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Radiologia May 2016Bowel obstruction is the most common abdominal emergency in newborns. Managing bowel obstruction is a challenge for both clinicians and radiologists. The clinical...
Bowel obstruction is the most common abdominal emergency in newborns. Managing bowel obstruction is a challenge for both clinicians and radiologists. The clinical presentation is nonspecific, and both the diagnosis and subsequent management are based on imaging studies. The traditional approach to studying obstructed newborns consists of plain-film abdominal X-rays and contrast-based studies of the gastrointestinal tract. Ultrasonography has proven useful in bowel obstruction, thus avoiding the use of ionizing radiation in certain cases, so diagnostic strategies should include it as a first-line technique. Using an appropriate combination of these techniques, it is possible to reach an accurate diagnosis quickly, orienting treatment and decreasing complications.
Topics: Algorithms; Humans; Infant, Newborn; Intestinal Obstruction; Radiography, Abdominal; Ultrasonography
PubMed: 27086549
DOI: 10.1016/j.rx.2016.02.005 -
Journal of Digital Imaging Apr 2018Computed tomography (CT) scans usually include some disadvantages due to the nature of the imaging procedure, and these handicaps prevent accurate abdomen segmentation....
Computed tomography (CT) scans usually include some disadvantages due to the nature of the imaging procedure, and these handicaps prevent accurate abdomen segmentation. Discontinuous abdomen edges, bed section of CT, patient information, closeness between the edges of the abdomen and CT, poor contrast, and a narrow histogram can be regarded as the most important handicaps that occur in abdominal CT scans. Currently, one or more handicaps can arise and prevent technicians obtaining abdomen images through simple segmentation techniques. In other words, CT scans can include the bed section of CT, a patient's diagnostic information, low-quality abdomen edges, low-level contrast, and narrow histogram, all in one scan. These phenomena constitute a challenge, and an efficient pipeline that is unaffected by handicaps is required. In addition, analysis such as segmentation, feature selection, and classification has meaning for a real-time diagnosis system in cases where the abdomen section is directly used with a specific size. A statistical pipeline is designed in this study that is unaffected by the handicaps mentioned above. Intensity-based approaches, morphological processes, and histogram-based procedures are utilized to design an efficient structure. Performance evaluation is realized in experiments on 58 CT images (16 training, 16 test, and 26 validation) that include the abdomen and one or more disadvantage(s). The first part of the data (16 training images) is used to detect the pipeline's optimum parameters, while the second and third parts are utilized to evaluate and to confirm the segmentation performance. The segmentation results are presented as the means of six performance metrics. Thus, the proposed method achieves remarkable average rates for training/test/validation of 98.95/99.36/99.57% (jaccard), 99.47/99.67/99.79% (dice), 100/99.91/99.91% (sensitivity), 98.47/99.23/99.85% (specificity), 99.38/99.63/99.87% (classification accuracy), and 98.98/99.45/99.66% (precision). In summary, a statistical pipeline performing the task of abdomen segmentation is achieved that is not affected by the disadvantages, and the most detailed abdomen segmentation study is performed for the use before organ and tumor segmentation, feature extraction, and classification.
Topics: Abdomen; Digestive System Diseases; Humans; Image Interpretation, Computer-Assisted; Radiography, Abdominal; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 29067570
DOI: 10.1007/s10278-017-0032-0 -
Journal of Medical Radiation Sciences Dec 2018There is discord on the value of the erect abdominal radiograph for diagnosing acute abdominal pathologies. The erect radiograph can be uncomfortable for patients in...
INTRODUCTION
There is discord on the value of the erect abdominal radiograph for diagnosing acute abdominal pathologies. The erect radiograph can be uncomfortable for patients in pain and increases patient radiation dose.
AIM
To determine if including the erect abdominal radiograph in plain abdominal radiography (PAR) improved diagnostic accuracy for identifying mechanical bowel obstruction and/or paralytic ileus in adults presenting with acute abdominal pain.
