{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T08:01:00Z","timestamp":1784707260140,"version":"3.55.0"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"1184","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the ability of abdominal radiographs-based radiomics features to predict surgical risk and timing in neonates with necrotizing enterocolitis (NEC), providing an objective basis for clinical decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort of 262 NEC patients (2016-2022) was divided into surgery and nonsurgery groups. Radiomics features were extracted from abdominal radiographs at NEC diagnosis using LASSO and Cox regression to generate a radiomics risk score (Riskscore). The cohort was split into training (n\u2009=\u2009184, 42 surgical cases) and test sets (n\u2009=\u200978, 18 surgical cases). Kaplan\u2013Meier survival curves and Cox proportional hazards models were used to assess surgical risk. A nomogram with AUC was developed to predict surgical exemption over 1-7\u2009weeks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The surgical group had lower gestational age and birth weight (P\u2009&amp;lt;\u2009.001). Significant differences in survival curves were seen between high- and low-risk groups in both sets (P\u2009&amp;lt;\u2009.001, P\u2009=\u2009.0047). Riskscore was a significant factor for surgical interventions (P\u2009&amp;lt;\u2009.05). The nomogram model showed good performance, with AUCs of 0.716-0.744 in the training set and 0.668-0.733 in the test set.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Abdominal radiographs-based radiomics feature analysis shows potential as a valuable tool for predicting surgical risk and timing in NEC patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Advances in knowledge<\/jats:title>\n                    <jats:p>This study is the first to assess abdominal radiographs\u2019 value in predicting surgical risk and timing for NEC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjr\/tqag113","type":"journal-article","created":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T13:31:25Z","timestamp":1779024685000},"page":"1624-1633","source":"Crossref","is-referenced-by-count":0,"title":["Cox regression model for predicting the surgical risk and timing of necrotizing enterocolitis based on abdominal radiographs radiomics features"],"prefix":"10.1093","volume":"99","author":[{"given":"Chaogang","family":"Lu","sequence":"first","affiliation":[{"name":"Department of Radiology, Huashan Hospital, Fudan University , Shanghai, 200040,","place":["China"]},{"name":"Department of Radiology, Children's Hospital of Fudan University , Shanghai, 201102,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingshu","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Children's Hospital of Fudan University , Shanghai, 201102,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinghao","family":"Zhu","sequence":"additional","affiliation":[{"name":"Institute of Artificial Intelligence, Beihang University , Beijing, 100191,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siqi","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Radiology, Children's Hospital of Fudan University , Shanghai, 201102,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaqin","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Radiology, Children's Hospital of Fudan University , Shanghai, 201102,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laishuan","family":"Wang","sequence":"additional","affiliation":[{"name":"National Health Commission Key Laboratory of Neonatal Diseases, Department of Neonatology, Children's Hospital of Fudan University , Shanghai, 201102,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1960-2071","authenticated-orcid":false,"given":"Mei","family":"Bai","sequence":"additional","affiliation":[{"name":"Department of Radiology, Children's Hospital of Fudan University , Shanghai, 201102,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongwei","family":"Qiao","sequence":"additional","affiliation":[{"name":"Department of Radiology, Children's Hospital of Fudan University , Shanghai, 201102,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"2026072203070749500_tqag113-B1","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1001\/jama.2021.23580","article-title":"Mortality, in-hospital morbidity, care practices, and 2-year outcomes for extremely preterm infants in the US, 