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Spinal cord anomalies in children with anorectal malformations: Ultrasound is a good screening test
Susan Jehangir1, Susan Adams2, Tracey Ong1
1Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, NSW, Australia.
Insights
Spinal ultrasound effectively screens for spinal cord anomalies in infants with anorectal malformations (ARMs). Abnormal ultrasound findings require MRI confirmation and may indicate a need for surgery.
Area of Science:
- Pediatric Imaging
- Radiology
- Congenital Anomalies
Background:
- Anorectal malformations (ARMs) are associated with a high incidence of spinal cord anomalies.
- Early detection and characterization of these anomalies are crucial for appropriate management.
Purpose of the Study:
- To correlate spinal ultrasound (US) and magnetic resonance imaging (MRI) findings in pediatric patients diagnosed with anorectal malformations (ARMs).
- To evaluate the diagnostic performance of spinal US as a screening tool for spinal cord anomalies in this population.
Main Methods:
- Retrospective analysis of records for children with ARM (2009-2017) from two pediatric hospitals.
- Spinal US performed up to 4 months and MRI within the first year of life.
- Comparison of US and MRI findings for the detection of spinal cord anomalies, including conus medullaris position and tethering.
Main Results:
- Spinal imaging was performed in 157 of 193 ARM patients; 44 underwent both US and MRI.
- Spinal US demonstrated 91% sensitivity and 75% specificity compared to MRI for detecting spinal cord anomalies.
- Abnormal US findings (low-lying, borderline low, or tethered cord) correlated with the need for surgical intervention.
Conclusions:
- Spinal ultrasound is a reliable screening test for spinal cord anomalies in infants with ARM.
- Abnormal US findings necessitate MRI confirmation and are indicative of potential spinal cord tethering requiring surgical correction.
Purpose:
The purpose of this study is to correlate spinal ultrasound (US) and magnetic resonance imaging (MRI) findings in patients with anorectal malformations (ARMs).
Methods:
A retrospective analysis of records was performed for children with ARM presenting to two major pediatric hospitals between 2009 and 2017. The primary outcome analyzed was detection of spinal cord anomalies. Spinal US was performed up to 4 months and MRI within the first year of life. The conus medullaris was considered normal if it had a tapering contour and terminated at or above the Lumbar 2-3 disk space.
Results:
One hundred ninety-three patients with ARM presented during the study period with a slight male preponderance (108, 56%). Spinal imaging was performed in 157(82%) - 137(87%) had US, 64(41%) had MRI and 44 (28%) had both. Of the 44 who had both; US was abnormal in 25 children-confirmed by MRI in 20 (80%). US was normal in 17 children- MRI showed a filum cyst in 1 and a lipoma in 2 children and was inconclusive in 2 children (p<0.001). All who required surgery except one child, were reported on spinal US to have a low lying cord, borderline low cord or tethered cord (p<.05). No child who was reported to have a normal spinal US required de-tethering at a later stage. Spinal US had an overall sensitivity of 91% and specificity of 75% compared to MRI for detecting spinal cord anomalies in children with ARM CONCLUSIONS: Spinal US performed in a tertiary pediatric imaging department was a good screening test for spinal cord anomalies in children with ARM. The finding of a low, borderline low or tethered cord on US mandates an MRI to confirm the findings and correlates with the need for operative correction of spinal cord tethering.
Study Type:
Clinical research paper.
Level Of Evidence:
2.
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