DOI: 10.1148/radiol.2352031718
Necrotizing Enterocolitis: Assessment of Bowel Viability with Color Doppler US1
Ricardo Faingold, MD,
Alan Daneman, MD,
George Tomlinson, PhD,
Paul S. Babyn, MD,
David E. Manson, MD,
Arun Mohanta, RDMS,
Aideen M. Moore, MD,
Jonathan Hellmann, MD,
Charles Smith, MD,
Ted Gerstle, MD and
Jae Hong Kim, MD
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).
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Figure 1a. High-resolution US scans of normal bowel obtained in a neonate by using a 15-MHz linear-array transducer. (a) Transverse gray-scale US scan obtained in the right upper quadrant shows several loops of bowel. Arrow indicates one loop in transverse section that has a normal bowel wall echotexture and different mural layers surrounded by a hypoechoic halo, which is thought to represent the prominent muscularis propria (typical gut appearance). (b) Transverse color Doppler US scan with a 15-mm square region of interest placed over the sampled bowel loops. Perfusion is indicated by the color Doppler signals. (c) Transverse color Doppler US scan depicts one linear color Doppler signal (arrow) within the 10-mm square region of interest, as well as several dots. The color Doppler signal in the upper left corner represents motion artifact.
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Figure 1b. High-resolution US scans of normal bowel obtained in a neonate by using a 15-MHz linear-array transducer. (a) Transverse gray-scale US scan obtained in the right upper quadrant shows several loops of bowel. Arrow indicates one loop in transverse section that has a normal bowel wall echotexture and different mural layers surrounded by a hypoechoic halo, which is thought to represent the prominent muscularis propria (typical gut appearance). (b) Transverse color Doppler US scan with a 15-mm square region of interest placed over the sampled bowel loops. Perfusion is indicated by the color Doppler signals. (c) Transverse color Doppler US scan depicts one linear color Doppler signal (arrow) within the 10-mm square region of interest, as well as several dots. The color Doppler signal in the upper left corner represents motion artifact.
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Figure 1c. High-resolution US scans of normal bowel obtained in a neonate by using a 15-MHz linear-array transducer. (a) Transverse gray-scale US scan obtained in the right upper quadrant shows several loops of bowel. Arrow indicates one loop in transverse section that has a normal bowel wall echotexture and different mural layers surrounded by a hypoechoic halo, which is thought to represent the prominent muscularis propria (typical gut appearance). (b) Transverse color Doppler US scan with a 15-mm square region of interest placed over the sampled bowel loops. Perfusion is indicated by the color Doppler signals. (c) Transverse color Doppler US scan depicts one linear color Doppler signal (arrow) within the 10-mm square region of interest, as well as several dots. The color Doppler signal in the upper left corner represents motion artifact.
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Figure 2a. US scans of the bowel in neonates with NEC. The color Doppler US scans show the patterns of increased perfusion in NEC that represent hyperemic viable bowel. (a) High-resolution transverse gray-scale US scan obtained with a linear-array transducer demonstrates pneumatosis intestinalis (arrows) in the wall of a loop of bowel. The bowel is surrounded by free fluid with low-level echoes. (b) High-resolution sagittal color Doppler US scan shows the circular or rim perfusion pattern in several loops of bowel. (c) Spectra from one of the loops in b show that the color Doppler signals are due to arterial wave pulsations, as depicted in the waveform below the image. (d) Transverse color Doppler US scan depicts the "Y" appearance (arrow) of prominent distal mesenteric and subserosal vessels. (e) Sagittal color Doppler US scan shows the zebra pattern or multiple color Doppler lines due to hyperemia of the valvulae conniventes.
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Figure 2b. US scans of the bowel in neonates with NEC. The color Doppler US scans show the patterns of increased perfusion in NEC that represent hyperemic viable bowel. (a) High-resolution transverse gray-scale US scan obtained with a linear-array transducer demonstrates pneumatosis intestinalis (arrows) in the wall of a loop of bowel. The bowel is surrounded by free fluid with low-level echoes. (b) High-resolution sagittal color Doppler US scan shows the circular or rim perfusion pattern in several loops of bowel. (c) Spectra from one of the loops in b show that the color Doppler signals are due to arterial wave pulsations, as depicted in the waveform below the image. (d) Transverse color Doppler US scan depicts the "Y" appearance (arrow) of prominent distal mesenteric and subserosal vessels. (e) Sagittal color Doppler US scan shows the zebra pattern or multiple color Doppler lines due to hyperemia of the valvulae conniventes.
