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Surgical outcomes after failed air enema reduction of intussusception in children in a paediatric hospital in Singapore
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Abstract / Clinical Radiology 71 (2016) S1eS10
Results: There were 81 malignant lesions, 34 benign lesions and one infectious lesion with 51% as localised, 17% loco-regional and the remainder metastatic disease. In 99% of lesions the needle biopsy was diagnostic. An accurate diagnosis was achieved in 50/81 (62%) of percutaneous biopsies for suspected malignancy cases or recurrence as confirmed on subsequent surgical specimen. None of the cases underwent repeat biopsy. All were without complications. The majority of cases required an overnight stay and simple analgesia post procedurally. Conclusion: The use of ultrasound-guided percutaneous biopsy is an accurate, safe and cost-effective method for evaluation of suspected lesions in the paediatric population. This can be performed instead of or in addition to open biopsy and help guide subsequent treatment. Surgical outcomes after failed air enema reduction of intussusception in children in a paediatric hospital in Singapore Authors: Eu-Leong Harvey James Teo Purpose: The aim of this study is to determine the surgical outcomes after failed air enema reduction of intussusception in children in a paediatric hospital in Singapore. Knowledge of the surgical findings in cases of failed reductions may potentially help clinicians determine which cases need further investigation should there be a secondary cause of the intussusception such as a pathological lead point. Methods and materials: A retrospective review of the surgical findings of all failed cases of air enema intussusception in children between 1 January 2013 and 31 December 2015 was performed. Results: Of the 263 procedures performed, 14 (5.32%) were unsuccessful. 3/ 3 cases were successfully reduced during repeat attempts a few hours later. 11 had surgery with six ileo-colic, two ileo-ileal, two ileo-colo-colic lesions found. One was found to have spontaneously reduced. Due to bowel infarction, two had right hemicolectomies, one had resection of the terminal ileum and one had partial resection of the transverse colon. Of these, two patients had reactive Peyer’s patches and one patient had enlarged mesenteric nodes, otherwise no other pathological lead point was found. Conclusion: Repeat reduction attempts may be beneficial as they were successful in 3/3 cases. Bowel infarction was found in 4/14 (28.9%) failed cases which resulted in surgery bowel resection. No significant pathological lead points were found in our population. Intussusception reduction: which is the best way to do it? Authors: Jeremy Oliver Lynch, Fayed Sheikh, Emily Guilhem, Alex Renn, Ioanna Papadopoulou, Kathryn Wessely Purpose: Paediatric intussusception is common, accounting for up to 25% of abdominal surgical emergencies in those younger than five years. It has a very high mortality if left untreated, but fortunately if reduction is achieved expediently the prognosis is usually very good. However, there is a wide variation in technique. Factors for which there is no apparent consensus include: the type of reducing agent, catheter, pressure device and limits, role of external manipulation, number of attempts, imaging technique and the use of adjunctive medications. Methods and materials: A systematic search was conducted of MEDLINE and EMBASE databases concerning recent evidence for the non-operative treatment of intussusception in the paediatric population up until April 2016. A comprehensive review of the evidence of each aspect of the procedure was performed. Results: 340 abstracts were reviewed. There were no randomised controlled trials. There is wide disparity in described technique for reduction, especially in the equipment used. Air and hydrostatic reduction are the most common techniques of non-operative management. Air enema in particular has a high success rate and low rate of recurrence. If recurrence does occur further attempts at non-operative reduction are often successful. Conclusion: Current practice for the specific techniques used in nonoperative management of intussusception is not currently backed by sufficient evidence. More research needs to be conducted for reliable guidelines to be formulated.