2013-2018","volume":"327","author":"Bell","year":"2022","journal-title":"JAMA"},{"key":"2026072203070749500_tqag113-B2","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1056\/NEJMra1005408","article-title":"Necrotizing enterocolitis","volume":"364","author":"Neu","year":"2011","journal-title":"N Engl J Med"},{"key":"2026072203070749500_tqag113-B3","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/j.jpeds.2019.11.011","article-title":"Contemporary outcomes for infants with necrotizing enterocolitis\u2014a systematic review","volume":"220","author":"Jones","year":"2020","journal-title":"J Pediatr"},{"key":"2026072203070749500_tqag113-B4","doi-asserted-by":"publisher","first-page":"1072","DOI":"10.1016\/j.jpedsurg.2009.02.013","article-title":"Mortality of necrotizing enterocolitis expressed by birth weight categories","volume":"44","author":"Fitzgibbons","year":"2009","journal-title":"J Pediatr Surg"},{"key":"2026072203070749500_tqag113-B5","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1038\/s41372-020-00880-z","article-title":"Delay in achieving enteral autonomy and growth outcomes in very low birth weight infants with surgical necrotizing enterocolitis","volume":"41","author":"McNelis","year":"2021","journal-title":"J Perinatol"},{"key":"2026072203070749500_tqag113-B6","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1007\/s00383-022-05283-z","article-title":"Effect of time of diagnosis to surgery on outcome, including long-term neurodevelopmental outcome, in necrotizing enterocolitis","volume":"39","author":"Duric","year":"2022","journal-title":"Pediatr Surg Int"},{"key":"2026072203070749500_tqag113-B7","doi-asserted-by":"publisher","first-page":"190","DOI":"10.2214\/AJR.07.3558","article-title":"Radiologists\u2019 agreement when using a 10-point scale to report abdominal radiographic findings of necrotizing enterocolitis in neonates and infants","volume":"191","author":"Coursey","year":"2008","journal-title":"AJR Am J Roentgenol"},{"key":"2026072203070749500_tqag113-B8","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1148\/radiol.2015151169","article-title":"Radiomics: images are more than pictures, they are data","volume":"278","author":"Gillies","year":"2016","journal-title":"Radiology"},{"key":"2026072203070749500_tqag113-B9","doi-asserted-by":"crossref","first-page":"488","DOI":"10.2967\/jnumed.118.222893","article-title":"Introduction to radiomics","volume":"61","author":"Mayerhoefer","year":"2020","journal-title":"J Nucl Med"},{"key":"2026072203070749500_tqag113-B10","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1038\/nrclinonc.2017.141","article-title":"Radiomics: the bridge between medical imaging and personalized medicine","volume":"14","author":"Lambin","year":"2017","journal-title":"Nat Rev Clin Oncol"},{"key":"2026072203070749500_tqag113-B11","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1002\/med.21846","article-title":"A review in radiomics: making personalized medicine a reality via routine imaging","volume":"42","author":"Guiot","year":"2022","journal-title":"Med Res Rev"},{"key":"2026072203070749500_tqag113-B12","doi-asserted-by":"publisher","first-page":"972","DOI":"10.17305\/bjbms.2022.7046","article-title":"An improved joint non-negative matrix factorization for identifying surgical treatment timing of neonatal necrotizing enterocolitis","volume":"22","author":"Qi","year":"2022","journal-title":"Bosn J of Basic Med Sci"},{"key":"2026072203070749500_tqag113-B13","doi-asserted-by":"publisher","first-page":"51050","DOI":"10.1109\/ACCESS.2021.3069191","article-title":"Multimodal AI system for the rapid diagnosis and surgical prediction of necrotizing enterocolitis","volume":"9","author":"Gao","year":"2021","journal-title":"IEEE Access"},{"key":"2026072203070749500_tqag113-B14","doi-asserted-by":"publisher","first-page":"1020","DOI":"10.1007\/s00261-023-04157-9","article-title":"Surgical prediction of neonatal necrotizing enterocolitis based on radiomics and clinical information","volume":"49","author":"Li","year":"2024","journal-title":"Abdom Radiol (NY)"},{"key":"2026072203070749500_tqag113-B15","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/S0031-3955(16)34975-6","article-title":"Necrotizing enterocolitis: treatment based on staging criteria","volume":"33","author":"Walsh","year":"1986","journal-title":"Pediatr Clin North Am"},{"key":"2026072203070749500_tqag113-B16","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1038\/s41390-024-03292-3","article-title":"Methods of identifying surgical necrotizing enterocolitis\u2014a systematic review