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Diagnostic value of the acute angle between the prestenotic and poststenotic duodenum in neonatal annular pancreas.

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Title: Diagnostic value of the acute angle between the prestenotic and poststenotic duodenum in neonatal annular pancreas.
Authors: Yang, Boyang1, He, Fan2, He, Qiuming3, Wang, Zhe3, Fang, Qian1, Zhong, Wei3 gzfezw@163.com, Wang, Hongying1 gzfe1122@163.com
Source: European Radiology. Jun2019, Vol. 29 Issue 6, p2902-2909. 8p. 2 Color Photographs, 1 Black and White Photograph, 1 Chart, 1 Graph.
Subjects: Duodenal obstructions, Duodenum, Pancreas, Receiver operating characteristic curves
Abstract: Objectives: To analyze the ability of upper gastrointestinal (GI) saline-contrast ultrasound (US) to detect neonatal annular pancreas.Methods: Sixty-two neonates, who presented duodenal obstruction and were examined by upper GI saline-contrast US before treatment, were retrospectively analyzed and categorized into four groups according to their final diagnosis: group A, annular pancreas (n = 28); group B, duodenal atresia (n = 2); group C, descending duodenal septum (n = 25); and group D, normal (n = 7). The ultrasonic characteristics were analyzed that especially focused on whether the angle between the prestenotic and poststenotic descending duodenum (at or below a derived cutoff) could identify neonatal annular pancreas.Results: To detect annular pancreas using the concave contour of the distal prestenotic duodenum, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined at 71.4%, 100%, 100%, and 80.9%, respectively. When using the hyperechogenic band around the constricted duodenum, the sensitivity, specificity, PPV, and NPV were determined at 82.1%, 94.1%, 92%, and 86.5%, respectively. For using the 40.7° acute angle cutoff between prestenotic and poststenotic descending duodenum, the values of sensitivity, specificity, PPV, and NPV were determined at 100%, 97.1%, 96.6%, and 100%, respectively, of which the area under the receiver operating characteristic curve was 0.979.Conclusions: Upper GI saline-contrast US has a lower possibility for misdiagnosis of neonatal annular pancreas when considering the acute angle between the prestenotic and poststenotic descending duodenum.Key Points: • This study includes the largest series of neonates with annular pancreas of which the characteristics were analyzed using the upper GI saline-contrast US. • Neonatal annular pancreas may be diagnosed by the characteristics-concave contour of the distal prestenotic duodenum; acute angle cutoff of 40.7° between the prestenotic and poststenotic duodenum; the "S" shape formed by the pylorus, the duodenal bulb, and the prestenotic and poststenotic descending duodenum. • The acute angle with the highest diagnostic value can be used to quantitatively diagnose neonatal annular pancreas and avoid potential misdiagnosis caused by sonographers' subjectivity. [ABSTRACT FROM AUTHOR]
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Abstract:<bold>Objectives: </bold>To analyze the ability of upper gastrointestinal (GI) saline-contrast ultrasound (US) to detect neonatal annular pancreas.<bold>Methods: </bold>Sixty-two neonates, who presented duodenal obstruction and were examined by upper GI saline-contrast US before treatment, were retrospectively analyzed and categorized into four groups according to their final diagnosis: group A, annular pancreas (n = 28); group B, duodenal atresia (n = 2); group C, descending duodenal septum (n = 25); and group D, normal (n = 7). The ultrasonic characteristics were analyzed that especially focused on whether the angle between the prestenotic and poststenotic descending duodenum (at or below a derived cutoff) could identify neonatal annular pancreas.<bold>Results: </bold>To detect annular pancreas using the concave contour of the distal prestenotic duodenum, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined at 71.4%, 100%, 100%, and 80.9%, respectively. When using the hyperechogenic band around the constricted duodenum, the sensitivity, specificity, PPV, and NPV were determined at 82.1%, 94.1%, 92%, and 86.5%, respectively. For using the 40.7° acute angle cutoff between prestenotic and poststenotic descending duodenum, the values of sensitivity, specificity, PPV, and NPV were determined at 100%, 97.1%, 96.6%, and 100%, respectively, of which the area under the receiver operating characteristic curve was 0.979.<bold>Conclusions: </bold>Upper GI saline-contrast US has a lower possibility for misdiagnosis of neonatal annular pancreas when considering the acute angle between the prestenotic and poststenotic descending duodenum.<bold>Key Points: </bold>• This study includes the largest series of neonates with annular pancreas of which the characteristics were analyzed using the upper GI saline-contrast US. • Neonatal annular pancreas may be diagnosed by the characteristics-concave contour of the distal prestenotic duodenum; acute angle cutoff of 40.7° between the prestenotic and poststenotic duodenum; the "S" shape formed by the pylorus, the duodenal bulb, and the prestenotic and poststenotic descending duodenum. • The acute angle with the highest diagnostic value can be used to quantitatively diagnose neonatal annular pancreas and avoid potential misdiagnosis caused by sonographers' subjectivity. [ABSTRACT FROM AUTHOR]
ISSN:09387994
DOI:10.1007/s00330-018-5922-0