METHODS
PAR of 40 consecutive adults presenting with suspected bowel obstruction or paralytic ileus was retrospectively sampled and independently reviewed by two emergency department (ED) consultants and two radiology consultants for bowel obstruction and paralytic ileus across two sessions. In session 1, the assessors assessed the supine abdominal radiographs (PAR 1) and clinical details in a randomised order, and session 2, at least 6 weeks later, they assessed the supine and erect radiographs (PAR 2) and clinical details of the randomly re-ordered cases. Computed tomography was the reference standard. Pair-wise comparisons of receiver operating characteristic curves were calculated to assess for significant differences in participants' diagnostic accuracy using MedCalc 16.4.3.
RESULTS
Average sensitivity, specificity and area under the receiver operating characteristic curves (AUROC) were 69.7%, 61.0% and 0.642 for PAR 1, respectively, and 80.0%, 53.4% and 0.632 for PAR 2 respectively. For AUROC there were no significant differences (P > 0.05) between PAR 1 and PAR 2. Intra-rater and inter-rater agreement improved in PAR 2.
CONCLUSION
There was no statistically significant improvement in diagnostic accuracy when including the erect radiograph in PAR for the acute abdomen.
Topics: Abdominal Pain; Adolescent; Adult; Female; Humans; Image Interpretation, Computer-Assisted; Intestinal Obstruction; Intestinal Pseudo-Obstruction; Male; Middle Aged; Observer Variation; Radiography, Abdominal; Retrospective Studies; Sensitivity and Specificity; Supine Position; Young Adult
PubMed: 30039624
DOI: 10.1002/jmrs.299 -
Arquivos de Gastroenterologia 2016- Several scoring was developed for evaluation of children with fecal retention using plain radiograph. There are controversies about specificity and sensitivity of...
BACKGROUND
- Several scoring was developed for evaluation of children with fecal retention using plain radiograph. There are controversies about specificity and sensitivity of these scoring system.
OBJECTIVES
- The aim of this study was to evaluate Barr, Blethyn, and Leech score in evaluation of fecal load in plain radiograph.
METHODS
- This case control study was conducted on children aged 2-14 years old with abdominal pain who visited Abuzar children's Hospital of Ahvaz University of Medical Sciences. This study was conducted in fall season. Children with history of previous abdominal surgery, any systemic illness including sickle cell anemia were excluded. Children with constipation were placed in case group. Subjects without constipation were placed in control group. Subjects without exclusion criteria were examined by physician who is blind to aim of the study. Careful history and physical examination was done. Demographic features, history of gastrointestinal problem, duration of abdominal pain, defecation habit, stool consistency (loose, hard), and results of physical examination were recorded. Rome III criteria was used for definition of constipation. Abdominal x-ray was ordered for each patients. Abdominal radiography was reviewed by radiologist. Barr, Leach, and Blethyn scores were calculated for each case.
RESULTS
- In this study 102 children with functional constipation and 102 children without constipation as a control were included. Mean ±SD for case and control group was 68.39±34.88 and 69.46±32.60 (P=0.82).Leech score (mean ±SD) was 11.05±2.177 and 5.67±3.228 for case and control group respectively (P<0.0001). Barr score (mean ±SD) was 14.86±3.54 and 7.16±5.59 for case and control group respectively (P=<0.0001). Blethyn (mean ±SD) score was 1.97±0.667 and 1.04±0.900 for case and control group respectively (P=0.000). Sensitivity and specificity of Barr score was 83% and 79% respectively. Sensitivity and specificity of Leech score was 92% and 80% respectively. Sensitivity and specificity of Blethyn score was 79% and 92% respectively.
CONCLUSION
- Barr, Blethyn and Leech scores were significantly higher in children with abdominal pain and constipation in contrast to children with abdominal pain and without constipation. Sensitivity of Leech score was more than Barr and Blethyn scoring systems. Specificity of Blethyn score was more than Barr and Leech score.
