Copyright ©2014 Baishideng Publishing Group Inc.
World J Radiol. Sep 28, 2014; 6(9): 730-736
Published online Sep 28, 2014. doi: 10.4329/wjr.v6.i9.730
Table 1 Positive and negative attributes of commonly used imaging modalities when applied to cases of suspected malrotation
Imaging modalityProsCons
Plain filmInexpensive, quick, may demonstrate classic appearance of duodenal obstruction, may give earlier indication for operative explorationMay masquerade as other abnormalities, may delay treatment (especially when read as “normal”), cannot exclude malrotation
UltrasoundAvoids radiation exposure, may demonstrate “whirlpool sign” indicative of volvulus, duplex to determine relationship of D3 and superior mesenteric vessels, Possibility to evaluate normal abdominal anatomyNormal sonogram may not exclude malrotation, quality related to technician experience
Upper GICurrently considered the “gold standard”, relatively non-invasive, available at pediatric centers, easily demonstrates duodenal obstruction, allows for visualization of the duodenojejunal junction, delayed imaging may show position of the cecumSmall amount of radiation, challenge to position patient for optimal imaging, may be distorted by bowel distention or indwelling tubes, duodenojejunal junction may have normal variation in position
Barium EnemaEasily demonstrates position of entire large bowel (especially cecum) quicklySmall amount of radiation, normal cecum position does not rule out proximal malrotation
CTQuick, allows for viewing position of SMA/SMV, may demonstrate “whirlpool sign” indicative of volvulus, visualization of all abdominal anatomyHigh radiation exposure, requires patient to remain still for short period of time, normal relationship between SMA/SMV does not exclude malrotation
MRINo radiation exposure, allows for viewing position of SMA/SMV, may demonstrate “whirlpool sign”, visualization of all abdominal anatomyRequires patient to remain still for a longer period of time, expensive, not accessible