Machine learning-based quantitative analysis of barium enema and clinical features for early diagnosis of short-segment Hirschsprung disease in neonate.

OBJECTIVE: To develop a mathematical model based on a combination of clinical and radiologic features (barium enema) for early diagnosis of short-segment Hirschsprung disease (SHSCR) in neonate. METHODS: The analysis included 54 neonates with biopsy-confirmed SHSCR (the cases) and 59 neonates undergoing barium enema for abdominal symptoms but no Hirschsprung disease (the control). Colon shape features extracted from barium enema images and clinical features were used to develop diagnostic models using support vector machine (SVM) and L2-regularized logistic regression (LR). The training cohort included 32 cases and 37 controls; testing cohort consisted 22 cases and 22 controls. Results were compared to interpretation by 2 radiologists. RESULTS: In the analysis by radiologists, 87 out of 113 cases were correctly classified. Six SHSCR cases were mis-classified into the non-HSCR group. In the remaining 20 cases, radiologists were unable to make a decision. Both the SVM and LR classifiers contained five clinical features and four shape features. The performance of the two classifiers was similar. The best model had 86.36% accuracy, 81.82% sensitivity, and 90.91% specificity. The AUC was 0.9132 for the best-performing SVM classifier and 0.9318 for the best-performing LR classifier. CONCLUSION: A combination of clinical features and colon shape features extracted from barium enemas can be used to improve early diagnosis of SHSCR in neonate.

Association of meteorological factors with pediatric intussusception in subtropical china: a 5-year analysis.

PURPOSE: The aim of this study was to determine whether climate factors correlate with variations in the rate of pediatric intussusception cases presenting to the Children's Hospital in Suzhou, China. MATERIAL AND METHODS: The hospital records of 5,994 pediatric cases of intussusception who had presented between Aug 2006 and Dec 2011 were retrospectively analyzed. Demographic data and air enema reduction data were collected for each case. RESULTS: The monthly rate of new intussusception cases fluctuated throughout the year generally rising from April to September with a peak from May to July. This annual cycling of intussusception incidence was highly significant over the 5 year observation period. Poisson regression analysis showed that the monthly number of intussusception cases was associated with an increase in mean temperature per month (P = 0.0001), sum of sunshine per month (P<0.0001), precipitation per month (P<0.0001), and was marginally associated with increased mean wind speed per month (P = 0.0709). CONCLUSION: The incidence of intussusception in Suzhou was seasonally variable with a peak in cases presenting during hotter, sunnier, and wetter months demonstrating a positive association with certain climatic factors.

Predictors of successful air enema reduction of intussusception in infants younger than 4 months.

OBJECTIVES: Intussusception is rare in infants younger than 4 months, and the use of air enema for reduction of intussusception has been limited. In this retrospective study, we analyzed the predictors of successful reduction of intussusception using air enema in infants younger than 4 months. METHODS: This is a retrospective chart review of 97 intussusception patients of younger than 4 months between January 2008 and December 2012. Demographic data, clinical presentation, and outcomes of air enemas were collected and analyzed. We used univariate and multivariate logistic regression analyses for significant predictors of successful reduction of intussusception using air enemas. RESULTS: Of the 97 infants younger than 4 months (median age 97.6 days, age range 41-119 days), 63 (65%) were boys and 34 (35%) were girls. The duration of symptoms ranged from 5 to 53 hours, with a median of 16.3 hours. The clinical features included paroxysmal crying (75%), vomiting (68%), bloody stools (61%), and palpable abdominal masses (32%). The duration of symptoms, bloody stools, and the shape of the intussusceptum were found to be significantly predictive of the outcome of air enema reduction of intussusception. CONCLUSIONS: The rate of successful reduction of intussusception using air enemas in infants younger than 4 months is low. Factors such as the duration of symptoms, bloody stools, and the shape of the intussusceptum are predictive of the outcome of air enema reduction of intussusception.

The role of plain radiography in assessing intussusception with vascular compromise in children.