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Figure 2c. US scans of the bowel in neonates with NEC. The color Doppler US scans show the patterns of increased perfusion in NEC that represent hyperemic viable bowel. (a) High-resolution transverse gray-scale US scan obtained with a linear-array transducer demonstrates pneumatosis intestinalis (arrows) in the wall of a loop of bowel. The bowel is surrounded by free fluid with low-level echoes. (b) High-resolution sagittal color Doppler US scan shows the circular or rim perfusion pattern in several loops of bowel. (c) Spectra from one of the loops in b show that the color Doppler signals are due to arterial wave pulsations, as depicted in the waveform below the image. (d) Transverse color Doppler US scan depicts the "Y" appearance (arrow) of prominent distal mesenteric and subserosal vessels. (e) Sagittal color Doppler US scan shows the zebra pattern or multiple color Doppler lines due to hyperemia of the valvulae conniventes.
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Figure 2d. US scans of the bowel in neonates with NEC. The color Doppler US scans show the patterns of increased perfusion in NEC that represent hyperemic viable bowel. (a) High-resolution transverse gray-scale US scan obtained with a linear-array transducer demonstrates pneumatosis intestinalis (arrows) in the wall of a loop of bowel. The bowel is surrounded by free fluid with low-level echoes. (b) High-resolution sagittal color Doppler US scan shows the circular or rim perfusion pattern in several loops of bowel. (c) Spectra from one of the loops in b show that the color Doppler signals are due to arterial wave pulsations, as depicted in the waveform below the image. (d) Transverse color Doppler US scan depicts the "Y" appearance (arrow) of prominent distal mesenteric and subserosal vessels. (e) Sagittal color Doppler US scan shows the zebra pattern or multiple color Doppler lines due to hyperemia of the valvulae conniventes.
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Figure 2e. US scans of the bowel in neonates with NEC. The color Doppler US scans show the patterns of increased perfusion in NEC that represent hyperemic viable bowel. (a) High-resolution transverse gray-scale US scan obtained with a linear-array transducer demonstrates pneumatosis intestinalis (arrows) in the wall of a loop of bowel. The bowel is surrounded by free fluid with low-level echoes. (b) High-resolution sagittal color Doppler US scan shows the circular or rim perfusion pattern in several loops of bowel. (c) Spectra from one of the loops in b show that the color Doppler signals are due to arterial wave pulsations, as depicted in the waveform below the image. (d) Transverse color Doppler US scan depicts the "Y" appearance (arrow) of prominent distal mesenteric and subserosal vessels. (e) Sagittal color Doppler US scan shows the zebra pattern or multiple color Doppler lines due to hyperemia of the valvulae conniventes.
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Figure 3a. NEC in a premature girl (gestational age, 33 weeks; corrected age, 34 weeks) with Bell stage IIB. The Bell stage was reclassified to IIIB after assessment of color Doppler US findings. (a) Gray-scale transverse US scan shows two loops of bowel surrounded by free peritoneal fluid with low-level echoes. The loop in the far field has a markedly thinned wall (arrow), which is suggestive of severe ischemia. The typical gut appearance is no longer present. (b) Transverse color Doppler US scan demonstrates flow in the bowel loop in the near field, as depicted by the color Doppler signals (arrowhead). The loop in the far field (arrow), however, lacks evidence of perfusion. (c) Spectra from the loop in the far field in b help confirm the absence of arterial flow. (d) Spectra from the loop in the near field in b help confirm the presence of an arterial waveform. (e) Intraoperative photograph shows perforation sites (indicated by inserted metal probe) adjacent to multiple hyperemic loops in the lower part of the image; the bowel loops in the upper right part of the photograph have a normal appearance. (f) Microscopic image of perforation site shows considerable thinning of the bowel wall with necrosis (arrow). (Hematoxylin-eosin stain; original magnification, x10.)
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Figure 3b. NEC in a premature girl (gestational age, 33 weeks; corrected age, 34 weeks) with Bell stage IIB. The Bell stage was reclassified to IIIB after assessment of color Doppler US findings. (a) Gray-scale transverse US scan shows two loops of bowel surrounded by free peritoneal fluid with low-level echoes. The loop in the far field has a markedly thinned wall (arrow), which is suggestive of severe ischemia. The typical gut appearance is no longer present. (b) Transverse color Doppler US scan demonstrates flow in the bowel loop in the near field, as depicted by the color Doppler signals (arrowhead). The loop in the far field (arrow), however, lacks evidence of perfusion. (c) Spectra from the loop in the far field in b help confirm the absence of arterial flow. (d) Spectra from the loop in the near field in b help confirm the presence of an arterial waveform. (e) Intraoperative photograph shows perforation sites (indicated by inserted metal probe) adjacent to multiple hyperemic loops in the lower part of the image; the bowel loops in the upper right part of the photograph have a normal appearance. (f) Microscopic image of perforation site shows considerable thinning of the bowel wall with necrosis (arrow). (Hematoxylin-eosin stain; original magnification, x10.)
