Agreement and reproducibility of radiological signs in NEC using The Duke Abdominal Assessment Scale (DAAS)

Markiet, Karolina; Szymańska-Dubowik, Anna; Jańczewska, Iwona; Domazalska-Popadiuk, Iwona; Zawadzka-Kepczynska, Anna; Bianek-Bodzak, Agnieszka

doi:10.1007/s00383-016-4022-y

Cited by 26 publications

(11 citation statements)

References 25 publications

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“…The early and correct diagnosis of NEC is of utmost importance. According to the literature, bowel dilatation is present in 75-90% of cases in initial NEC, and focal or separated dilatation reflects more-advanced disease [13]. In our study, generalized intestinal dilatation was observed in 55.45% of neonates in Stage 1 and 2.…”

Section: Discussionsupporting

confidence: 61%

Short-term Outcome of Low Birth Weight Preterm Infants with Necrotizing Enterocolitis: A Prospective Cohort Study

Pan¹

2018

J Neonat Surg

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Aim: The purpose of this study was to analyze the nature of the disease, the surgical procedures, complications, and survival of preterm infants with necrotizing enterocolitis (NEC) from two tertiary care referral neonatal intensive units in central India.Materials and Methods: A prospective study of a cohort of 110 preterm neonates with gestational age less than 36 weeks and weight less than 1600 g infants diagnosed to have NEC were followed for 90 days. All the neonates were born between January 2015 and December 2017 and treated at two neonatal intensive care units. Infants with sepsis, congenital gastrointestinal anomalies, major cardiac problems, and intraventricular hemorrhage were excluded.Results: Mean gestational age in this cohort was 32.40 ± 3.87 weeks, and the mean age of NEC onset was 13.04 ± 3.54 postnatal days. There were 39 neonates with Stage 1, 45 with Stage 2, and 26 with stage 3 NEC. Pneumoperitoneum, positive paracentesis and progressive clinical deterioration were the indications for laparotomy. The most common complications were sepsis 97/110 (88.18%). Post-operative complications occurred in 22 (84.61%) infants, wound infection in 19 (73.07%), intestinal stricture in 9 (34.61%), wound dehiscence in 7 (26.92%), stoma stenosis in 3 (11.53%), ileostomy prolapse in 2 (7.69%), and burst abdomen in 1 (3.84 %). The overall 90-day survival rate was 87.27% (96/110), and the post-operative survival rate was 46.15% (12/26). The age of gestation, weight, and extent of the disease were the main risk factor for mortality.Conclusion: The short-term outcomes for Stage 3 NEC were associated with high morbidity and mortality. The outlook for infants with Stage 1 and 2 NEC was favorable.

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Section: Discussionsupporting

confidence: 61%

Short-term Outcome of Low Birth Weight Preterm Infants with Necrotizing Enterocolitis: A Prospective Cohort Study

Pan¹

2018

J Neonat Surg

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“…AR in two projections and US was recommended for diagnosis in all cases, followed by repeated examinations at 4-6-h intervals, or at least daily, with supine and left lateral decubitus films each time and repeated ultrasounds every 12 to 24 h [24]. Details of radiographic patterns, analysed already in 1979 to identify early signs of NEC [18], were later systematised in the Duke Abdominal Assessment Scale (DAAS) [25–27]. …”

Section: Introductionmentioning

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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“…Imaging reporting remains a challenge, as nonspecific results do not exclude the presence of NEC [27]. Various studies [28], [29], highlights the low agreement and reproducibility in the consistency of reporting of AR signs among clinicians and also among different professional groups. CAD can offer a solution in both training and improving inter-expert agreement in radiological reports.…”

Section: Need For Cam In Neonatal Radiologymentioning

confidence: 99%

A Deep Learning Based Suggested Model to Detect Necrotising Enterocolitis in Abdominal Radiography Images

Druten

Sharif

Chan

et al. 2019

2019 International Conference on Computing, Electronics &Amp; Communications Engineering (iCCECE)

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Despite decades of exploration into necrotising enterocolitis (NEC), we still lack the capacity to accurately diagnose the disease to improve outcomes in its management. Existing diagnostics struggle to delineate NEC from other neonatal intestinal diseases; it is also unable to highlight those likely to deteriorate to needing emergency life-saving surgery before it is too late. The diagnosis of NEC is heavily dependent on interpretation of radiological findings, especially abdominal radiography (AR) and abdominal ultrasound (AUS). Interexpert variability in interpreting AR imaging, and in the case of AUS, performing and interpreting the test, remains an unresolved challenge. With the compounding impact of the shrinking radiology workforce, a novel approach is imperative. Computer assisted detection (CAD) and classification of abnormal pathology in medical imaging is a rapidly evolving field of clinical and biomedical research. This technology is widely used as a preliminary screening tool. This research paper proposes a deep learning-based model to classify AR images in an automated manner, generating class activation maps (CAM) from various imaging features consistent with NEC pathology, as agreed by expert consensus papers (in neonatology and paediatric radiology). It also compares it with conventional machine learning methods. The suggested model aims to produce heatmaps for various imaging features to highlight NEC pathology in AR (or in future AUS). Once the model is trained, validation is done through quantitative measures and visually by the attending radiologist (clinician) reviewing the validity of the colour maps highlighting the pathology of the AR image (future extension to AUS). As the volume of imaging data is increasing year by year, CAD can be a key strategy to assist radiology departments meet service needs. This technology can greatly assist in screening for NEC, improving the detection of NEC and potentially aid in the earlier identification of disease. Furthermore, it can fast track research cost effectively by creating big data through the automatic labeling of imaging data to create big-data for NEC databases.

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Agreement and reproducibility of radiological signs in NEC using The Duke Abdominal Assessment Scale (DAAS)

Cited by 26 publications

References 25 publications

Short-term Outcome of Low Birth Weight Preterm Infants with Necrotizing Enterocolitis: A Prospective Cohort Study

Short-term Outcome of Low Birth Weight Preterm Infants with Necrotizing Enterocolitis: A Prospective Cohort Study

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

A Deep Learning Based Suggested Model to Detect Necrotising Enterocolitis in Abdominal Radiography Images

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