Topics: Abdominal Pain; Adolescent; Age Factors; Case-Control Studies; Child; Child, Preschool; Constipation; Defecation; Fecal Impaction; Female; Humans; Male; Radiography, Abdominal; Sensitivity and Specificity; Severity of Illness Index
PubMed: 27438417
DOI: 10.1590/S0004-28032016000300004 -
BMC Pediatrics Jul 2019The current standard treatment of neonates with intestinal perforation is surgery. However, the mortality rate after surgical treatment for intestinal perforation is... (Review)
Review
BACKGROUND
The current standard treatment of neonates with intestinal perforation is surgery. However, the mortality rate after surgical treatment for intestinal perforation is very high for very low birth weight (VLBW) and extremely low birth weight (ELBW) neonates. In this review, conservative treatment of pneumoperitoneum among VLBW and ELBW neonates is investigated.
METHODS
Between January 2015 and December 2017, data from all of the VLBW and ELBW neonates with pneumoperitoneum who survived without surgical treatment were collected from Shenzhen Maternity and Child Healthcare Hospital in Guangdong, China. Twenty-two neonates with birth weight less than 1500 g were diagnosed with pneumoperitoneum. Following careful evaluation and discussion, eleven were treated conservatively and this was successful in eight. Details of the eight neonates including birth weight, gestational age, gender, risk factors, time of the perforation, treatment and prognosis were retrospectively recorded. A literature review was performed of previously reported cases that had used conservative treatment.
RESULTS
The median gestational age and birth weight of the eight neonates were 27 weeks (range 24w to 31w) and 855 g (range 650 g to 1440 g), respectively. Pneumoperitoneum was confirmed by X-ray in all at a median of 8 days of life. They received full parenteral support for a median of 22 days. All eight neonates received a combination of piperacillin-tazobactam and meropenem as first-choice antibiotics, two of them also received fluconazole as anti-fungal medication. Median duration of hospitalisation was 80 days.
CONCLUSIONS
Conservative treatment with careful surveillance may be a practical choice for the VLBW and ELBW neonates with intestinal perforation. Further studies are needed for confirmation.
Topics: Anti-Bacterial Agents; China; Conservative Treatment; Female; Gestational Age; Humans; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Intestinal Perforation; Male; Pneumoperitoneum; Radiography, Abdominal; Respiration, Artificial; Retrospective Studies
PubMed: 31345184
DOI: 10.1186/s12887-019-1641-1 -
BMC Gastroenterology Jun 2018Pneumatosis cystoides intestinalis (PCI) is characterized by gas-filled cysts in the intestinal submucosa and subserosa. There are few reports of PCI occurring in... (Review)
Review
BACKGROUND
Pneumatosis cystoides intestinalis (PCI) is characterized by gas-filled cysts in the intestinal submucosa and subserosa. There are few reports of PCI occurring in duodenum and rectum. Here we demonstrated four different endoscopic manifestations of PCI and three cases with intestinal stricture all were successfully managed by medical conservative treatment.
CASE PRESENTATION
There are 6 cases of PCI with varied causes encountered, in which the etiology, endoscopic features, treatment methods and prognosis of patients were studied. One case was idiopathic, while the other one case was caused by exposing to trichloroethylene (TCE), and the remaining four cases were secondary to diabetes, emphysema, therioma and diseases of immune system. Of the six patients, all complained of abdominal distention or diarrhea, three (50%) reported muco-bloody stools, two (33.3%) complained of abdominal pain. In four other patients, PCI occurred in the colon, especially the sigmoid colon, while in the other two patients, it occurred in duodenum and rectum. Endoscopic findings were divided into bubble-like pattern, grape or beaded circular forms, linear or cobblestone gas formation and irregular forms. After combination of medicine and endoscopic treatment, the symptoms of five patients were relieved, while one patient died of malignant tumors.
CONCLUSION
PCI endoscopic manifestations were varied, and radiology combined with endoscopy can avoid misdiagnosis. The primary bubble-like pattern can be cured by endoscopic resection, while removal of etiology combined with drug therapy can resolve majority of secondary cases, thereby avoiding the adverse risks of surgery.
