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

Abstract

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.

Portal venous gas by ultrasound in advance of impending necrotizing enterocolitis of a very low birth weight infant

“…And the advantage on diagnosis, classification, assessment of complications such as intestinal stenosis and the need for surgical treatment has been verified by Garbi‐Goutel et al To date, it is widely accepted that ultrasound combined with X‐ray should be applied in the early onset of NEC . Questionnaire survey conducted in Germany in 2018 shows that 58% stated that ultrasound was used for NEC at their hospitals …”

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

“…In a recent multi-specialist survey, Ahle et al 2018 [22], 202 clinicians had a 90% agreement that abdominal radiography (AR) is the first-line imaging modality and it contains the most clinically recognised features signs to identify NEC. There was a resounding agreement on the importance of AR biomarkers in diagnosing, monitoring and guideline decisions on surgery.…”

Soap bubble appearance: an ominous sign

“…Necrotising enterocolitis continues to have significant morbidity and mortality in premature neonates. Its overall incidence is 1 in 1000 but is as high as 20% in preterm neonates with birth weight <1500 g 1. The incidence is inversely proportional to gestational age with 90% occurring in preterm neonates.…”

“…It may occur in first 2–3 days of life with 90% occurring within the first 10 days 2. If necrotising enterocolitis is suspected and there is a doubt in the supine, abdominal radiograph, then a cross-table lateral or a lateral decubitus film is recommended 1. The index case demonstrated the classical soap bubble pattern of gas distribution seen in necrotising enterocolitis.…”