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  • 03/07/2018

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

Allan Felipe Fattori AlvesAna Luiza Menegatti PavanGuilherme Giacomini, Caio Cesar Quini, Sergio Marrone Ribeiro, Rozemeire Garcia Marquez, Maria Regina Bentlin, André Petean Trindade, José Ricardo de Arruda Miranda, Diana Rodrigues de Pina

Jornal de Pediatria, available online 3 July 2018



The objective of this study was to develop and validate a computational tool to assist radiological decisions on necrotizing enterocolitis.


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 histopathologicalanalysis. 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.


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.


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.