American Journal of Roentgenology, Vol 154, 779-783, Copyright © 1990 by American Roentgen Ray Society
Diagnostic quality of portable abdominal radiographs in neonates with necrotizing enterocolitis: digitized vs nondigitized images
GW qross, SM Ehrlich and Y Wang
Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107.
Digital manipulation of radiographic images has prompted significant
interest because of the potential for improving image quality and
diagnostic accuracy. We compared conventional and digital radiographs in
the evaluation of neonatal necrotizing enterocolitis (NEC). Fifty abdominal
radiographs in neonates with suspected or autopsy-confirmed NEC and 50
similar radiographs of neonates without suspicion of NEC were digitized.
Definition of intraabdominal anatomy was optimized by window width and
level adjustment. Hard-copy radiographs of the digitally manipulated images
were then produced by a laser printer. Twelve general radiologists each
evaluated, without benefit of clinical information, a random mixture of 50
cases of NEC and normal controls, with both conventional and digital images
for each case, for a total of 100 radiographs reviewed. Each image was
evaluated for overall suspicion of NEC and the presence and severity of six
radiographic signs of NEC. The radiologists also rated their confidence in
their assessments. The results were compared with those from a similar
analysis by an experienced pediatric radiologist to ensure validity of
image evaluation. No statistically significant differences were found
between the conventional and digital imaging formats for the assessment of
the signs of NEC (p = .15) or for determination of the overall suspicion of
NEC (p = .07). Our results show the digitized and the conventional,
nondigitized radiographs to be at least equally useful for evaluating the
radiographic signs of NEC and suggesting an appropriate diagnosis.
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