Topics: Adult; Aged; Colon; Duodenum; Endoscopy, Gastrointestinal; Female; Humans; Intestinal Obstruction; Male; Middle Aged; Pneumatosis Cystoides Intestinalis; Radiography, Abdominal; Rectum; Tomography, X-Ray Computed
PubMed: 29954324
DOI: 10.1186/s12876-018-0794-y -
African Journal of Paediatric Surgery :... 2015Plain abdominal radiographs remain an important aid for clinicians in the diagnosis of gastrointestinal perforation, especially in neonates and very sick children where... (Review)
Review
Plain abdominal radiographs remain an important aid for clinicians in the diagnosis of gastrointestinal perforation, especially in neonates and very sick children where clinical features of peritonitis may not be as prominent. Suggestive radiographic features are not always very obvious, especially when taken in the supine position and may lead to delayed or missed diagnosis. Through a pictorial review of plain radiographs, this article highlights a number of documented features of gastrointestinal perforation on X-ray in the paediatric setting, which increases the accuracy of diagnosis.
Topics: Abdominal Injuries; Child; Humans; Intestinal Perforation; Radiography, Abdominal; Trauma Severity Indices
PubMed: 26612119
DOI: 10.4103/0189-6725.170177 -
European Radiology May 2017To develop recommendations that can be used as guidance for standardized approach regarding indications, patient preparation, sequences acquisition, interpretation and...
OBJECTIVE
To develop recommendations that can be used as guidance for standardized approach regarding indications, patient preparation, sequences acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for diagnosis and grading of pelvic floor dysfunction (PFD).
METHODS
The technique included critical literature between 1993 and 2013 and expert consensus about MRI protocols by the pelvic floor-imaging working group of the European Society of Urogenital Radiology (ESUR) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) from one Egyptian and seven European institutions. Data collection and analysis were achieved in 5 consecutive steps. Eighty-two items were scored to be eligible for further analysis and scaling. Agreement of at least 80 % was defined as consensus finding.
RESULTS
Consensus was reached for 88 % of 82 items. Recommended reporting template should include two main sections for measurements and grading. The pubococcygeal line (PCL) is recommended as the reference line to measure pelvic organ prolapse. The recommended grading scheme is the "Rule of three" for Pelvic Organ Prolapse (POP), while a rectocele and ARJ descent each has its specific grading system.
CONCLUSION
This literature review and expert consensus recommendations can be used as guidance for MR imaging and reporting of PFD.
KEY POINTS
• These recommendations highlight the most important prerequisites to obtain a diagnostic PFD-MRI. • Static, dynamic and evacuation sequences should be generally performed for PFD evaluation. • The recommendations were constructed through consensus among 13 radiologists from 8 institutions.
Topics: Defecography; Female; Humans; Magnetic Resonance Imaging; Pelvic Floor; Pelvic Organ Prolapse; Radiography, Abdominal; Rectocele
PubMed: 27488850
DOI: 10.1007/s00330-016-4471-7 -
The British Journal of Radiology Jan 2022Multisystem inflammatory syndrome in children (MIS-C) is seen as a serious delayed complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)...
OBJECTIVE
Multisystem inflammatory syndrome in children (MIS-C) is seen as a serious delayed complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The aim of this study was to describe the most common imaging features of MIS-C associated with SARS-CoV-2.
METHODS
A retrospective review was made of the medical records and radiological imaging studies of 47 children (26 male, 21 female) in the age range of 25 months-15 years who were diagnosed with MIS-C between August 2020 and March 2021. Chest radiographs were available for all 47 patients, thorax ultrasound for 6, chest CT for 4, abdominal ultrasound for 42, abdomen CT for 9, neck ultrasound for 4, neck CT for 2, brain CT for 1, and brain MRI for 3.