INTRODUCTION: The diagnostic value of colour Doppler sonography for the detection of blood flow in intussusception is questionable. The purpose of this study was to evaluate plain radiography in the assessment of vascular compromise in children with intussusception. MATERIAL AND METHODS: The hospital notes of 1,119 paediatric cases of intussusception who presented between January 2007 and February 2008 were retrospectively analysed. Informed consent was given by the parents before the air enema and this study was approved by the hospital ethics committee. Overall, the plain abdominal X-rays of 190 cases were assessed independently by two experienced radiologists, and disagreements were settled by discussion. Symptom profiles, operative notes and pathological records were compared to plain radiography. SAS V8.1 was used for the analysis. RESULTS: Of the 190 patients, 30 cases had vascular compromise on plain films, as shown by the "coffee-bean" sign or "banana" sign. There was a paucity of gas in 36 cases, a quadrant-specific gas pattern in 51 cases, and the film showed a mass in 73 cases. Statistical analysis that compared signs on plain radiography signs and symptom onset showed a significant difference. Ninety-five cases were irreducible by air enema and required surgical intervention. The location of these intussusceptions were ileo-ileal-colic (n = 44), ileo-colic (n = 25), ileo-ileal (n = 14), ileo-caecal (n = 10), and ileo-colic-colic (n = 2). Eleven cases had intestinal necrosis and underwent resection of the necrotic bowel. CONCLUSIONS: The signs of intussusception on plain radiography were significant during the clinical assessment of children with secondary ischaemic bowel. The radiological findings were shown to have a high concordance with pathology in the assessment of intussusception.The diagnostic value of colour Doppler sonography for the detection of blood flow in intussusception is questionable. The purpose of this study was to evaluate plain radiography in the assessment of vascular compromise in children with intussusception.

[Analyses of air enema and radiographic film for acute intussusception in children].

OBJECTIVE: To analyze the different success rates of air enema in intussusception cases at different ages and evaluate the value of plain film in assessing the pathogenetic condition of intussusception and intussusception with vascular compromise in children. METHODS: A retrospective analysis was performed on the success rates of air enema in 1119 pediatric cases of intussusception at different ages. The radiographic findings of 190 cases were analyzed. Air enema reduction failed in 95 cases. And 95 control cases were randomly selected for reduction by air enema. Their operative and pathological data were analyzed and compared with the findings of plain film. Intestinal obstruction with vascular compromise was analyzed by a comparison of plain film and pathology. The plain films of patients were analyzed by two experienced radiologist independently. Whenever there was dissension, they discussed and reached an agreement. RESULTS: In all cases of intussusception, the successful reduction rate was 91.5%. The cases within 1-year-old were 627 cases, air enema success rate was 87.1% and the success rate of air enema was 97.2% in beyond 1-year-old group. There was significant difference between two groups (χ(2) = 36.01, P < 0.01). In 95 cases of failed air enema reduction, 14 cases were ileoileal, 10 ileocaecal and 25 ileocolic. And 44 cases were ileoilealcolic and 2 ileocoliccolic. Eleven cases had intestinal necrosis. Four cases had small bowel duplication cyst and 3 with Meckel's diverticulum. Intestinal obstruction with vascular compromise in plain film had a high concordance with pathology (kappa = 0.7128). The pathology type was somewhat correlated with the finding of plain film (P < 0.01). As assessed by plain film, there were intussusceptions with vascular compromise (n = 30) with a coffee-bean sign or banana sign, a paucity of bowel gas (n = 36), quadrant gas (n = 51) and mass or crescent (n = 73). Through an analysis between plain film signs and the onset of symptom by Spearman correlation (nonzero correlation = 20.67, P < 0.01), there was statistical significance. CONCLUSION: The successful rate of air enema in intussusception is lower in within 1-year-old group than beyond 1-year-old group. The sign of plain film is more significant in assessing the pathogenetic conditions of intussusception. And it has a high concordance with pathology in assessing the intestinal obstruction with vascular compromise.