Radiologists' Agreement When Using a 10-Point Scale to Report Abdominal Radiographic Findings of Necrotizing Enterocolitis in Neonates and Infants

Coursey, Courtney A.; Hollingsworth, Caroline L.; Gaca, A; Maxfield, Charles M.; DeLong, David M.; Bisset, George S.

doi:10.2214/ajr.07.3558

Cited by 52 publications

(45 citation statements)

References 27 publications

(32 reference statements)

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“… a) Duke Abdominal Assessment Scale [25]Percentages refer to the proportions of all 202 respondents. No significant differences between subgroups were detected…”

Section: Resultsmentioning

confidence: 99%

The role of imaging in the management of necrotising enterocolitis: a multispecialist survey and a review of the literature

2018

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ObjectivesTo investigate current practices and perceptions of imaging in necrotising enterocolitis (NEC) according to involved specialists, put them in the context of current literature, and identify needs for further investigation.MethodsTwo hundred two neonatologists, paediatric surgeons, and radiologists answered a web-based questionnaire about imaging in NEC at their hospitals. The results were descriptively analysed, using proportion estimates with 95% confidence intervals.ResultsThere was over 90% agreement on the value of imaging for confirmation of the diagnosis, surveillance, and guidance in decisions on surgery as well as on abdominal radiography as the first-choice modality and the most important radiographic signs. More variation was observed regarding some indications for surgery and the use of some ultrasonographic signs. Fifty-eight per cent stated that ultrasound was used for NEC at their hospital. Examination frequency, often once daily or more but with considerable variations, and projections used in AR were usually decided individually rather than according to fixed schedules. Predicting the need of surgery was regarded more important than formal staging.ConclusionDespite great agreement on the purposes of imaging in NEC and the most important radiographic signs of the disease, there was considerable diversity in routines, especially regarding examination frequency and the use of ultrasound. Apart from continuing validation of ultrasound, important objectives for future studies include definition of the supplementary roles of both imaging modalities in relation to other diagnostic parameters and evaluation of various imaging routines in relation to timing of surgery, complications, and mortality rate.Key Points• Imaging is an indispensable tool in the management of necrotising enterocolitis• Predicting the need of surgery is regarded more important than formal staging• There is great consensus on important signs of NEC on abdominal radiography• There is more uncertainty regarding the role of ultrasound• Individualised management is preferred over standardised diagnostic algorithmsElectronic supplementary materialThe online version of this article (10.1007/s00330-018-5362-x) contains supplementary material, which is available to authorized users.

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“… a) Duke Abdominal Assessment Scale [25]Percentages refer to the proportions of all 202 respondents. No significant differences between subgroups were detected…”

Section: Resultsmentioning

confidence: 99%

The role of imaging in the management of necrotising enterocolitis: a multispecialist survey and a review of the literature

2018

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“…While plain abdominal radiographs remain the main and most used modality in the evaluation and monitoring of the NEC, it is true that the most specific sign that defines the diagnosis is the presence of intramural gas (37,40,46,50,51). Unfortunately, this radiographic sign is present in the advanced stages of the disease when the damage of the wall has been consolidated leading perforation.…”

Section: Discussionmentioning

confidence: 99%

“…It consists in a score based on radiological findings that increases with disease severity, ranging from 0 (normal gas pattern) to 10 (pneumoperitoneum) (37,38).…”

Section: Imagingmentioning

confidence: 99%

Diagnostic imaging features of necrotizing enterocolitis: a narrative review

Esposito¹,

Mamone²,

Serafino³

et al. 2017

Quant. Imaging Med. Surg.

