Prospective evaluation of radionuclide scanning in detection of intestinal necrosis in neonatal necrotizing enterocolitis.
The ability of external imaging to demonstrate intestinal infarction in neonatal necrotizing enterocolitis (NEC) was prospectively evaluated. The radiopharmaceutical technetium--99m diphosphonate was injected intravenously and the patients subsequently underwent abdominal scanning. Clinical patient care and interpretation of the images were entirely independent throughout the study. Of 33 studies, 7 were positive, 4 were suspicious, and 22 were negative. One false positive study detected ischemia without transmural infarction. The second false positive scan occurred postoperatively and was due to misinterpretation of the hyperactivity along the surgical incision. None of the suspicious cases had damaged bowel. The two false negative studies clearly failed to demonstrate frank intestinal necrosis. The presence of very small areas of infarction, errors in technical settings, subjective interpretation of scans and delayed clearance of the radionuclide in a critically ill neonate may all limit the accuracy of external abdominal scanning. However, in spite of an error rate of 12%, it is likely that this technique will enhance the present clinical, laboratory, and radiologic parameters of patient management in NEC.
D002986:Clinical Trials as Topic; D003951:Diagnostic Errors; D004164:Diphosphonates; D004311:Double-Blind Method; D004761:Enterocolitis, Pseudomembranous / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000000981:diagnostic imaging*; D007422:Intestines / Q000473:pathology; D009336:Necrosis / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011877:Radionuclide Imaging; D013667:Technetium; D017556:Technetium Compounds
D004164:Diphosphonates; D017556:Technetium Compounds; D013667:Technetium; C029045:technetium Tc 99m diphosphonate