Monica Epelman

Correlation of sonographic findings and outcome in necrotizing enterocolitis

BackgroundThere is little in the literature regarding the use of gray-scale and Doppler sonography of the bowel in necrotizing enterocolitis (NEC) and how findings depicted by this modality might assist in predicting outcome and influence management.ObjectiveTo correlate sonographic findings with outcome in NEC.Materials and methodsThis was a retrospective analysis of clinical and abdominal ultrasonography (AUS) findings in NEC from January 2003 to December 2005. AUS findings were evaluated for portal venous gas, free gas, peritoneal fluid, bowel wall thickness, echogenicity, perfusion and intramural gas. Patients were categorized into two groups, according to their outcome.ResultsA total of 40 infants were identified who had AUS for NEC prior to any surgical intervention. Group A comprised 18 neonates treated medically and recovered fully, and group B comprised 22 neonates who required surgery or died. Free gas (six patients) and focal fluid collections (three patients) were only found in group B. Increased bowel wall echogenicity, absent bowel perfusion, portal venous gas, bowel wall thinning, bowel wall thickening, free fluid with echoes and intramural gas were seen in both groups, but more frequently in group B. Anechoic free fluid was seen more frequently in group A. Increased bowel perfusion was seen equally in both groups.ConclusionAn adverse outcome was associated with the sonographic findings of free gas, focal fluid collections or three or more of the following: increased bowel wall echogenicity, absent bowel perfusion, portal venous gas, bowel wall thinning, bowel wall thickening, free fluid with echoes and intramural gas. Sonographic findings are useful in predicting outcome and therefore might help guide management.

Imaging of the brain in full-term neonates: does sonography still play a role?

To date the literature comparing the usefulness of US and MR examinations of the neonatal brain suggests that US is not as effective a modality as MR. However, available studies were done on older equipment and published descriptions of the abnormalities found in the term brain are often incomplete. The purpose of this article is to emphasize technical factors that may be useful to optimize US imaging of the term neonatal brain, to provide a description of the sonographic findings in the brain in full-term neonates with hypoxic–ischaemic injury and to provide some data regarding the accuracy of sonography. While MR imaging may reveal abnormalities of the brain more floridly than sonography, we believe that sonography remains an extremely useful modality for evaluation of the full-term neonatal brain and it is probably a more accurate modality in this age group than the current literature suggests. Further prospective studies comparing sonographic and MR imaging findings are required to document the accuracy of sonography better and to help us define the role of this modality better. Such studies may help us select which patients really require MR imaging.

Imaging of the Newborn: Imaging of the Newborn

Preface 1. Introduction to the principles of the radiological investigation of the neonate Sara B. DeMauro, John Mernagh, Monica Epelman and Haresh Kirpalani 2. Evidence based use of diagnostic imaging: reliability and validity Sara B. DeMauro and Haresh Kirpalani 3. The chest David Munson, Monica Epelman, David Millar and Haresh Kirpalani 4. Neonatal congenital heart disease Jeffrey C. Hellinger and Mary M. K. Seshia 5. Special considerations for neonatal ECMO Maria Fraga, James Connolly, Holly Hedrick and Natalie Rintoul 6. The central nervous system Hiten Mehta, Monica Epelman, Claire Miller, John Mernagh and Elaine Boyle 7. The gastrointestinal tract Garry Inglis, Michael A. Posencheg, John Mernagh and David Cartwright 8. The kidney Kevin Meyers and Monica Epelman 9. Some principles of in utero and postnatal formation of the skeleton Martin Reed, Saima Aftab and Anne Ades 10. Metabolic diseases Xing-Chang Wei and Aneal Khan 11. Catheters and tubes David Cartwright and Garry Inglis 12. Routine prenatal screening during pregnancy Eileen Y. Wang, John Mernagh and Michael A. Posencheg 13. Antenatal diagnosis of selected defects Michael A. Posencheg and Eileen Wang Index.