischemia and perforation). The pathogenesis of the disorder has not yet been clarified and clinical symptoms and signs are relatively unspecific. In particular, ACPO has to be differentiated from colonic obstruction and toxic megacolon. For this blood tests and radiological tests are required, e.g. plain abdominal radiograph, abdominal computed tomography (CT) and water soluble contrast enema, which are also required for detection of complications. Patients with ACPO should generally receive supportive therapy for decompression of the gastrointestinal tract (e.g. gastric and rectal tubes) and to minimize predisposing factors. In most uncomplicated cases this leads to resolution of colonic dilatation. Clinical and radiological controls at close intervals are required until the condition is resolved. If patients do not respond within 1-2 days or if ACPO has already reached a critical duration (>3-4 days) or extent (i.e. cecal diameter ≥12 cm), neostigmine should be administered and leads to durable success in approximately 3 out of 4 patients. Patients who are still refractory to treatment should receive endoscopic decompression. More invasive therapeutic options, such as cecostomy or (segmental) colonic resection should only be considered for patients who still do not respond to treatment or present with the abovementioned complications.
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Alshamari M, Norrman E, Geijer M, Jansson K, Geijer H. Diagnostic accuracy of low-dose CT compared with abdominal radiography in non-traumatic acute abdominal pain: prospective study and systematic review. Eur Radiol 2015; 26:1766-74. [PMID: 26385800 DOI: 10.1007/s00330-015-3984-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 08/13/2015] [Accepted: 08/31/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Abdominal radiography is frequently used in acute abdominal non-traumatic pain despite the availability of more advanced diagnostic modalities. This study evaluates the diagnostic accuracy of low-dose CT compared with abdominal radiography, at similar radiation dose levels. METHODS Fifty-eight patients were imaged with both methods and were reviewed independently by three radiologists. The reference standard was obtained from the diagnosis in medical records. Sensitivity and specificity were calculated. A systematic review was performed after a literature search, finding a total of six relevant studies including the present. RESULTS Overall sensitivity with 95 % CI for CT was 75 % (66-83 %) and 46 % (37-56 %) for radiography. Specificity was 87 % (77-94 %) for both methods. In the systematic review the overall sensitivity for CT varied between 75 and 96 % with specificity from 83 to 95 % while the overall sensitivity for abdominal radiography varied between 30 and 77 % with specificity 75 to 88 %. CONCLUSIONS Based on the current study and available evidence, low-dose CT has higher diagnostic accuracy than abdominal radiography and it should, where logistically possible, replace abdominal radiography in the workup of adult patients with acute non-traumatic abdominal pain. KEY POINTS • Low-dose CT has a higher diagnostic accuracy than radiography. • A systematic review shows that CT has better diagnostic accuracy than radiography. • Radiography has no place in the workup of acute non-traumatic abdominal pain.
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Affiliation(s)
- Muhammed Alshamari
- Department of Radiology, Faculty of Medicine and Health, Örebro University, SE 701 85, Örebro, Sweden.
| | - Eva Norrman
- Department of Medical Physics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mats Geijer
- Department of Medical Imaging and Physiology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Kjell Jansson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Håkan Geijer
- Department of Radiology, Faculty of Medicine and Health, Örebro University, SE 701 85, Örebro, Sweden
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Moon HJ, Noh SE, Kim JH, Joo MC. Diagnostic value of plain abdominal radiography in stroke patients with bowel dysfunction. Ann Rehabil Med 2015; 39:243-52. [PMID: 25932421 PMCID: PMC4414971 DOI: 10.5535/arm.2015.39.2.243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 09/23/2014] [Indexed: 01/14/2023] Open
Abstract
Objective To evaluate the diagnostic value of plain abdominal radiography in stroke patients with bowel dysfunction. Methods A total of 59 stroke patients were recruited and assigned into constipation or non-constipation group. Patients were interviewed to obtain clinical information, constipation score, and Bristol stool form scale. The total and segmental colon transit time (CTT) was measured using radio-opaque markers (Kolomark). The degree of stool retention was evaluated by plain abdominal radiography and scored by two different methods (Starreveld score and Leech score). The relationship between the clinical aspects, CTT, and stool retention score using plain abdominal radiography was determined. Results Average constipation score was 4.59±2.16. Average Bristol stool form scale was 3.86±1.13. The total and segmental CTTs showed significant differences between the constipation and non-constipation groups. There was statistically significant (p<0.05) correlation between the total CTT and constipation score or between Starreveld score and Leech score. Each segmental CTT showed significant correlation (p<0.05) between segmental stool retention scores. Conclusion The stool retention score showed significant correlation with constipation score as well as total and segmental CTT. Thus, plain abdominal radiography is a simple and convenient method for the evaluation of bowel dysfunction in stroke patients.