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Figure 3c. NEC in a premature girl (gestational age, 33 weeks; corrected age, 34 weeks) with Bell stage IIB. The Bell stage was reclassified to IIIB after assessment of color Doppler US findings. (a) Gray-scale transverse US scan shows two loops of bowel surrounded by free peritoneal fluid with low-level echoes. The loop in the far field has a markedly thinned wall (arrow), which is suggestive of severe ischemia. The typical gut appearance is no longer present. (b) Transverse color Doppler US scan demonstrates flow in the bowel loop in the near field, as depicted by the color Doppler signals (arrowhead). The loop in the far field (arrow), however, lacks evidence of perfusion. (c) Spectra from the loop in the far field in b help confirm the absence of arterial flow. (d) Spectra from the loop in the near field in b help confirm the presence of an arterial waveform. (e) Intraoperative photograph shows perforation sites (indicated by inserted metal probe) adjacent to multiple hyperemic loops in the lower part of the image; the bowel loops in the upper right part of the photograph have a normal appearance. (f) Microscopic image of perforation site shows considerable thinning of the bowel wall with necrosis (arrow). (Hematoxylin-eosin stain; original magnification, x10.)
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Figure 3d. NEC in a premature girl (gestational age, 33 weeks; corrected age, 34 weeks) with Bell stage IIB. The Bell stage was reclassified to IIIB after assessment of color Doppler US findings. (a) Gray-scale transverse US scan shows two loops of bowel surrounded by free peritoneal fluid with low-level echoes. The loop in the far field has a markedly thinned wall (arrow), which is suggestive of severe ischemia. The typical gut appearance is no longer present. (b) Transverse color Doppler US scan demonstrates flow in the bowel loop in the near field, as depicted by the color Doppler signals (arrowhead). The loop in the far field (arrow), however, lacks evidence of perfusion. (c) Spectra from the loop in the far field in b help confirm the absence of arterial flow. (d) Spectra from the loop in the near field in b help confirm the presence of an arterial waveform. (e) Intraoperative photograph shows perforation sites (indicated by inserted metal probe) adjacent to multiple hyperemic loops in the lower part of the image; the bowel loops in the upper right part of the photograph have a normal appearance. (f) Microscopic image of perforation site shows considerable thinning of the bowel wall with necrosis (arrow). (Hematoxylin-eosin stain; original magnification, x10.)
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Figure 3e. NEC in a premature girl (gestational age, 33 weeks; corrected age, 34 weeks) with Bell stage IIB. The Bell stage was reclassified to IIIB after assessment of color Doppler US findings. (a) Gray-scale transverse US scan shows two loops of bowel surrounded by free peritoneal fluid with low-level echoes. The loop in the far field has a markedly thinned wall (arrow), which is suggestive of severe ischemia. The typical gut appearance is no longer present. (b) Transverse color Doppler US scan demonstrates flow in the bowel loop in the near field, as depicted by the color Doppler signals (arrowhead). The loop in the far field (arrow), however, lacks evidence of perfusion. (c) Spectra from the loop in the far field in b help confirm the absence of arterial flow. (d) Spectra from the loop in the near field in b help confirm the presence of an arterial waveform. (e) Intraoperative photograph shows perforation sites (indicated by inserted metal probe) adjacent to multiple hyperemic loops in the lower part of the image; the bowel loops in the upper right part of the photograph have a normal appearance. (f) Microscopic image of perforation site shows considerable thinning of the bowel wall with necrosis (arrow). (Hematoxylin-eosin stain; original magnification, x10.)
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Figure 3f. NEC in a premature girl (gestational age, 33 weeks; corrected age, 34 weeks) with Bell stage IIB. The Bell stage was reclassified to IIIB after assessment of color Doppler US findings. (a) Gray-scale transverse US scan shows two loops of bowel surrounded by free peritoneal fluid with low-level echoes. The loop in the far field has a markedly thinned wall (arrow), which is suggestive of severe ischemia. The typical gut appearance is no longer present. (b) Transverse color Doppler US scan demonstrates flow in the bowel loop in the near field, as depicted by the color Doppler signals (arrowhead). The loop in the far field (arrow), however, lacks evidence of perfusion. (c) Spectra from the loop in the far field in b help confirm the absence of arterial flow. (d) Spectra from the loop in the near field in b help confirm the presence of an arterial waveform. (e) Intraoperative photograph shows perforation sites (indicated by inserted metal probe) adjacent to multiple hyperemic loops in the lower part of the image; the bowel loops in the upper right part of the photograph have a normal appearance. (f) Microscopic image of perforation site shows considerable thinning of the bowel wall with necrosis (arrow). (Hematoxylin-eosin stain; original magnification, x10.)
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Figure 4. NEC in a girl (gestational age, 26 weeks; corrected age, 31 weeks) with Bell stage IIIA. The Bell stage was reclassified to IIIB after assessment of color Doppler US findings. Transverse color Doppler US scan shows multiple loops of bowel with absent perfusion. Color Doppler signals in the lower part of the image indicate some perfusion in the larger distal mesenteric vessel.
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Copyright © 2005 by the Radiological Society of North America.
