Novel qualitative and quantitative ultrasound markers to facilitate prenatal diagnosis of congenital duodenal obstruction

Figures & data

Figure 1. Measurement of the length and maximum transverse diameters of the fetal dilated small duodenum by ultrasound.

Figure 2. Measurement of the longitudinal dimension of dilated stomach by ultrasound.

Figure 3. (a) A fetus was diagnosed annular pancreas by postnatal surgery. Prenatal ultrasound shown that the dilated bowel connected with the stomach, and the end of the enlarged intestine was located at the level of right side of spine at 35 weeks. White arrow indicates the stomach; yellow arrow indicates the end of the enlarged intestine; blue arrow indicates the spine. (b) A fetus was diagnosed high jejunal atresia by postnatal surgery. Prenatal ultrasound shown that the enlarged intestine, in a “C” shape, connected with the stomach, and extended from the right side of the abdominal cavity to the left side, and the end of the enlarged intestine significantly exceeded the level of left side of spine at 29 weeks. White Arrow indicates the stomach; yellow arrow indicates the end of the enlarged intestine; blue arrow indicates the spine.

Table 1. Clinical characteristics of patients with CDO and high jejunal obstruction.

Features	All patients (n = 42)	CDO (n = 26)	High jejunal obstruction (n = 16)	p-Value
Maternal age	30.71 ± 4.08	30.27 ± 4.09	31.43 ± 4.08	.374
Gravidity	2 (1–3)	2 (1–3)	1 (0–2)	.838
Parity	1 (0–2)	1 (0–2)	1.5 (1–2)	.041
Gestational age at detection	33.70 ± 3.05	34.05 ± 3.19	33.4 ± 2.82	.35
GDM	7 (16.7%)	5 (19.2%)	2 (12.5%)	.887^a
Polyhydramnios	27 (64.3%)	18 (69.2%)	9 (56.3%)	.394
Natural labor	23 (54.8%)	12 (46.2%)	11 (68.8%)	.106
Cesarean section	16 (38.1%)	13 (50%)	3 (18.8%)
Forceps delivery	3 (7.1%)	1 (3.8%)	2 (12.5%)
Gestational age at birth	36.80 ± 2.08	37.57 ± 1.47	35.55 ± 2.34	<.001
Preterm birth	18 (42.9%)	6 (23.1%)	12 (75%)	.001
Birth weight (g)	2563.81 ± 470.42	2723.85 ± 383.73	2303.75 ± 492.87	<.001
Sex female/male	21/21	14/12	7/9	.525
Apgar score at 1 min	9 (9–10)	9 (9–10)	9 (9–10)	.928
Apgar score at 5 min	10 (9–10)	10 (10–10)	9 (9–10)	.001
Length of hospital stay	17 (14–30)	14 (11–17)	35.5 (23–46)	<.001

CDO: congenital duodenal obstruction; Data presented as median (range), mean ± SD, or frequency (percentage).

The bold values are statistically significant.

^aCalculated with continuity correction.

Table 2. Prenatal sonographic findings of patients with CDO and high jejunal obstruction.

Measurements	CDO (n = 26)	High jejunal obstruction (n = 16)	p-Value
Head circumference (mm)	314.5 (298.75–328.25)	301.50 (292.25–319.50)	.111
Abdomen circumference (mm)	293.69 ± 32.02	282.81 ± 31.12	.286
Femur length (mm)	65.50 (59.75–68.25)	60 (58–65.25)	.089
Dilated intestinal length (mm)	33.62 ± 11.83	97.13 ± 31.01	.0001
Dilated stomach length (mm)	48.73 ± 7.06	52.56 ± 10.15	.156
I/S ratio	0.70 ± 0.27	1.86 ± 0.54	.0001
Maximum intestinal dilatation (mm)	19.80 ± 7.02	22.13 ± 6.71	.296
Dilated bowel ends on the left side of the spine	0	16 (100%)	.0001

CDO: congenital duodenal obstruction; ratio of dilated intestinal length and dilated stomach length.

^aCalculated with continuity correction.

Figure 4. The ROC curves in the prenatal diagnosis of fetal CDO.

Table 3. Results of receiver operating characteristic curve analysis.

Indicators	AUC (95%CI)	p-Value	Cut off	Specificity (%)	Sensitivity (%)
Dilated intestinal length	0.995 (0.907–1.000)	<.001	≤51	96.15	100
Stomach length	0.606 (0.443–0.753)	.273	≤50	65.4	62.5
I/S ratio	0.988 (0.894–1.000)	<.001	≤1	92.3	100
Maximum intestinal dilatation	0.614 (0.452–0.760)	.207	≤19	50	75

Pairwise comparisons of AUCs: dilated intestinal length vs. I/S ratio, p = .33.

Table 4. Correlation between the location of CDO and ultrasound metrics.

Measurements	Correlation coefficient	p-Value
Dilated intestinal length	0.686	<.001
Stomach length	−0.036	.863
I/S ratio	0.660	<.001
Maximum intestinal dilatation	0.284	.159