Diagnostic quality of portable abdominal radiographs in neonates with necrotizing enterocolitis: digitized vs nondigitized images.

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.