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Affiliation(s)
- Hyo Jeong Moon
- Department of Rehabilitation Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Se Eung Noh
- Department of Rehabilitation Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Ji Hee Kim
- Department of Rehabilitation Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
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Park HJ, Noh SE, Kim GD, Joo MC. Plain abdominal radiograph as an evaluation method of bowel dysfunction in patients with spinal cord injury. Ann Rehabil Med 2013; 37:547-55. [PMID: 24020036 PMCID: PMC3764350 DOI: 10.5535/arm.2013.37.4.547] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 05/28/2013] [Indexed: 01/11/2023] Open
Abstract
Objective To evaluate the usefulness of plain abdominal radiography as an evaluation method for bowel dysfunction in patients with spinal cord injury (SCI). Methods Forty-four patients with SCI were recruited. Patients were interviewed about their clinical symptoms, and the constipation score and Bristol stool form scale were assessed. The colon transit time (CTT) was measured by using radio-opaque markers (Kolomark). The degree of stool retention and the presence of megacolon or megarectum were evaluated using plain abdominal radiographs. We examined the relationship between clinical aspects and CTT and plain abdominal radiography. Results The constipation scores ranged from 1 to 13, and the average was 4.19±3.11, and the Bristol stool form scale ranged from 1 to 6, with an average of 4.13±1.45. CTTs were 19.3±16.17, 19.3±13.45, 15.32±13.15, and 52.42±19.14 in the right, left, rectosigmoid, and total colon. Starreveld scores were 3.4±0.7, 1.8±0.86, 2.83±0.82, 2.14±1, and 10.19±2.45 in the ascending, transverse, descending, rectosigmoid, and total colon. Leech scores were 3.28±0.7, 2.8±0.8, 2.35±0.85, and 8.45±1.83 in the right, left, rectosigmoid, and total colon. The number of patients with megacolon and megarectum was 14 (31.8%) and 11 (25%). There were statistically significant correlations between the total CTT and constipation score (p<0.05), and Starreveld and Leech scores (p<0.05). Significant correlations were observed between each segmental CTT and the segmental stool retention score (p<0.05). Conclusion Plain abdominal radiography is useful as a convenient and simple method of evaluation of bowel dysfunction in patients with SCI.
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Affiliation(s)
- Hyun Joon Park
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea. ; Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
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Camera L, Calabrese M, Sarnelli G, Longobardi M, Rocco A, Cuomo R, Salvatore M. Pseudopneumoperitoneum in chronic intestinal pseudo-obstruction: A case report. World J Gastroenterol 2011; 17:2972-5. [PMID: 21734810 PMCID: PMC3129513 DOI: 10.3748/wjg.v17.i24.2972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Revised: 02/09/2011] [Accepted: 02/16/2011] [Indexed: 02/06/2023] Open
Abstract
Chronic intestinal pseudo-obstruction (CIPO) is a rare disease due to a severe gastrointestinal motility disorder which may mimic, on both clinical and radiological grounds, mechanical obstruction. We report a case of a 26-year-old woman who presented to our institution for plain abdominal radiography for referred long-lasting constipation with recurrent episodes of abdominal pain and distension. At X-ray, performed both in the upright and supine position, an isolated air-fluid level was depicted in the left flank, together with a number of radiological signs suggestive of pneumoperitoneum. First, subphrenic radiolucency could be observed in the upright film. Second, the intestinal wall of some jejunal loops appeared to be outlined in the right flank. Third, the inferior cardiac border was clearly depicted in the upright film. The patient however had no evidence of peritoneal signs but only hypoactive bowel movements. Unenhanced multi-detector computed tomography (MDCT) of the abdomen and pelvis was therefore performed. MDCT revealed abnormal air-driven distension of the small and large bowel, without evidence of extra-luminal air. All radiological signs of pneumoperitoneum turned out to be false-positive results. The patient was submitted to pan-colonoscopy and to anorectal manometry to rule out Hirshprung’s disease, and was finally discharged with a diagnosis of CIPO.
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