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Li L, Jin X, Liu S, Fan H. Prenatal ultrasound findings and prenatal diagnosis of fetal skeletal dysplasia. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:575-587. [PMID: 38561934 DOI: 10.1002/jcu.23673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/26/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To analyze the value of prenatal ultrasound and molecular testing in diagnosing fetal skeletal dysplasia (SD). METHODS Clinical data, prenatal ultrasound data, and molecular results of pregnant women with fetal SD were collected in the ultrasound department of our clinic from May 2019 to December 2021. RESULTS A total of 40 pregnant women with fetal SD were included, with 82.5% exhibiting short limb deformity, followed by 25.0% with central nervous system malformations, 17.50% with facial malformations, 15% with cardiac malformations, and 12.5% with urinary system malformations. The genetic testing positive rate was 70.0% (28/40), with 92.8% (26/28) being single-gene disorders due to mutations in FGFR3, COL1A1, COL1A2, EVC2, FLNB, LBR, and TRPV4 genes. The most common SD subtypes were osteogenesis imperfecta (OI), thanatophoric dysplasia (TD), and achondroplasia (ACH). The gestational age (GA) at initial diagnosis for TD, OI, and ACH was 16.6, 20.9, and 28.3 weeks, respectively (p < 0.05), with no significant difference in femoral shortening between the three groups (p > 0.05). Of the OI cases, 5 out of 12 had a family history. CONCLUSION Short limb deformity is the most prevalent phenotype of SD. When fetal SD is suspected, detailed ultrasound screening should be conducted, combined with GA at initial diagnosis, family history, and molecular evidence, to facilitate more accurate diagnosis and enhance prenatal counseling and perinatal management.
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Affiliation(s)
- Lili Li
- Department of Ultrasound, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaofei Jin
- Department of Ultrasound, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Suna Liu
- Department of Neonatal Disease Screening, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Hui Fan
- Department of Ultrasound, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Hwang SW, Hwang K, Tukeshov SK. Craniofacial Features of Dwarfism in the Paintings of Velázquez. J Craniofac Surg 2023; 34:1804-1806. [PMID: 37220719 DOI: 10.1097/scs.0000000000009368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/09/2023] [Indexed: 05/25/2023] Open
Abstract
This study describes the craniofacial features of achondroplastic dwarfism in the paintings of Velázquez. In a PubMed search, using [Velázquez] and [dwarf], 13 titles were found. In a Google Image search, [Velázquez] and [dwarf] retrieved 5 paintings. The craniofacial manifestations of the dwarfs depicted in the paintings were analyzed. Frontal bossing, antimongoloid slant, depressed nasal bridge (saddle nose), bulbous tip, malar hypoplasia, malocclusion, and chin asymmetry were observed. The presence of each manifestation was checked. In 5 paintings, portraits of 6 dwarfs having craniofacial deformities were found: Mariabárbola Asquin (left) in Las Meninas , Nicolasito Pertusato (right) in Las Meninas , Portrait of Sebastián de Morra, Portrait of Francisco Lezcano, The Jester Don Diego de Acedo, and Prince Balthasar Charles with a Dwarf. The most frequent craniofacial manifestation was malar hypoplasia (100%), followed by a bulbous tip (83.3%), saddle nose (66.7%), and frontal bossing (50%). Antimongoloid slant, malocclusion, and chin asymmetry were relatively rare (16.7% each). Through an analysis of 6 dwarfs in Velázquez's paintings, we can show that he realized and frequently expressed the craniofacial manifestations of achondroplasia: malar hypoplasia, bulbous tip, saddle nose, and frontal bossing. Despite the rarity of these presentations, he was also aware of antimongoloid slant, malocclusion, and chin asymmetry. Velázquez was a famous painter in the 17th century (i.e., during the Baroque period). Based on his excellent expression of the craniofacial manifestations of dwarfism, we can assume that he had a sound knowledge of anatomy, as well as malformations.