Accuracy of provisional reporting and compliance with the NICE guidance on CT head following trauma in children Authors: Stephen Sammut, Vincent Leung, Jooly Joseph, Thuzar Win Purpose: The National Institute for Health and Care Excellence (NICE) issued new guidance for performing computed tomography (CT) following head injury (HI) in children January 2014. We wanted to assess our local adherence to this guidance. Additionally, we wanted to establish what the common discrepancies were between provisional reports and verified consultant reports. Methods and materials: A retrospective review was conducted in a University Teaching Hospital of all CT head scans for trauma over a 12-month period (October 2014eSeptember 2015) in patients aged <16 years. The clinical criteria were identified through the request card as well as the clinical notes. A major discrepancy was considered one which would affect management or acute decision making. Results: During the 12-month period, 61 CT head scans were performed following HI; 59% of the children were male. A written radiology report was provided within 60 minutes in 93% of cases. In the remaining four cases, three were reported within 90 minutes (98%). There were 16 discrepancies (26%), which were all classified as minor. The majority of the scans were verified by a consultant within 12 hours (39 scans, 64%) and compliance with NICE clinical criteria for scanning was good (89%). Conclusion: A provisional written report was provided within 60 minutes for the vast majority of patients and no major discrepancies were identified between the trainee report and the verified reports. Adherence to NICE clinical criteria is important to avoid unnecessary radiation to paediatric patients. Highlighting the need to provide written reports promptly, as well as review areas to reduce the minor discrepancy rate will help improve the performance of radiology trainees. Integrating multi-detector SPECT/CT into the routine workflow of WBS in oncology patients e what is the additional clinical value? Authors: Pratik Adusumilli, Fahmid Chowdhury Purpose: This retrospective study aimed to analyse the clinical value of additional focused hybrid multi-detector single positron emission tomography/computed tomography (SPECT/CT) performed selectively in a protocol-driven manner in whole bone scintigraphy (WBS) in oncology patients, by looking into the reporter confidence in diagnosis with and without SPECT/CT. Methods and materials: The study cohort consisted of 88 consecutive cancer patients undergoing WBS followed by an additional SPECT/CT acquisition. Retrospective evaluation of images was performed by an experienced dual-trained nuclear medicine radiologist. No specific clinical information was provided for this analysis. The WBS images were graded blindly on a five-point scale designed to evaluate the likelihood of a lesion being benign or malignant. This was followed by re-grading of the case with the SPECT/CT images. Interpretation was applied on a per-patient basis. Results: Overall, there was a 76.2% increase in definitive classification for the SPECT/CT scans compared to WBS alone, with a 35.2% reduction in unclear findings. There was a 48.9% increase in the number of patients being reclassified to benign and a 27.3% increase in reclassification to malignant; 5.7% of the scans deemed to be probably benign on WBS were reclassified to definitely malignant on SPECT/CT, with an additional 5.7% reclassified to probably malignant. Conclusion: This retrospective study shows that hybrid imaging with multi-detector SPECT/CT is superior to WBS in providing more confident and definitive classification of bone scintigraphic findings in oncology patients. SPECT/CT can be implemented in a protocol-driven manner to achieve this increase in diagnostic confidence. Determinants of human brown adipose tissue prevalence and volume on 18F-FDG PET/CT scans e a retrospective analysis of 3,295 scans Authors: Terence Alan Jones, Narendra Reddy, Sarah Wayte, Oludolapo Adesanya, Thomas Barber, Charles Hutchinson
Abstract / Clinical Radiology 71 (2016) S1eS10
Results: There were 81 malignant lesions, 34 benign lesions and one infectious lesion with 51% as localised, 17% loco-regional and the remainder metastatic disease. In 99% of lesions the needle biopsy was diagnostic. An accurate diagnosis was achieved in 50/81 (62%) of percutaneous biopsies for suspected malignancy cases or recurrence as confirmed on subsequent surgical specimen. None of the cases underwent repeat biopsy. All were without complications. The majority of cases required an overnight stay and simple analgesia post procedurally. Conclusion: The use of ultrasound-guided percutaneous biopsy is an accurate, safe and cost-effective method for evaluation of suspected lesions in the paediatric population. This can be performed instead of or in addition to open biopsy and help guide subsequent treatment. Surgical outcomes after failed air enema reduction of intussusception in children in a paediatric hospital in Singapore Authors: Eu-Leong Harvey James Teo Purpose: The aim of this study is to determine the surgical outcomes after failed air enema reduction of intussusception in children in a paediatric hospital in Singapore. Knowledge of the surgical findings in cases of failed reductions may potentially help clinicians determine which cases need further investigation should there be a secondary cause of the intussusception such as a pathological lead point. Methods and materials: A retrospective review of the surgical findings of all failed cases of air enema intussusception in children between 1 January 2013 and 31 December 2015 was performed. Results: Of the 263 procedures performed, 14 (5.32%) were unsuccessful. 3/ 3 cases were successfully reduced during repeat attempts a few hours later. 11 had surgery with six ileo-colic, two ileo-ileal, two ileo-colo-colic lesions found. One was found to have spontaneously reduced. Due to bowel infarction, two had right hemicolectomies, one had resection of the terminal ileum and one had partial resection of the transverse colon. Of these, two patients had reactive Peyer’s patches and one patient had enlarged mesenteric nodes, otherwise no other pathological lead point was found. Conclusion: Repeat reduction attempts may be beneficial as they were successful in 3/3 cases. Bowel infarction was found in 4/14 (28.9%) failed cases which resulted in surgery bowel resection. No significant pathological lead points were found in our population. Intussusception reduction: which is the best way to do it? Authors: Jeremy Oliver Lynch, Fayed Sheikh, Emily Guilhem, Alex Renn, Ioanna Papadopoulou, Kathryn Wessely Purpose: Paediatric intussusception is common, accounting for up to 25% of abdominal surgical emergencies in those younger than five years. It has a very high mortality if left untreated, but fortunately if reduction is achieved expediently the prognosis is usually very good. However, there is a wide variation in technique. Factors for which there is no apparent consensus include: the type of reducing agent, catheter, pressure device and limits, role of external manipulation, number of attempts, imaging technique and the use of adjunctive medications. Methods and materials: A systematic search was conducted of MEDLINE and EMBASE databases concerning recent evidence for the non-operative treatment of intussusception in the paediatric population up until April 2016. A comprehensive review of the evidence of each aspect of the procedure was performed. Results: 340 abstracts were reviewed. There were no randomised controlled trials. There is wide disparity in described technique for reduction, especially in the equipment used. Air and hydrostatic reduction are the most common techniques of non-operative management. Air enema in particular has a high success rate and low rate of recurrence. If recurrence does occur further attempts at non-operative reduction are often successful. Conclusion: Current practice for the specific techniques used in nonoperative management of intussusception is not currently backed by sufficient evidence. More research needs to be conducted for reliable guidelines to be formulated.