and meta-analysis","volume":"97","author":"Bethell","year":"2025","journal-title":"Pediatr Res"},{"key":"2026072203070749500_tqag113-B17","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.1016\/j.mri.2012.05.001","article-title":"3D Slicer as an image computing platform for the quantitative imaging network","volume":"30","author":"Fedorov","year":"2012","journal-title":"Magn Reson Imaging"},{"key":"2026072203070749500_tqag113-B18","doi-asserted-by":"publisher","first-page":"e0237587","DOI":"10.1371\/journal.pone.0237587","article-title":"FeAture Explorer (FAE): a tool for developing and comparing radiomics models","volume":"15","author":"Song","year":"2020","journal-title":"PLoS One"},{"key":"2026072203070749500_tqag113-B19","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1148\/radiol.2020191145","article-title":"The image biomarker standardization initiative: standardized quantitative radiomics for high-throughput image-based phenotyping","volume":"295","author":"Zwanenburg","year":"2020","journal-title":"Radiology."},{"key":"2026072203070749500_tqag113-B20","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1186\/s12911-024-02695-w","article-title":"A time series algorithm to predict surgery in neonatal necrotizing enterocolitis","volume":"24","author":"Cui","year":"2024","journal-title":"BMC Med Inform Decis Mak"},{"key":"2026072203070749500_tqag113-B21","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1542\/pir.2017-0002","article-title":"Necrotizing enterocolitis","volume":"38","author":"Rich","year":"2017","journal-title":"Pediatr Rev"},{"key":"2026072203070749500_tqag113-B22","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1186\/s13052-018-0528-3","article-title":"Current status of laboratory and imaging diagnosis of neonatal necrotizing enterocolitis","volume":"44","author":"D\u2019Angelo","year":"2018","journal-title":"Ital J Pediatr"},{"key":"2026072203070749500_tqag113-B23","doi-asserted-by":"publisher","first-page":"CD001241","DOI":"10.1002\/14651858.CD001241.pub8","article-title":"Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants","volume":"8","author":"Oddie","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"2026072203070749500_tqag113-B24","doi-asserted-by":"publisher","first-page":"1229850","DOI":"10.3389\/fped.2023.1229850","article-title":"Recent advances in our understanding of NEC diagnosis, prognosis and surgical approach","volume":"11","author":"Bethell","year":"2023","journal-title":"Front Pediatr"},{"key":"2026072203070749500_tqag113-B25","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1097\/ANC.0000000000000063","article-title":"Prevention and early recognition of necrotizing enterocolitis: a tale of 2 tools\u2014eNEC and GutCheck: NEC","volume":"14","author":"Gephart","year":"2014","journal-title":"Adv Neonatal Care"},{"key":"2026072203070749500_tqag113-B26","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1038\/jp.2014.37","article-title":"Discrimination of GutCheckNEC: a clinical risk index for necrotizing enterocolitis","volume":"34","author":"Gephart","year":"2014","journal-title":"J Perinatol"},{"key":"2026072203070749500_tqag113-B27","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1056\/NEJMoa1605566","article-title":"Survival and neurodevelopmental outcomes among periviable infants","volume":"376","author":"Younge","year":"2017","journal-title":"N Engl J Med"},{"key":"2026072203070749500_tqag113-B28","doi-asserted-by":"crossref","first-page":"1079894","DOI":"10.3389\/fped.2022.1079894","article-title":"Risk factors for necrotizing enterocolitis in neonates: a meta-analysis","volume":"10","author":"Su","year":"2023","journal-title":"Front Pediatr"},{"key":"2026072203070749500_tqag113-B29","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1111\/1552-6909.12032","article-title":"Expert consensus building using e-Delphi for necrotizing enterocolitis risk assessment","volume":"42","author":"Gephart","year":"2013","journal-title":"J Obstet Gynecol Neonatal Nurs"},{"key":"2026072203070749500_tqag113-B30","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1001\/jama.2015.10244","article-title":"Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993\u20132012","volume":"314","author":"Stoll","year":"2015","journal-title":"JAMA"},{"key":"2026072203070749500_tqag113-B31","doi-asserted-by":"publisher","first-page":"e001583","DOI":"10.1136\/bmjpo-2022-001583","article-title":"Outcomes for necrotising enterocolitis (NEC) in babies born at the threshold of viability: