Radiology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

DOI: 10.1148/radiol.2491071821
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hooker, R. L.
Right arrow Articles by Kan, J. H.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Hooker, R. L.
Right arrow Articles by Kan, J. H.
(Radiology 2008;248:987-994.)
© RSNA, 2008

Pediatric Imaging

Radiographic Evaluation of Intussusception: Utility of Left-Side-Down Decubitus View1

Robert L. Hooker, MD, Marta Hernanz-Schulman, MD, Chang Yu, PhD, and J. Herman Kan, MD

1 From the Department of Radiology and Radiological Sciences, Vanderbilt Children's Hospital (R.L.H., M.H., J.H.K.), and the Department of Biostatistics (C.Y.), Vanderbilt University, 2200 Children's Way, Nashville, TN 37232. From the 2007 RSNA Annual Meeting. Received October 23, 2007; revision requested January 10, 2008; revision received February 4; accepted March 24; final version accepted April 15. Address correspondence to J.H.K. (e-mail: herman.kan{at}vanderbilt.edu).

Purpose: To assess the incremental value of the left-side-down decubitus view in radiographic evaluation of ileocolic intussusception.

Materials and Methods: The institutional review board approved this retrospective investigation with waiver of informed consent. Between February 24, 2002, and January 25, 2007, 304 studies (300 patients; mean age, 1.3 years; range, 0.1–3.9 years) met the following inclusion criteria: kidney ureter bladder (KUB) and decubitus views obtained, with subsequent proof of diagnosis. Using a consensus approach, two pediatric radiologists evaluated KUB and decubitus views for four variables: (a) discrete mass and (b) small-bowel obstruction (positive criteria); (c) air or stool in ascending colon and (d) cecal air or stool (negative criteria). On the basis of these criteria, each study was graded as negative, positive, or indeterminate for intussusception. Diagnostically determinate studies and the ability to visualize or exclude intussusception were calculated to determine sensitivity and specificity. The difference between proportions was calculated, along with 95% confidence intervals. Agreement between the supine KUB view and supine KUB plus left-side-down decubitus views was tested with the McNemar test.

Results: Intussusception was present in 58 of 304 studies (19%). Adding the decubitus view to the KUB view increased the number of determinate studies from 110 of 304 (36.2%) to 205 of 304 (67.4%) (difference, 31.2 percentage points; P < .001). Intussusception was correctly identified with KUB view alone in 35 of 58 studies (60.3%); this value increased to 43 of 58 (74.1%) with KUB plus decubitus views (P = .0215). Intussusception was correctly excluded with the KUB view alone in 63 of 246 studies (25.6%); this increased to 143 of 246 studies (58.1%) with addition of the decubitus view (P < .0001).

Conclusion: The addition of decubitus views increased the number of diagnostically determinate studies and increased the ability to diagnose or exclude intussusception. The authors believe that a left-side-down decubitus view should be included in the initial evaluation of patients suspected of having intussusception, particularly when the supine view is diagnostically indeterminate.

© RSNA, 2008