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Affiliation(s)
- Se Won Hwang
- Department of Plastic, Reconstructive Microsurgery and Hand Surgery, Kyrgyz State Medical Academy, and National Hospital of Kyrgyzstan, Bishkek, Kyrgyzstan
| | - Kun Hwang
- Department of Plastic Surgery, Armed Forces Capital Hospital, Bundang-gu, Seongnam-City, Gyeonggi-do, and Ewha Medical Academy, Ewha Womans University Medical Center, Seoul, Republic of Korea
| | - Sultan K Tukeshov
- Department of Plastic, Reconstructive Microsurgery and Hand Surgery, Kyrgyz State Medical Academy, and National Hospital of Kyrgyzstan, Bishkek, Kyrgyzstan
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3
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Almutiry A, Alotaibi F, Almutiry B, Aldowsari MK, Alotaibi M, Boucelham A. Craniofacial and Dental Manifestations in Pediatric Patients with Achondroplasia: A Case Report and Clinical View. Int J Clin Pediatr Dent 2023; 16:409-415. [PMID: 37519965 PMCID: PMC10373753 DOI: 10.5005/jp-journals-10005-2589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Aim The aim of this case report is to describe the dentofacial manifestations of achondroplasia and highlight concerns associated with dental management of pediatric patients with achondroplasia. Background Achondroplasia is the most common form of skeletal dysplasia (dwarfism) with clinical manifestations including disproportionate limb shortening and stunted stature. The craniofacial characteristics of achondroplasia are relative macrocephaly, depression of the nasal bridge, and maxillary hypoplasia. Special precautions are necessary during dental management of pediatric patients with achondroplasia due to a large head size, implanted shunts, airway obstruction, and difficulty in head control. Case description A 6 years and 7 months male, the patient was diagnosed with achondroplasia, currently receiving vitamin D, no known drug allergy, and a mixed dentition stage with multiple caries, mouth breather, and a high risk of further caries based on a caries risk assessment due to poor oral hygiene. As the patient was uncooperative and required extensive dental care, dental rehabilitation was conducted under general anesthesia using oral intubation due to nasal obstruction. Future examinations were planned for every 3 months. Conclusion The current case demonstrated that the characteristics of achondroplasia might cause respiratory, neurological, skeletal, orthodontic, and psychological difficulties. Pediatric dentists who treat these patients must be able to detect these characteristics and difficulties, as dental treatment is limited by practical issues associated with this condition. Clinical significance The characteristic features of achondroplasia are attributed to skeletal, respiratory, neurologic, orthodontic, and psychosocial issues. The dentist should be aware of the features of achondroplasia, which can potentially restrict dental management. How to cite this article Almutiry A, Alotaibi F, Almutiry B, et al. Craniofacial and Dental Manifestations in Pediatric Patients with Achondroplasia: A Case Report and Clinical View. Int J Clin Pediatr Dent 2023;16(2):409-415.
