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A prospective comparison of intestinal sonography and abdominal radiographs in a neonatal intensive care unit

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Abstract

Background

No study reported in the literature comprehensively compares findings on neonatal abdominal radiographs with sonography.

Objective

To compare the findings on abdominal radiographs and sonograms in infants in intensive care, to better understand how the various intestinal gas patterns on radiographs relate to the spectrum of appearances on sonography and, second, to evaluate the ability of sonography to differentiate necrotizing enterocolitis from other intestinal pathology.

Materials and methods

We prospectively evaluated sonograms and radiographs, blinded to the other modality and to clinical information. Patients’ charts were reviewed by a third blinded reader and used as a reference standard for diagnosis. We made associations between sonographic findings, radiographic intestinal gas patterns and clinical diagnoses.

Results

We included 75 infants with gestational ages between 23 weeks and 41 weeks. Sonographic abnormalities were present in infants with all radiographic intestinal gas patterns, including normal patterns. We only saw absent intestinal perfusion and fluid collections on sonography (suggesting intestinal necrosis and sealed perforation) in infants with intestinal dilatation with elongation on radiographs. Separation of intestinal loops on radiographs was most commonly caused by reasons other than intestinal wall thickening. Increased intestinal echogenicity or free fluid with echoes on sonography correlated with a diagnosis of necrotizing enterocolitis, whereas anechoic free fluid correlated with absence of necrotizing enterocolitis.

Conclusion

Sonography is complementary to radiographs in infants with suspected intestinal pathology, with a spectrum of appearances seen on each modality. Some sonographic findings either strongly suggest necrotizing enterocolitis or supply evidence against this diagnosis.

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Conflicts of interest

None.

Author information

Author notes

  1. Cicero T. Silva

    Present address: Yale University School of Medicine, New Haven, CT, USA

  2. Daniel Levine

    Present address: The Royal Marsden NHS Foundation Trust, London, UK

Authors and Affiliations

  1. Department of Diagnostic Imaging, The University of Toronto, The Hospital for Sick Children, 555 University Ave., Toronto, Canada, M5G1X8

    Cicero T. Silva, Alan Daneman, Oscar M. Navarro & Daniel Levine

  2. Department of Family and Community Medicine, The University of Toronto, The Hospital for Sick Children, Toronto, Canada

    Rahim Moineddin

  3. Department of Pediatrics, The University of Toronto, The Hospital for Sick Children, Toronto, Canada

    Aideen M. Moore

Authors
  1. Cicero T. Silva
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  2. Alan Daneman
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  3. Oscar M. Navarro
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  4. Rahim Moineddin
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  5. Daniel Levine
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  6. Aideen M. Moore
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Corresponding author

Correspondence to Alan Daneman.

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Silva, C.T., Daneman, A., Navarro, O.M. et al. A prospective comparison of intestinal sonography and abdominal radiographs in a neonatal intensive care unit. Pediatr Radiol 43, 1453–1463 (2013). https://doi.org/10.1007/s00247-013-2777-z

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  • DOI: https://doi.org/10.1007/s00247-013-2777-z

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