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The impact of high-frequency transducers on the sonographic measurements of the pyloric muscle thickness in infants

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Abstract

Background

Ultrasound is the modality of choice for the diagnosis of hypertrophic pyloric stenosis (HPS). The evolution of high-frequency transducers in ultrasound has led to inconsistent ways of measuring the pylorus.

Objective

To standardize the measurements and evaluate the appearance of the normal and hypertrophied pylorus with high-frequency transducers.

Materials and methods

We retrospectively analyzed abdominal ultrasounds of infants with suspected HPS from January 2019-December 2020. We classified the layers of the pylorus while assessing the stratified appearance. Two pediatric radiologists measured the muscle thickness of the pylorus independently by two methods for interrater agreement. Measurement (a) includes the muscularis propria and muscularis mucosa. Measurement (b) includes only the muscularis propria. We also evaluated the echogenicity of the muscularis propria. The interrater agreement, mean, range of the muscle thickness, and the diagnostic accuracy of the two sets of measurements were calculated.

Results

We included 300 infants (114 F:186 M), 59 with HPS and 241 normal cases. There was a strong agreement between the readers assessed in the first 100 cases, and ICC was 0.99 (95% CI, 0.98–0.99). Measurement (a), median thickness is 2.4 mm in normal cases and 4.8 mm in HPS. Measurement (b), median thickness is 1.4 mm in normal cases and 4.0 mm in HPS. Measurement (a) has an accuracy of 89.7% (95% CI, 85.7−92.8%) with 98.3% sensitivity and 87.6% specificity. Measurement (b) has an accuracy of 98.0% (95% CI, 95.7−99.3%) with 89.8% sensitivity and 100.0% specificity. The pylorus stratification is preserved in all normal cases and 31/59 (52.5%) cases of HPS. There was complete/partial loss of stratification in 28/59 (47.5%) cases of HPS. In all HPS cases, the muscularis propria was echogenic.

Conclusion

Measuring the muscularis propria solely has a better diagnostic accuracy, decreasing the overlap of negative and positive cases. The loss of pyloric wall stratification and echogenic muscularis propria is only seen in HPS.

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Data availability

The data used in this study is available upon reasonable request from the corresponding author.

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Authors and Affiliations

  1. Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada

    Ayat Yousef, Alan Daneman, Afsaneh Amirabadi & Ricardo Faingold

  2. Department of Medical Imaging, University of Toronto, 555 University Ave, Toronto, ON, M5G 1X8, Canada

    Ayat Yousef, Alan Daneman, Afsaneh Amirabadi & Ricardo Faingold

Authors
  1. Ayat Yousef
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  2. Alan Daneman
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  3. Afsaneh Amirabadi
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  4. Ricardo Faingold
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Correspondence to Ricardo Faingold.

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Yousef, A., Daneman, A., Amirabadi, A. et al. The impact of high-frequency transducers on the sonographic measurements of the pyloric muscle thickness in infants. Pediatr Radiol 54, 737–742 (2024). https://doi.org/10.1007/s00247-024-05881-0

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  • DOI: https://doi.org/10.1007/s00247-024-05881-0

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