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Affiliation(s)
- Amal Almutiry
- Department of Pediatric Dentistry, King Saud Medical City, Riyadh, Saudi Arabia
| | - Fares Alotaibi
- Department of Pediatric Dentistry, King Saud Medical City, Riyadh, Saudi Arabia
| | - Bashayer Almutiry
- Department of Pediatric Dentistry, King Saud Medical City, Riyadh, Saudi Arabia
| | - Mannaa K Aldowsari
- Department of Pediatric Dentistry and Orthodontics, college of dentistry King Saud University, Riyadh, Saudi Arabia
| | - Maha Alotaibi
- Department of Clinic Genetic and Metabolic, King Saud Medical City, Riyadh, Saudi Arabia
| | - Aboubekri Boucelham
- Department of Pediatric Dentistry, King Saud Medical City, Riyadh, Saudi Arabia
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What to Expect of Feeding Abilities and Nutritional Aspects in Achondroplasia Patients: A Narrative Review. Genes (Basel) 2023; 14:genes14010199. [PMID: 36672940 PMCID: PMC9858955 DOI: 10.3390/genes14010199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Achondroplasia is an autosomal dominant genetic disease representing the most common form of human skeletal dysplasia: almost all individuals with achondroplasia have identifiable mutations in the fibroblast growth factor receptor type 3 (FGFR3) gene. The cardinal features of this condition and its inheritance have been well-established, but the occurrence of feeding and nutritional complications has received little prominence. In infancy, the presence of floppiness and neurological injury due to foramen magnum stenosis may impair the feeding function of a newborn with achondroplasia. Along with growth, the optimal development of feeding skills may be affected by variable interactions between midface hypoplasia, sleep apnea disturbance, and structural anomalies. Anterior open bite, prognathic mandible, retrognathic maxilla, and relative macroglossia may adversely impact masticatory and respiratory functions. Independence during mealtimes in achondroplasia is usually achieved later than peers. Early supervision of nutritional intake should proceed into adolescence and adulthood because of the increased risk of obesity and respiratory problems and their resulting sequelae. Due to the multisystem involvement, oral motor dysfunction, nutrition, and gastrointestinal issues require special attention and personalized management to facilitate optimal outcomes, especially because of the novel therapeutic options in achondroplasia, which could alter the progression of this rare disease.
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Cormier-Daire V, AlSayed M, Alves I, Bengoa J, Ben-Omran T, Boero S, Fredwall S, Garel C, Guillen-Navarro E, Irving M, Lampe C, Maghnie M, Mortier G, Sousa SB, Mohnike K. Optimising the diagnosis and referral of achondroplasia in Europe: European Achondroplasia Forum best practice recommendations. Orphanet J Rare Dis 2022; 17:293. [PMID: 35897040 PMCID: PMC9327303 DOI: 10.1186/s13023-022-02442-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 07/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Achondroplasia is the most common form of skeletal dysplasia, with serious comorbidities and complications that may occur from early infancy to adulthood, requiring lifelong management from a multidisciplinary team expert in the condition The European Achondroplasia Forum guiding principles of management highlight the importance of accurate diagnosis and timely referral to a centre specialised in the management of achondroplasia to fully support individuals with achondroplasia and their families, and to appropriately plan management. The European Achondroplasia Forum undertook an exploratory audit of its Steering Committee to ascertain the current situation in Europe and to understand the potential barriers to timely diagnosis and referral. RESULTS Diagnosis of achondroplasia was primarily confirmed prenatally (66.6%), at Day 0 (12.8%) or within one month after birth (12.8%). For suspected and confirmed cases of achondroplasia, a greater proportion were identified earlier in the prenatal period (87.1%) with fewer diagnoses at Day 0 (5.1%) or within the first month of life (2.6%). Referral to a specialist centre took place after birth (86.6%), predominantly within the first month, although there was a wide variety in the timepoint of referral between countries and in the time lapsed between suspicion or confirmed diagnosis of achondroplasia and referral to a specialist centre. CONCLUSIONS The European Achondroplasia Forum guiding principles of management recommend diagnosis of achondroplasia as early as possible. If concerns are raised at routine ultrasound, second line investigation should be implemented so that the diagnosis can be reached as soon as possible for ongoing management. Clinical and radiological examination supported by molecular testing is the most effective way to confirm diagnosis of achondroplasia after birth. Referral to a centre specialised in achondroplasia care should be made as soon as possible on suspicion or confirmation of diagnosis. In countries or regions where there are no official skeletal dysplasia reference or specialist centres, priority should be given to their creation or recognition, together with incentives to improve the structure of the existing multidisciplinary team managing achondroplasia. The length of delay between diagnosis of achondroplasia and referral to a specialist centre warrants further research.
