Prospective evaluation of radionuclide scanning in detection of intestinal necrosis in neonatal necrotizing enterocolitis

• Published in: Journal of pediatric surgery Vol. 16; no. 3; pp. 241 - 245
• Main Authors: Haase, Gerald M., Sfakianakis, George N., Lobe, Thom E., Thomas Boles, E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.1981
• Subjects: Clinical Trials as Topic; Diagnostic Errors; Diphosphonates; Double-Blind Method; Enterocolitis, Pseudomembranous - diagnostic imaging; Enterocolitis, Pseudomembranous - pathology; Humans; Infant, Newborn; Infant, Newborn, Diseases - diagnostic imaging; Intestinal infarction (necrosis); Intestines - pathology; Necrosis - diagnostic imaging; neonatal necrotizing enterocolitis; Prospective Studies; radionuclide abdominal scanning; Radionuclide Imaging; Technetium; Technetium Compounds; neonatal necrotizing enterocolitis; Intestinal infarction (necrosis); radionuclide abdominal scanning
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/S0022-3468(81)80672-0

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.