Accuracy of provisional reporting and compliance with the NICE guidance on CT head following trauma in children Authors: Stephen Sammut, Vincent Leung, Jooly Joseph, Thuzar Win Purpose: The National Institute for Health and Care Excellence (NICE) issued new guidance for performing computed tomography (CT) following head injury (HI) in children January 2014. We wanted to assess our local adherence to this guidance. Additionally, we wanted to establish what the common discrepancies were between provisional reports and verified consultant reports. Methods and materials: A retrospective review was conducted in a University Teaching Hospital of all CT head scans for trauma over a 12-month period (October 2014eSeptember 2015) in patients aged <16 years. The clinical criteria were identified through the request card as well as the clinical notes. A major discrepancy was considered one which would affect management or acute decision making. Results: During the 12-month period, 61 CT head scans were performed following HI; 59% of the children were male. A written radiology report was provided within 60 minutes in 93% of cases. In the remaining four cases, three were reported within 90 minutes (98%). There were 16 discrepancies (26%), which were all classified as minor. The majority of the scans were verified by a consultant within 12 hours (39 scans, 64%) and compliance with NICE clinical criteria for scanning was good (89%). Conclusion: A provisional written report was provided within 60 minutes for the vast majority of patients and no major discrepancies were identified between the trainee report and the verified reports. Adherence to NICE clinical criteria is important to avoid unnecessary radiation to paediatric patients. Highlighting the need to provide written reports promptly, as well as review areas to reduce the minor discrepancy rate will help improve the performance of radiology trainees. Integrating multi-detector SPECT/CT into the routine workflow of WBS in oncology patients e what is the additional clinical value? Authors: Pratik Adusumilli, Fahmid Chowdhury Purpose: This retrospective study aimed to analyse the clinical value of additional focused hybrid multi-detector single positron emission tomography/computed tomography (SPECT/CT) performed selectively in a protocol-driven manner in whole bone scintigraphy (WBS) in oncology patients, by looking into the reporter confidence in diagnosis with and without SPECT/CT. Methods and materials: The study cohort consisted of 88 consecutive cancer patients undergoing WBS followed by an additional SPECT/CT acquisition. Retrospective evaluation of images was performed by an experienced dual-trained nuclear medicine radiologist. No specific clinical information was provided for this analysis. The WBS images were graded blindly on a five-point scale designed to evaluate the likelihood of a lesion being benign or malignant. This was followed by re-grading of the case with the SPECT/CT images. Interpretation was applied on a per-patient basis. Results: Overall, there was a 76.2% increase in definitive classification for the SPECT/CT scans compared to WBS alone, with a 35.2% reduction in unclear findings. There was a 48.9% increase in the number of patients being reclassified to benign and a 27.3% increase in reclassification to malignant; 5.7% of the scans deemed to be probably benign on WBS were reclassified to definitely malignant on SPECT/CT, with an additional 5.7% reclassified to probably malignant. Conclusion: This retrospective study shows that hybrid imaging with multi-detector SPECT/CT is superior to WBS in providing more confident and definitive classification of bone scintigraphic findings in oncology patients. SPECT/CT can be implemented in a protocol-driven manner to achieve this increase in diagnostic confidence. Determinants of human brown adipose tissue prevalence and volume on 18F-FDG PET/CT scans e a retrospective analysis of 3,295 scans Authors: Terence Alan Jones, Narendra Reddy, Sarah Wayte, Oludolapo Adesanya, Thomas Barber, Charles Hutchinson