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Affiliation(s)
- Valerie Cormier-Daire
- Department of Clinical Genetics, Centre of Reference for Constitutional Bone Diseases (MOC), INSERM UMR 1163, Imagine Institute, Necker-Enfants Malades Hospital, Paris Centre University, Paris, France.
| | - Moeenaldeen AlSayed
- Department of Medical Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.,Faculty of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | | | | | - Tawfeg Ben-Omran
- Division of Genetics and Genomic Medicine, Sidra Medicine & Hamad Medical Corporation, Doha, Qatar
| | - Silvio Boero
- Pediatric Orthopaedic and Traumatology Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Svein Fredwall
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Catherine Garel
- Department of Radiology, Armand-Trousseau Hospital, Paris, France
| | - Encarna Guillen-Navarro
- Medical Genetics Section, Department of Pediatrics, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, University of Murcia-UMU, Murcia, Spain.,CIBERER-ISCIII, Madrid, Spain
| | - Melita Irving
- Department of Clinical Genetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christian Lampe
- Clinic of Neuropediatrics, Epileptology and Social Pediatrics, University Hospital Giessen and Marburg, Giessen, Germany
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16147, Genoa, Italy
| | - Geert Mortier
- Department of Medical Genetics, and Centre for Rare Diseases, UZ Leuven, Leuven, Belgium
| | - Sérgio B Sousa
- Medical Genetics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Portugal AND University Clinic of Genetics, Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal
| | - Klaus Mohnike
- Central German Competence Network for Rare Diseases (ZSE), Universitätskinderklinik, Otto-von-Guericke Universität, Magdeburg, Germany
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Wrobel W, Pach E, Ben-Skowronek I. Advantages and Disadvantages of Different Treatment Methods in Achondroplasia: A Review. Int J Mol Sci 2021; 22:ijms22115573. [PMID: 34070375 PMCID: PMC8197470 DOI: 10.3390/ijms22115573] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 02/06/2023] Open
Abstract
Achondroplasia (ACH) is a disease caused by a missense mutation in the FGFR3 (fibroblast growth factor receptor 3) gene, which is the most common cause of short stature in humans. The treatment of ACH is necessary and urgent because untreated achondroplasia has many complications, both orthopedic and neurological, which ultimately lead to disability. This review presents the current and potential pharmacological treatments for achondroplasia, highlighting the advantages and disadvantages of all the drugs that have been demonstrated in human and animal studies in different stages of clinical trials. The article includes the potential impacts of drugs on achondroplasia symptoms other than short stature, including their effects on spinal canal stenosis, the narrowing of the foramen magnum and the proportionality of body structure. Addressing these effects could significantly improve the quality of life of patients, possibly reducing the frequency and necessity of hospitalization and painful surgical procedures, which are currently the only therapeutic options used. The criteria for a good drug for achondroplasia are best met by recombinant human growth hormone at present and will potentially be met by vosoritide in the future, while the rest of the drugs are in the early stages of clinical trials.
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Abstract
Achondroplasia is the most common short-stature skeletal dysplasia, additionally marked by rhizomelia, macrocephaly, midface hypoplasia, and normal cognition. Potential medical complications associated with achondroplasia include lower extremity long bone bowing, middle-ear dysfunction, obstructive sleep apnea, and, more rarely, cervicomedullary compression, hydrocephalus, thoracolumbar kyphosis, and central sleep apnea. This is the second revision to the original 1995 health supervision guidance from the American Academy of Pediatrics for caring for patients with achondroplasia. Although many of the previously published recommendations remain appropriate for contemporary medical care, this document highlights interval advancements in the clinical methods available to monitor for complications associated with achondroplasia. This document is intended to provide guidance for health care providers to help identify individual patients at high risk of developing serious sequelae and to enable intervention before complications develop.
