title: Sonographic and radiographic imaging features of the neonate with necrotizing enterocolitis: correlating findings with outcomes.
abstract: BACKGROUND
  Abdominal radiography is the reference standard in imaging neonates with necrotizing enterocolitis (NEC); however, ultrasound of the abdomen including bowel may be of value in this setting.
  
  
  OBJECTIVE
  To correlate sonographic and radiographic findings with patient outcomes in NEC.
  
  
  METHODS
  We reviewed sonographic and radiographic exams, as well as clinical, pathological and laboratory records. Ultrasound images were reviewed for free intraperitoneal gas, peritoneal fluid, pneumatosis intestinalis, portal gas, bowel vascularity, bowel wall thickness and echogenicity, peristalsis and the presence of dilated bowel with anechoic contents. Contemporaneously acquired radiographs were reviewed for intraperitoneal gas, pneumatosis intestinalis, portal gas, the sentinel loop sign and gas pattern. Patients were categorized into two groups based on clinical outcome.
  
  
  RESULTS
  Forty-four neonates receiving 55 sonograms were included. Focal fluid collections, echogenic free fluid, increased bowel wall echogenicity and increased bowel wall thickness were statistically significant in predicting an unfavorable outcome. Other features approached significance in predicting poor outcomes: free peritoneal gas, pneumatosis intestinalis, aperistalsis, bowel wall thinning and absent bowel perfusion. Anechoic free peritoneal fluid predicted a good outcome. The sentinel loop sign on radiographs predicted an unfavorable outcome.
  
  
  CONCLUSIONS
  Abdominal sonography and radiography in patients with NEC can help prognosticate the outcome.
authors.affiliation: Department of Radiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA, karl.muchantef@mail.mcgill.ca.
authors.forename: Karl
authors.initials: K
authors.lastname: Muchantef
authors.forename: Monica
authors.initials: M
authors.lastname: Epelman
authors.forename: Kassa
authors.initials: K
authors.lastname: Darge
authors.forename: Haresh
authors.initials: H
authors.lastname: Kirpalani
authors.forename: Pablo
authors.initials: P
authors.lastname: Laje
authors.forename: Sudha A
authors.initials: SA
authors.lastname: Anupindi
mesh_terms: D020345:Enterocolitis, Necrotizing / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D018608:Ultrasonography, Doppler / Q000379:methods*