Necrotizing Enterocolitis: Assessment of Bowel Viability with Color Doppler US

PURPOSE: To determine whether absence of bowel wall perfusion at color Doppler ultrasonography (US) is indicative of bowel necrosis in neonates with necrotizing enterocolitis (NEC).

MATERIALS AND METHODS: This study was approved by the research ethics board, and informed consent was obtained. Sixty-two neonates enrolled in the prospective study underwent US of the bowel wall. Neonates were divided into two groups. Group A included 30 control subjects with gestational ages (GAs) ranging from 24 to 41 weeks. Group B included 32 neonates with GAs ranging from 24 to 40 weeks who were clinically proved to have or suspected of having NEC. All neonates in group B underwent abdominal radiography. Normative values were calculated in group A. In group B, the sensitivities and specificities of color Doppler US and abdominal radiography for detection of bowel necrosis were computed by using the modified Bell staging criteria for NEC as the reference standard.

RESULTS: Two neonates were excluded from group B; thus, a total of 60 neonates were included in the study. In group A, bowel wall thickness ranged from 1.1 to 2.6 mm. Bowel wall perfusion was detected with color Doppler US in all 30 neonates. Color Doppler signals ranged from one to nine dots per square centimeter. Twenty-two of 30 neonates in group B received a diagnosis of NEC. Mild to moderate NEC was diagnosed in 12 neonates. Color Doppler US depicted an isolated segment of bowel-absent blood flow in two neonates; this finding was confirmed with laparotomy. In 10 neonates with severe NEC, color Doppler US depicted isolated or multiple segments of bowel with absent perfusion. Pneumoperitoneum was present in only four neonates. The remaining eight neonates at risk for NEC had no evidence of loops without perfusion at color Doppler US. The sensitivity of free air at abdominal radiography as a positive sign for severe NEC with necrotic bowel was 40% compared with the 100% sensitivity of absence of flow at color Doppler US (P = .03).

CONCLUSION: Color Doppler US is more accurate than abdominal radiography in depicting bowel necrosis in NEC.

© RSNA, 2005


  • 1 Buonomo C. The radiology of necrotizing enterocolitis. Radiol Clin North Am 1999; 37:1187-1198. Crossref, MedlineGoogle Scholar
  • 2 Berdon WE, Grossman H, Baker DH, Mizrahi A, Barlow O, Blanc WA. Necrotizing enterocolitis in premature infant. Radiology 1964; 83:879-887. LinkGoogle Scholar
  • 3 Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 1986; 33:179-201. Crossref, MedlineGoogle Scholar
  • 4 Ballance WA, Dahms BB, Shenker N, Kliegman RM. Pathology of neonatal necrotizing enterocolitis: a ten-year experience. J Pediatr 1990; 117:S6-S13. Crossref, MedlineGoogle Scholar
  • 5 Miller SF, Seibert JJ, Kinder DL, Wilson AR. Use of ultrasound in detection of occult bowel perforation in neonates. J Ultrasound Med 1993; 12:531-535. Crossref, MedlineGoogle Scholar
  • 6 Kodroff MB, Hartenburg MA, Goldschmidt RA. Ultrasonographic diagnosis of gangrenous bowel in neonatal necrotizing enterocolitis. Pediatr Radiol 1984; 14:168-170. Crossref, MedlineGoogle Scholar
  • 7 Kosloske AM, Papile L, Burnstein J. Indications for operation in acute necrotizing enterocolitis of the neonate. Surgery 1980; 87:502-508. MedlineGoogle Scholar
  • 8 Patel U, Leonidas JC, Furie D. Sonographic detection of necrotizing enterocolitis in infancy. J Ultrasound Med 1990; 9:673-675. Crossref, MedlineGoogle Scholar
  • 9 Bomelburg T, Von Lengerke HJ. Sonographic findings in infants with suspected necrotizing enterocolitis. Eur J Radiol 1992; 15:149-153. Crossref, MedlineGoogle Scholar
  • 10 Fotter R, Sorantin E. Diagnostic imaging in necrotizing enterocolitis. Acta Paediatr Suppl 1994; 396:41-44. MedlineGoogle Scholar
  • 11 Robberecht EA, Afschrift M, De Bel CE, et al. Sonographic demonstration of portal venous gas in necrotizing enterocolitis. Eur J Pediatr 1988; 147:192-194. Crossref, MedlineGoogle Scholar
  • 12 Lindley S, Mollitt DL, Seibert JJ, Golladay ES. Portal vein ultrasonography in the early diagnosis of necrotizing enterocolitis. J Pediatr Surg 1986; 21:530-532. Crossref, MedlineGoogle Scholar
  • 13 Schmidt H, Schramm A. The corroborative capacity and value of imaging diagnosis and duplex sonography in newborn infants with necrotizing enterocolitis. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 1994; 160:524-530. CrossrefGoogle Scholar
  • 14 Riccabona M, Joannou A, Maurer U, Muller W, Schwinger W. Doppler ultrasound in necrotizing enterocolitis. Z Geburtshilfe Perinatol 1993; 197:87-89. MedlineGoogle Scholar
  • 15 Deeg KH, Rupprecht T, Schmid E. Doppler sonographic detection of increased flow velocities in the celiac trunk and SMA in infants with necrotizing enterocolitis. Pediatr Radiol 1993; 23:578-582. Crossref, MedlineGoogle Scholar
  • 16 Danse EM, Van Beers BE, Jamart J, et al. Prognosis of ischemic colitis: comparison of color Doppler sonography with early clinical and laboratory findings. AJR Am J Roentgenol 2000; 175:1151-1154. Crossref, MedlineGoogle Scholar
  • 17 Jeffrey RB, Sommer G, Debatin JF. Color Doppler sonography of focal gastrointestinal lesions: initial clinical experience. J Ultrasound Med 1994; 13:473-478. Crossref, MedlineGoogle Scholar
  • 18 Teefey SA, Roarke MC, Brink JA, et al. Bowel wall thickening: differentiation of inflammation from ischemia with color Doppler and duplex US. Radiology 1996; 198:547-551. LinkGoogle Scholar
  • 19 Siegel MJ, Friedland JA, Hildebolt CF. Bowel wall thickening in children: differentiation with US. Radiology 1997; 203:631-635. LinkGoogle Scholar
  • 20 Spalinger J, Patriquin H, Miron MC, et al. Doppler US in patients with Crohn disease: vessel density in the diseased bowel reflects disease activity. Radiology 2000; 217:787-791. LinkGoogle Scholar
  • 21 Gonzalez-Crussi F, Hsueh W. Experimental model of ischemic bowel necrosis: the role of platelet-activating factor and endotoxin. Am J Pathol 1983; 112:127-135. MedlineGoogle Scholar
  • 22 Hsueh W, Caplan MS, Tan X, MacKendrick W, Gonzalez-Crussi F. Necrotizing enterocolitis of the newborn: pathogenetic concepts in perspective. Pediatr Dev Pathol 1998; 1:2-16. Crossref, MedlineGoogle Scholar

Article History

Published in print: May 2005