Robert Liles Hooker MD, Presenter: Nothing to Disclose

J. Herman Kan MD, Abstract Co-Author: Nothing to Disclose

Chang Yu PhD, Abstract Co-Author: Nothing to Disclose

Marta Hernanz-Schulman MD, Abstract Co-Author: Stockholder, Biogen Idec Inc Stockholder, Bristol-Myers Squibb Company Stockholder, Healthways, Inc Stockholder, Pfizer Inc Stockholder, Tutogen Medical, Inc

Left side down decubitus directs air into ascending colon and cecum, theoretically improving accuracy in plain film diagnosis of ileocolic intussusception. Plain film diagnosis of intussusception has been cited at 45%. Our purpose is to assess the incremental value of left side down decubitus in plain film evaluation of ileocolic intussusception

This study was IRB-approved. Between 9/01/02 and 12/30/06, 158 subjects (1.3 years, 0.2-3.9) were identified meeting inclusion criteria: KUB and decubitus with follow up US or enema, considered proof of diagnosis. KUB and decubitus were evaluated separately by consensus of 2 pediatric radiologists blinded to final diagnosis, for 6 variables: discrete mass and small bowel obstruction (positive criteria); ascending colon air, ascending colon stool, cecal air, cecal stool (negative criteria). Based on these criteria, each study was assigned a confidence level 1(-) to 5(+). The number of studies considered diagnostically determinate and our ability to visualize or exclude intussusception was calculated

Intussusception was present in 56/158 (35%) subjects. KUB alone vs KUB+decubitus decreased indeterminate (3) results from 81 (51%) to 26 (17%), difference=-34%,CI=(-42%,-27%). Determinate studies (1,2 or 4,5) increased from 77 (49%) to 132 (83%), difference=34%,CI=(27%,42%). High determinate studies (1 or 5) increased from 27 (17%) to 65 (41%), difference=24%, CI=(17%,30%). Intussusception was correctly identified with KUB alone versus KUB+decubitus 32/56 (57%,CI=44%,70%) versus 38/56 (68%, CI=56%,80%), respectively. Intussusception was correctly excluded with KUB alone versus KUB+decubitus 32/102 (31%,CI=22%,40%) versus 65/102 (64%,CI=54%, 73%), respectively, which is statistically significantly different

The addition of decubitus views increased the number of studies considered diagnostically determinate as well as increased our ability to diagnose or exclude intussusception

Increasing plain film utility in the evaluation of intussusception increases efficacy and timeliness of subsequent management and positively impacts patient outcome and satisfaction

Hooker, R, Kan, J, Yu, C, Hernanz-Schulman, M, Utility of Left Side Down Decubitus View in the Imaging Evaluation of Intussusception.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5014018.html