Materials and Methods: This study was approved by the medical ethics committees of the authors' institutions, and informed consent was obtained from participants' parents or guardians. Forty asymptomatic volunteers underwent MR imaging to detect the appendix. Mean age (± standard deviation) for the 18 boys was 12.8 years ± 2.4 (range, 9–17 years) and for the 22 girls was 12.7 years ± 2.7 (range, 8–17 years). The MR imaging protocol consisted of axial T1-weighted fast spin-echo (SE), axial and coronal T2-weighted fast SE, and axial T2-weighted fat-saturated fast SE sequences. Two observers interpreted results independently, and coefficients were calculated to evaluate agreement. The rate of detection was defined as the percentage of times that the appendix was visualized with at least one sequence. Body mass index was recorded for all participants.

Results: The normal appendix was detected by one observer in 19 cases (48%) and by the other in 20 cases (50%). The rate of appendix detection after observers reached a consensus was 48% (95% confidence interval: 32%, 64%). Interobserver agreement for appendix detection was good for most sequences analyzed. The greatest rate of normal appendix detection was found with the axial T2-weighted fast SE sequence (48%).

Conclusion: The rate of normal appendix detection in children and adolescents at unenhanced MR imaging was 48%, which is similar to computed tomographic but lower than ultrasonographic detection rates.

© RSNA, 2008

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

Materials and Methods: Research ethics board approval, with waived informed patient consent, was obtained for review of the data of 37 children (17 male, 20 female; age range, 1–20 months; mean age, 4.3 months) in whom gastrostomy or gastrojejunostomy tubes were inserted between 1995 and 2004. Twenty-two patients had CDH, eight had gastroschisis, five had omphalocele, and two had both CDH and omphalocele. The technical success and complications of the procedures were recorded. Tube maintenance problems were analyzed separately from postprocedural complications. Initial and final patient growth percentiles were compared by using a one-sided paired Student t test.

Results: Thirty-six of the 38 procedures performed in the 37 patients were successful. There were three intraprocedural complications (two cases of access difficulty, one case of bleeding) and three major complications (one skin and prosthetic material infection, one track loss during tube replacement, one delayed gastrostomy track closure necessitating surgery). Sixteen patients had at least one minor complication (cellulitis, feeding intolerance, skin-site bleeding, intussusception). Twenty-two patients had at least one tube maintenance problem. All patients gained weight (mean weight gain, 4.7 kg) after the procedure, with a significant increase in growth percentile (average increase, 6.5%; P = .029).

Conclusion: Radiologically guided percutaneous gastrostomy and gastrojejunostomy tube placements in children with gastroschisis, omphalocele, and/or CDH are associated with high success rates and low major complication rates. Although tube maintenance problems and minor complications are common, use of gastrostomy and gastrojejunostomy tubes effectively improves nutritional support.

© RSNA, 2008