Ultra-High Frequency Ultrasound Imaging of Bowel Wall in Hirschsprung’s Disease—Correlation and Agreement Analyses of Histoanatomy

Abstract

Hirschsprung’s disease (HD) is characterized by aganglionosis in the bowel wall, requiring resection. Ultra-high frequency ultrasound (UHFUS) imaging of the bowel wall has been suggested to be an instantaneous method of deciding resection length. The aim of this study was to validate UHFUS imaging of the bowel wall in children with HD by exploring the correlation and systematic differences between UHFUS and histopathology. Resected fresh bowel specimens of children 0–1 years old, operated on for rectosigmoid aganglionosis at a national HD center 2018–2021, were examined ex vivo with UHFUS center frequency 50 MHz. Aganglionosis and ganglionosis were confirmed by histopathological staining and immunohistochemistry. Histoanatomical layers of bowel wall in histopathological and UHFUS images, respectively, were outlined using MATLAB programs. Both histopathological and UHFUS images were available for 19 aganglionic and 18 ganglionic specimens. The thickness of muscularis interna correlated positively between histopathology and UHFUS in both aganglionosis (R = 0.651, p = 0.003) and ganglionosis (R = 0.534, p = 0.023). The muscularis interna was systematically thicker in histopathology than in UHFUS images in both aganglionosis (0.499 vs. 0.309 mm; p < 0.001) and ganglionosis (0.644 versus 0.556 mm; p = 0.003). Significant correlations and systematic differences between histopathological and UHFUS images support the hypothesis that UHFUS reproduces the histoanatomy of the bowel wall in HD accurately.

A Computer Program for Assessing Histoanatomical Morphometrics in Ultra-High-Frequency Ultrasound Images of the Bowel Wall in Children: Development and Inter-Observer Variability

“…After surgical resection, the retrieved bowel wall segment was pinned to a cork mat and subjected to ex vivo UHFUS imaging from the serosal surface, at sites representing aganglionic and ganglionic bowel wall segments, respectively [11]. The specimen was then fixed in formalin and embedded in paraffin, and the presence of aganglionosis and ganglionosis was confirmed by histopathology (hematoxylin-eosin) and immunohistochemistry (S100 and calretinin) [9,11].…”

“…Currently, diagnosis of HD is by histopathological and immunohistological analyses of tissue biopsies [8], which are time-consuming and costly to perform. In order to replace the use of biopsies both during primary and surgical diagnosis with an instant and secure diagnostic method, the use of UHFUS is being explored [9]. Histoanatomical differences between aganglionic and ganglionic bowel wall have been suggested, and good correlations between histoanatomy and UHFUS of bowel wall specimens from HD patients have been confirmed [10].…”

UHFUS: A Valuable Tool in Evaluating Exocrine Gland Abnormalities in Sjögren’s Disease

“…Moreover, UHFUS equipment is designed to automatically adjust its output to ensure that mechanical and thermal limits are not exceeded for all imaging modalities. Overall, UHFUS offers versatility, cost-effectiveness, and non-invasiveness, making it a promising imaging modality that is continually evolving and expanding its applications in clinical practice [12][13][14].…”