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Affiliation(s)
- Julie Hoover-Fong
- Greenberg Center for Skeletal Dysplasias, McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland;
| | - Charles I Scott
- Nemours/Alfred I. duPont Hospital for Children and Sidney Kimmel Medical College, Thomas Jefferson University, Wilmington, Delaware; and
| | - Marilyn C Jones
- Department of Pediatrics, University of California, San Diego and Rady Children's Hospital, San Diego, California
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8
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Affiliation(s)
- Elaine Pereira
- NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY
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9
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Achondroplasia: Orocraniofacial Features and Orthodontic-Surgical Management Guidelines Proposal. J Craniofac Surg 2019; 29:2186-2191. [PMID: 30277952 DOI: 10.1097/scs.0000000000004819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In this study, the authors aimed to describe orocraniofacial features and to suggest orthodontic-surgical managements in achondroplasia, based on a literature review. The authors focused on skeletal and dentoalveolar malocclusion in order to highlight the place of orthognathic surgery, based on our experience of 3 patients. Maxillary hypoplasia in achondroplasia typically results in an Angle class III malocclusion with an anterior open bite. The other orocraniofacial features include enlarged calvarium, prominent forehead and frontal bossing, midface hypoplasia, elongated lower face and saddle-shaped nose due to lack of development of the nasomaxillary complex.All our patients had a typical facial appearance but each of them had their own particularities regarding medical history and severity of the dentoskeletal dysmorphosis. Two of them were successfully treated by orthognathic surgery; the other declined surgical treatment and underwent orthopedic treatment only (anchorage plates). The treatment failure of this 3rd patient raises the question of the efficiency of anchorage plates in achondroplasia. In the light of the literature and our results, the authors conclude the need for personalized management based on age, medical history, severity of the dentoskeletal dysmorphosis, functional and/or esthetic disorders, and the patient's needs and requests. In any patient, orthodontic management should be initiated at an early age, and orthognathic surgery modalities should be personalized and adapted to each situation.
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Vivanti AJ, Costa JM, Rosefort A, Kleinfinger P, Lohmann L, Cordier AG, Benachi A. Optimal non-invasive diagnosis of fetal achondroplasia combining ultrasonography with circulating cell-free fetal DNA analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:87-94. [PMID: 29380944 DOI: 10.1002/uog.19018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/27/2017] [Accepted: 01/17/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To assess the performance of non-invasive prenatal testing (NIPT) for achondroplasia using high-resolution melting (HRM) analysis, and to propose an optimal diagnostic strategy combining ultrasound examination and cell-free fetal DNA (cffDNA) analysis. METHODS In this prospective multicenter study, cffDNA was extracted from blood of pregnant women at risk for fetal achondroplasia (owing to paternal achondroplasia, previous affected child or suspected rhizomelic shortening) and of pregnant low-risk controls. The presence of either one of the two main fibroblast growth factor receptor 3 gene (FGFR3) mutations was determined using HRM combined with confirmation by SNaPshot minisequencing. Results were compared with phenotypes obtained using three-dimensional computed tomography or postnatal examination, and/or molecular diagnosis by an invasive procedure. Fetal biometry (head circumference and femur length) was analyzed in order to develop a strategy in which cffDNA analysis for diagnosis of achondroplasia is offered only in selected cases. RESULTS Eighty-six blood samples from women at risk for fetal achondroplasia and 65 from controls were collected. The overall sensitivity and specificity of NIPT were 1.00 (95% CI, 0.87-1.00) and 1.00 (95% CI, 0.96-1.00), respectively. Critical reduction in femur length of affected fetuses could be observed from 26 weeks' gestation. CONCLUSIONS HRM combined with SNaPshot minisequencing is a reliable method for NIPT for achondroplasia. Its implementation in routine clinical care combined with ultrasonography is an efficient strategy for the non-invasive diagnosis of achondroplasia. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A J Vivanti
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, AP-HP, Clamart, France
- Université Paris Sud, Orsay, France
| | - J-M Costa
- Laboratoire CERBA, Saint-Ouen l'Aumône, France
| | - A Rosefort
- Service de Gynécologie-Obstétrique, Hôpital Tenon, AP-HP, Paris, France
| | | | - L Lohmann
- Laboratoire CERBA, Saint-Ouen l'Aumône, France
| | - A-G Cordier
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, AP-HP, Clamart, France
- Université Paris Sud, Orsay, France
| | - A Benachi
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, AP-HP, Clamart, France
- Université Paris Sud, Orsay, France
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Milks KS, Hill LM, Hosseinzadeh K. Evaluating skeletal dysplasias on prenatal ultrasound: an emphasis on predicting lethality. Pediatr Radiol 2017; 47:134-145. [PMID: 27904917 DOI: 10.1007/s00247-016-3725-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 07/20/2016] [Accepted: 10/04/2016] [Indexed: 11/25/2022]
Abstract
Lethal skeletal dysplasias can be diagnosed by prenatal ultrasound (US) using several sonographic parameters. Degree of femoral shortening, lung volumes, femur length to abdominal circumference ratio, and chest circumference to abdominal circumference ratio are the most sensitive and specific predictors. Although there are more than 450 different skeletal dysplasias, only a few are lethal in the perinatal period. We review current fetal US literature and present an updated algorithmic approach to first establish lethality and, second, evaluate for hallmark sonographic features to help determine a specific diagnosis.