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Necrotizing enterocolitis (NEC) is an inflammatory process, characterized by intestinal necrosis of variable extension, leading to perforation, generalized peritonitis and death. The classical pathogenetic theory focuses on mucosal damage related to a stress induced intestinal ischemia leading to mucosal injury and bacterial colonization of the wall. A more recent hypothesis emphasizes the role of immaturity of gastrointestinal and immune system, particularly of the premature, responsible of bowel wall vulnerability and suffering. NEC is the most common gastrointestinal emergency in the newborn, with a higher incidence in the preterm; improvement of neonatal resuscitation techniques enables the survival of premature of very low birth weight (VLBW) with prolongation of hospital stay for perinatal and neonatal care and a higher risk of NEC. Clinical presentation of NEC in newborn ranges from mild forms with moderate gastrointestinal tract disorder and that can heal spontaneously, to very serious forms with fulminant course characterized by perforation, peritonitis, sepsis, disseminated intravascular coagulation (DIC) and shock. Imaging modality in the diagnosis of NEC is historically represented by the plain-film abdominal radiographs which can be performed every 6 hours because of the rapid evolution that may occur in the patient's clinical condition.However ultrasound (US), in recent years, is playing an increasingly important role in the evaluation of early stages of the disease as it provides images in real time of the abdominal structures being able to assess the presence and validity of peristalsis of the bowel loops, detect the thickness of the intestinal wall and the presence of minimal amounts of fluid in the peritoneal cavity. In this paper we review the pathogenesis, clinical presentation and imaging of NEC with a particular attention to the emergent role of US in the diagnosis of the disease.

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“…[2] Presence of PVG in the abdominal radiograph of a patient with NEC has very high score (score 9 out of 10) in 10 point Duke abdominal assessment scale (DASS) score. [3] Coursey et al observed that presence of fixed bowel loop, significant or highly probable pneumatosis intestinalis or portal vein gas in abdominal radiographs progressed to pneumoperitoneum in 46.5% study group of NEC patients but not in control patients. [4] Presence of PVG is fleeting and that is why it has low reported incidence of 10% to 30%, but has 61% incidence in NEC with pan-intestinal involvement.…”

Section: Portal Vein Gas In Necrotising Enterocolitismentioning

confidence: 96%

Portal Vein Gas in Necrotising Enterocolitis

Rajendran

Hassan

2017

J Neonat Surg

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How to cite: Rajendran R, Hassan HAK. Portal vein gas in necrotising enterocolitis. J Neonatal Surg. 2017; 6:83. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A 28-day-old boy developed abdominal distension, blood-stained gastric drainage, apnoea and hypotension. Born to G7P4A3 mother at 36w gestation, his birthweight was 1450g. He was treated in the immediate postnatal period for respiratory distress due to hyaline membrane disease with surfactant and mechanical ventilation. He was then treated for probable sepsis. On 21st day of birth he was found to have conjugated hyperbilirubinemia, intermittent pale stools and intermittent light-yellow stools, lethargy and hepatomegaly. C-reactive protein was positive. Echocardiogram showed small patent ductus arteriosus. He was given nasogastric tube-feeds of formula milk in the last 3 days. On examination, abdomen was uniformly distended and soft without erythema, oedema, tenderness or mass. Abdominal skiagram showed dilated bowel loops and portal vein gas (PVG), indirect evidence of free air and fluid in peritoneal cavity (Fig.1). DISCUSSIONClinically and radiologically, our patient had modified Bell's stage IIIB NEC. Presence of PVG is very prominent in radiographs, but pneumoperitoneum, the hallmark of stage IIIB was, not typical. Portal vein gas represents gas distributed through fine radicles of portal vein. The bacterial translocation and production of hydrogen gas into the bowel wall cause pneumatosis intestinalis. This gas can embolize from CLINICAL IMAGE

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Radiologists' Agreement When Using a 10-Point Scale to Report Abdominal Radiographic Findings of Necrotizing Enterocolitis in Neonates and Infants

Cited by 52 publications

References 27 publications

The role of imaging in the management of necrotising enterocolitis: a multispecialist survey and a review of the literature

The role of imaging in the management of necrotising enterocolitis: a multispecialist survey and a review of the literature

Diagnostic imaging features of necrotizing enterocolitis: a narrative review

Portal Vein Gas in Necrotising Enterocolitis

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