Radiographic predictors determined with an objective assessment tool for neonatal patients with necrotizing enterocolitis.

OBJECTIVE: The objective of this study was to develop and validate a computational tool to assist radiological decisions on necrotizing enterocolitis. METHODOLOGY: Patients that exhibited clinical signs and radiographic evidence of Bell's stage 2 or higher were included in the study, resulting in 64 exams. The tool was used to classify localized bowel wall thickening and intestinal pneumatosis using full-width at half-maximum measurements and texture analyses based on wavelet energy decomposition. Radiological findings of suspicious bowel wall thickening and intestinal pneumatosis loops were confirmed by both patient surgery and histopathological analysis. Two experienced radiologists selected an involved bowel and a normal bowel in the same radiography. The full-width at half-maximum and wavelet-based texture feature were then calculated and compared using the Mann-Whitney U test. Specificity, sensibility, positive and negative predictive values were calculated. RESULTS: The full-width at half-maximum results were significantly different between normal and distended loops (median of 10.30 and 15.13, respectively). Horizontal, vertical, and diagonal wavelet energy measurements were evaluated at eight levels of decomposition. Levels 7 and 8 in the horizontal direction presented significant differences. For level 7, median was 0.034 and 0.088 for normal and intestinal pneumatosis groups, respectively, and for level 8 median was 0.19 and 0.34, respectively. CONCLUSIONS: The developed tool could detect differences in radiographic findings of bowel wall thickening and IP that are difficult to diagnose, demonstrating the its potential in clinical routine. The tool that was developed in the present study may help physicians to investigate suspicious bowel loops, thereby considerably improving diagnosis and clinical decisions.

ABDOMEN-PELVIS COMPUTED TOMOGRAPHY PROTOCOL OPTIMIZATION: AN IMAGE QUALITY AND DOSE ASSESSMENT.

Computed tomography (CT) has a high level of sensitivity and specificity for the diagnosis and follow-up of pathologies of the abdomen-pelvis region. Some features, such as automatic tube current modulation (ATCM), permits the acquisition of quality images with low radiation doses. This study evaluated the image quality and radiation dose of abdomen-pelvis CT protocols with ATCM technique. Were performed five CT protocols using 16-slice and 64-slice scanners, an anthropomorphic phantom for dosimetric measurements, an analytical phantom and retrospective examinations for image quality analysis. Were found significant reduction in effective dose. The highest absorbed doses were found in the stomach and spleen (56.1 and 47.2 mGy, respectively). Objective parameters as noise, low contrast and spatial resolution did not significantly differ between the protocols (p > 0.05). All protocols received the range of 'Optimum/Acceptable' in patient's image quality analysis. This methodology can be reproduced in any clinical routine to optimize CT protocols.