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Affiliation(s)
- Kathryn S Milks
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Lyndon M Hill
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Women's Hospital, University of Pittsburg Medical Center, Pittsburgh, PA, USA
| | - Keyanoosh Hosseinzadeh
- Department of Radiology, Wake Forest Baptist University School of Medicine, Winston-Salem, NC, USA
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12
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Fagen KE, Blask AR, Rubio EI, Bulas DI. Achondroplasia in the Premature Infant: An Elusive Diagnosis in the Neonatal Intensive Care Unit. AJP Rep 2017; 7:e8-e12. [PMID: 28210519 PMCID: PMC5310945 DOI: 10.1055/s-0036-1592188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Achondroplasia is a difficult prenatal diagnosis to make before the late second and third trimester. We describe two cases where an infant was born prematurely with no overt signs of achondroplasia. Despite multiple chest and abdominal radiographs during the neonatal course, the diagnosis was not made until term equivalent age was reached. We retrospectively reviewed these two cases to highlight the elusive findings of achondroplasia in the premature infant.
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Affiliation(s)
- Kimberly E Fagen
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Maryland; Department of Radiology, Children's National Health System, Washington, District of Columbia
| | - Anna R Blask
- Department of Radiology, Children's National Health System, Washington, District of Columbia
| | - Eva I Rubio
- Department of Radiology, Children's National Health System, Washington, District of Columbia
| | - Dorothy I Bulas
- Department of Radiology, Children's National Health System, Washington, District of Columbia
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Huang H, Li S, Lu S, Ge H, Sun L. Prenatal diagnosis of single gene disorders using amniotic fluid as the starting material for PCR. Analyst 2016; 141:285-90. [PMID: 26587643 DOI: 10.1039/c5an01840d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A rapid and inexpensive method for fetal genetic diagnosis using amniotic fluid (AF) as the starting material was demonstrated in this study.
