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Necrotizing Enterocolitis: Assessment of Bowel Viability with Color Doppler US¹

¹ From the Department of Diagnostic Imaging (R.F., A.D., G.T., P.S.B., D.E.M., A.M.) and the Divisions of Neonatology (A.M.M., J.H., J.H.K.), Pathology (C.S.), and Pediatric General Surgery (T.G.), Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada. Received October 23, 2003; revision requested January 13, 2004; final revision received July 9; accepted August 4. Address correspondence to R.F., Department of Medical Imaging, Montreal Children’s Hospital, 2300 Tupper St, Montreal, QC, Canada H3H 1P3 (e-mail: ricardo.faingold@muhc.mcgill.ca).

PURPOSE: To determine whether absence of bowel wall perfusion at color Doppler ultrasonography (US) is indicative of bowel necrosis in neonates with necrotizing enterocolitis (NEC).

MATERIALS AND METHODS: This study was approved by the research ethics board, and informed consent was obtained. Sixty-two neonates enrolled in the prospective study underwent US of the bowel wall. Neonates were divided into two groups. Group A included 30 control subjects with gestational ages (GAs) ranging from 24 to 41 weeks. Group B included 32 neonates with GAs ranging from 24 to 40 weeks who were clinically proved to have or suspected of having NEC. All neonates in group B underwent abdominal radiography. Normative values were calculated in group A. In group B, the sensitivities and specificities of color Doppler US and abdominal radiography for detection of bowel necrosis were computed by using the modified Bell staging criteria for NEC as the reference standard.

RESULTS: Two neonates were excluded from group B; thus, a total of 60 neonates were included in the study. In group A, bowel wall thickness ranged from 1.1 to 2.6 mm. Bowel wall perfusion was detected with color Doppler US in all 30 neonates. Color Doppler signals ranged from one to nine dots per square centimeter. Twenty-two of 30 neonates in group B received a diagnosis of NEC. Mild to moderate NEC was diagnosed in 12 neonates. Color Doppler US depicted an isolated segment of bowel-absent blood flow in two neonates; this finding was confirmed with laparotomy. In 10 neonates with severe NEC, color Doppler US depicted isolated or multiple segments of bowel with absent perfusion. Pneumoperitoneum was present in only four neonates. The remaining eight neonates at risk for NEC had no evidence of loops without perfusion at color Doppler US. The sensitivity of free air at abdominal radiography as a positive sign for severe NEC with necrotic bowel was 40% compared with the 100% sensitivity of absence of flow at color Doppler US (P = .03).

CONCLUSION: Color Doppler US is more accurate than abdominal radiography in depicting bowel necrosis in NEC.

© RSNA, 2005

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