Diagnosis of adult midgut malrotation in CT: sign of absent retromesenteric duodenum reliable.

IF 4.5 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Insights into Imaging Pub Date : 2025-02-17 DOI:10.1186/s13244-025-01921-x

Min Yang, Shaokun Zheng, Jian Shu, Zhenwei Yao

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Abstract

Objectives: To compare the incidence of absent retromesenteric duodenum with other radiological signs and to assess its diagnostic significance for midgut malrotation in adults.

Methods: This IRB-approved retrospective single-center study involved adult patients who underwent abdominal CT scans. Patients were screened for the presence of the absent retromesenteric duodenum sign. Signs observed included the position of the duodenal-jejunal junction (DJJ) and jejunum within the abdomen, the relationship between the superior mesenteric artery (SMA) and superior mesenteric vein (SMV), the locations of the ascending colon, cecum, and appendix, and the presence of intestinal volvulus.

Results: A total of 5594 patients were included. Seven patients exhibited the sign of absent retromesenteric duodenum. Four of these patients were identified as those diagnosed with midgut malrotation in the past five years. The common features observed in all 11 patients were: the horizontal segment of the duodenum did not traverse behind the SMA but instead curved rightwards and forwards adjacent to it; the DJJ and jejunum were positioned in the right abdomen; the SMV was anterior to the SMA. In 7 patients (7/11), the ascending colon, cecum, and appendix were located in the left abdomen. 5 patients (5/11) showed a high cecum position, and 2 patients (2/11) exhibited a pelvic appendix.

Conclusion: The absent retromesenteric duodenum sign in CT diagnosis of adult midgut malrotation has proven to be more reliable.

Critical relevance statement: Radiologists should routinely identify the course of the duodenum horizontal segment in CT images, to prevent misdiagnosis of adult midgut malrotation.

Key points: CT is suitable for the diagnosis of adult midgut malrotation. Absent retromesenteric duodenum for diagnosing adult midgut malrotation is more reliable than other signs. Diagnostic CT criteria for adult midgut malrotation need updating.

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成人中肠旋转不良的CT诊断：肠系膜后十二指肠缺失征象可靠。

目的：比较肠系膜后十二指肠缺失与其他影像学征象的发生率，探讨其对成人中肠旋转不良的诊断意义。方法：这项经irb批准的回顾性单中心研究纳入了接受腹部CT扫描的成年患者。筛查患者是否有肠系膜后十二指肠征。观察指标包括十二指肠-空肠交界处（DJJ）和空肠在腹部的位置、肠系膜上动脉（SMA）和肠系膜上静脉（SMV）的关系、升结肠、盲肠和阑尾的位置以及肠扭转的存在。结果：共纳入5594例患者。7例患者表现为肠系膜后十二指肠缺失征。其中4例患者在过去5年中被诊断为中肠旋转不良。所有11例患者的共同特征是：十二指肠水平段没有穿过SMA后面，而是在其附近向右和向前弯曲；DJJ和空肠位于右腹部；SMV位于SMA前部。7例（7/11）患者升结肠、盲肠和阑尾位于左腹部。5例（5/11）表现为盲肠高位，2例（2/11）表现为盆腔阑尾。结论：肠系膜后十二指肠征缺失对成人中肠旋转不良的CT诊断更为可靠。关键相关性声明：放射科医师应在CT图像中常规识别十二指肠水平段的路线，以防止成人中肠旋转不良的误诊。重点：CT对成人中肠旋转不良的诊断是有价值的。肠系膜后十二指肠缺失诊断成人中肠旋转不良比其他征象更可靠。成人中肠旋转不良的CT诊断标准需要更新。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Insights into Imaging Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

7.30

自引率

4.30%

发文量

182

审稿时长

13 weeks

期刊介绍： Insights into Imaging (I³) is a peer-reviewed open access journal published under the brand SpringerOpen. All content published in the journal is freely available online to anyone, anywhere! I³ continuously updates scientific knowledge and progress in best-practice standards in radiology through the publication of original articles and state-of-the-art reviews and opinions, along with recommendations and statements from the leading radiological societies in Europe. Founded by the European Society of Radiology (ESR), I³ creates a platform for educational material, guidelines and recommendations, and a forum for topics of controversy. A balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes I³ an indispensable source for current information in this field. I³ is owned by the ESR, however authors retain copyright to their article according to the Creative Commons Attribution License (see Copyright and License Agreement). All articles can be read, redistributed and reused for free, as long as the author of the original work is cited properly. The open access fees (article-processing charges) for this journal are kindly sponsored by ESR for all Members. The journal went open access in 2012, which means that all articles published since then are freely available online.