a case\u2013control study","volume":"6","author":"Vallant","year":"2022","journal-title":"BMJ Paediatr Open"},{"key":"2026072203070749500_tqag113-B32","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1055\/s-0034-1543984","article-title":"Early detection tool of intestinal dysfunction: impact on necrotizing enterocolitis severity","volume":"32","author":"Fox","year":"2015","journal-title":"Amer J Perinatol"},{"key":"2026072203070749500_tqag113-B33","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1001\/jamapediatrics.2016.3633","article-title":"Development of a gestational age\u2013specific case definition for neonatal necrotizing enterocolitis","volume":"171","author":"Battersby","year":"2017","journal-title":"JAMA Pediatr"},{"key":"2026072203070749500_tqag113-B34","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s12887-021-02973-w","article-title":"Predictive factors for the surgical treatment of necrotizing enterocolitis in preterm infants: a single-center retrospective study","volume":"22","author":"Liu","year":"2022","journal-title":"BMC Pediatr"},{"key":"2026072203070749500_tqag113-B35","doi-asserted-by":"publisher","first-page":"1148","DOI":"10.1016\/j.jamcollsurg.2013.11.015","article-title":"Mortality and management of surgical necrotizing enterocolitis in very low birth weight neonates: a prospective cohort study","volume":"218","author":"Hull","year":"2014","journal-title":"J Am Coll Surg"},{"key":"2026072203070749500_tqag113-B36","doi-asserted-by":"publisher","first-page":"1490","DOI":"10.3390\/antiox10091490","article-title":"Male disadvantage in oxidative stress-associated complications of prematurity: a systematic review, meta-analysis and meta-regression","volume":"10","author":"Westering-Kroon","year":"2021","journal-title":"Antioxidants"},{"key":"2026072203070749500_tqag113-B37","doi-asserted-by":"publisher","first-page":"2945","DOI":"10.1089\/ars.2009.2671","article-title":"Antenatal steroids and antioxidant enzyme activity in preterm infants: influence of gender and timing","volume":"11","author":"Vento","year":"2009","journal-title":"Antioxid Redox Signal"},{"key":"2026072203070749500_tqag113-B38","doi-asserted-by":"publisher","first-page":"2743","DOI":"10.1007\/s00431-024-05505-7","article-title":"Machine learning-based analysis for prediction of surgical necrotizing enterocolitis in very low birth weight infants using perinatal factors: a nationwide cohort study","volume":"183","author":"Kim","year":"2024","journal-title":"Eur J Pediatr"},{"key":"2026072203070749500_tqag113-B39","doi-asserted-by":"publisher","first-page":"e89860","DOI":"10.1371\/journal.pone.0089860","article-title":"A data-driven algorithm integrating clinical and laboratory features for the diagnosis and prognosis of necrotizing enterocolitis","volume":"9","author":"Ji","year":"2014","journal-title":"PLoS One"},{"key":"2026072203070749500_tqag113-B40","doi-asserted-by":"publisher","first-page":"20200975","DOI":"10.1259\/bjr.20200975","article-title":"Artificial intelligence in paediatric radiology: future opportunities","volume":"94","author":"Davendralingam","year":"2021","journal-title":"Br J Radiol"},{"key":"2026072203070749500_tqag113-B41","doi-asserted-by":"publisher","first-page":"161592","DOI":"10.1016\/j.jpedsurg.2024.06.001","article-title":"Artificial intelligence vs. doctors: diagnosing necrotizing enterocolitis on abdominal radiographs","volume":"59","author":"Weller","year":"2024","journal-title":"J Pediatr Surg"}],"container-title":["British Journal of Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjr\/advance-article-pdf\/doi\/10.1093\/bjr\/tqag113\/68302717\/tqag113.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjr\/article-pdf\/99\/1184\/1624\/68302717\/tqag113.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjr\/article-pdf\/99\/1184\/1624\/68302717\/tqag113.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T07:07:15Z","timestamp":1784704035000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjr\/article\/99\/1184\/1624\/8680202"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,15]]},"references-count":41,"journal-issue":{"issue":"1184","published-online":{"date-parts":[[2026,5,15]]},"published-print":{"date-parts":[[2026,8,1]]}},"URL":"https:\/\/doi.org\/10.1093\/bjr\/tqag113","relation":{},"ISSN":["0007-1285","1748-880X"],"issn-type":[{"value":"0007-1285","type":"print"},{"value":"1748-880X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8]]},"published":{"date-parts":[[2026,5,15]]}}}