RESULTS
The most common finding on chest radiographs was perihilar-peribronchial thickening (46%). The most common findings on abdominal ultrasonography were mesenteric inflammation (42%), and hepatosplenomegaly (38%, 28%). Lymphadenopathy was determined in four patients who underwent neck ultrasound, one of whom had deep neck infection on CT. One patient had restricted diffusion and T2 hyperintensity involving the corpus callosum splenium on brain MRI, and one patient had epididymitis related with MIS-C.
CONCLUSION
Pulmonary manifestations are uncommon in MIS-C. In the abdominal imaging, mesenteric inflammation, hepatosplenomegaly, periportal edema, ascites and bowel wall thickening are the most common findings.
ADVANCES IN KNOWLEDGE
The imaging findings of MIS-C are non-specific and can mimic many other pathologies. Radiologists should be aware that these findings may indicate the correct diagnosis of MIS-C.
Topics: Adolescent; Brain; COVID-19; Child; Child, Preschool; Female; Humans; Magnetic Resonance Imaging; Male; Neck; Neuroimaging; Radiography, Abdominal; Radiography, Thoracic; Retrospective Studies; Systemic Inflammatory Response Syndrome; Tomography, X-Ray Computed; Ultrasonography
PubMed: 34889647
DOI: 10.1259/bjr.20210570 -
The British Journal of Radiology May 2018To evaluate the image quality, radiation dose, and renal safety of contrast medium (CM)-reduced abdominal-pelvic CT combining 80-kVp and sinogram-affirmed iterative...
Application of 80-kVp scan and raw data-based iterative reconstruction for reduced iodine load abdominal-pelvic CT in patients at risk of contrast-induced nephropathy referred for oncological assessment: effects on radiation dose, image quality and renal function.
OBJECTIVE
To evaluate the image quality, radiation dose, and renal safety of contrast medium (CM)-reduced abdominal-pelvic CT combining 80-kVp and sinogram-affirmed iterative reconstruction (SAFIRE) in patients with renal dysfunction for oncological assessment.
METHODS
We included 45 patients with renal dysfunction (estimated glomerular filtration rate <45 ml per min per 1.73 m) who underwent reduced-CM abdominal-pelvic CT (360 mgI kg, 80-kVp, SAFIRE) for oncological assessment. Another 45 patients without renal dysfunction (estimated glomerular filtration rate >60 ml per lmin per 1.73 m) who underwent standard oncological abdominal-pelvic CT (600 mgI kg, 120-kVp, filtered-back projection) were included as controls. CT attenuation, image noise, and contrast-to-noise ratio (CNR) were compared. Two observers performed subjective image analysis on a 4-point scale. Size-specific dose estimate and renal function 1-3 months after CT were measured.
RESULTS
The size-specific dose estimate and iodine load of 80-kVp protocol were 32 and 41%,, respectively, lower than of 120-kVp protocol (p < 0.01). CT attenuation and contrast-to-noise ratio of parenchymal organs and vessels in 80-kVp images were significantly better than those of 120-kVp images (p < 0.05). There were no significant differences in quantitative or qualitative image noise or subjective overall quality (p > 0.05). No significant kidney injury associated with CM administration was observed.
CONCLUSION
80-kVp abdominal-pelvic CT with SAFIRE yields diagnostic image quality in oncology patients with renal dysfunction under substantially reduced iodine and radiation dose without renal safety concerns. Advances in knowledge: Using 80-kVp and SAFIRE allows for 40% iodine load and 32% radiation dose reduction for abdominal-pelvic CT without compromising image quality and renal function in oncology patients at risk of contrast-induced nephropathy.
Topics: Abdomen; Adult; Aged; Aged, 80 and over; Algorithms; Contrast Media; Female; Humans; Image Processing, Computer-Assisted; Iodine; Kidney; Kidney Diseases; Male; Middle Aged; Pelvis; Radiation Dosage; Radiographic Image Enhancement; Radiography, Abdominal; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 29470108
DOI: 10.1259/bjr.20170632