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Affiliation(s)
- Huan Huang
- Department of Gynecology and Obstetrics
- First Affiliated Hospital of Nanjing Medical University
- Nanjing
- China
| | - Shuo Li
- Information Engineering Department
- Nanjing Xiaozhuang University
- Nanjing
- China
| | - Shuolian Lu
- Department of Gynecology and Obstetrics
- First Affiliated Hospital of Nanjing Medical University
- Nanjing
- China
| | - Hongshan Ge
- Reproductive Health Center
- Second Affiliated Hospital of Wenzhou Medical University
- Wenzhou
- China
| | - Lizhou Sun
- Department of Gynecology and Obstetrics
- First Affiliated Hospital of Nanjing Medical University
- Nanjing
- China
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14
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Radiation dose reduction at MDCT with iterative reconstruction for prenatal diagnosis of skeletal dysplasia: preliminary study using normal fetal specimens. AJR Am J Roentgenol 2015; 203:1249-56. [PMID: 25415702 DOI: 10.2214/ajr.13.11578] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate to what degree the radiation dose can be reduced without affecting the ability to evaluate normal fetal bones at MDCT with iterative reconstruction. MATERIALS AND METHODS Fifteen normal fetal specimens immersed in containers (30- and 35-cm diameter) were scanned with a 64-MDCT scanner, with tube voltage of 100 kVp and tube current of 600, 300, 150, 100, and 50 mA. Images were subjected to adaptive statistical iterative reconstruction (ASIR). The fetal dose was measured using glass dosimeters. We calculated the relative ratio of the dose at 600 mA. Image quality was evaluated on maximum-intensity-projection and volume-rendering images. Two radiologists recorded the visualization scores of five regions. Images at 600 mA were considered to be standard. RESULTS With the 30-cm-diameter container, the fetal dose was 10.15 mGy (relative ratio, 100%) at a tube current of 600, 51% at 300, 25% at 150, 17% at 100, and 9% at 50 mA. With the 35-cm-diameter container the fetal dose was 10.01 mGy (relative ratio, 100%) at 600, 47% at 300, 24% at 150, 17% at 100, and 8% at 50 mA. Visual evaluation showed that in both containers, with ASIR 90%, there was a statistically significant difference between 50-and 600-mA images (p<0.01) but not between 600-mA images and those acquired at 100, 150, and 300 mA (p=0.08-1.00). CONCLUSION The fetal radiation dose for the evaluation of normal fetal bones can be reduced by 83% with ASIR 90%.
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Gorincour G, Chaumoitre K, Bourliere-Najean B, Bretelle F, Sigaudy S, D'Ercole C, Philip N, Potier A, Petit P, Panuel M. Fetal skeletal computed tomography: when? How? Why? Diagn Interv Imaging 2014; 95:1045-53. [PMID: 25216796 DOI: 10.1016/j.diii.2014.04.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To study the additional role of fetal skeletal computed tomography in suspected prenatal bone abnormalities. MATERIALS AND METHODS Two centers included in a retrospective study all fetuses who benefited from skeletal computed tomography for a suspected constitutional bone disease or focal dysostosis. RESULTS A total of 198 patients were included. CT was performed in 112 patients (56%) for an isolated short femur below the third percentile (group A), in 15 patients (8%) for bowed or fractured femur (group B), in 23 patients (12%) for biometric discrepancy between a short femur and increased head circumference (group C) and in 48 patients (24%) for suspected focal dysostosis (group D). CT was interpreted as normal in 126 cases (64%), i.e. 87% in group A, 0% in group B, 65% in group C and 25% in group D. When including only cases with postnatal or postmortem clinical and/or radiological confirmation was available, CT provided additional and/or more accurate information than ultrasound in 20% of cases in group A, 66% in group B, 30% in group C and 72% in group D. Sixty-seven percent of patients in whom CT was interpreted as normal were lost to follow-up. CONCLUSION In isolated short femur, fetal skeletal CT is normal in the great majority of cases although protocolized follow-up of these babies is absolutely compulsory, as a large proportion is lost to follow-up. Fetal skeletal CT can confirm or improve imaging for the suspected diagnosis in suspected focal dysostosis or constitutional bone disease.
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Affiliation(s)
- G Gorincour
- Department of Pediatric and Prenatal Imaging, La Timone Children's Hospital, 264, rue Saint-Pierre, 13385 Marseille Cedex 5, France; Multidisciplinary Department of Prenatal Diagnosis, La Timone Children's Hospital, 264, rue Saint-Pierre, 13385 Marseille Cedex 5, France.
| | - K Chaumoitre
- Department of Medical Imaging, Nord Hospital, chemin des Bourrely, 13015 Marseille, France; Multidisciplinary Centre for Prenatal Diagnosis, Nord Hospital, chemin des Bourrely, 13015 Marseille, France
| | - B Bourliere-Najean
- Department of Pediatric and Prenatal Imaging, La Timone Children's Hospital, 264, rue Saint-Pierre, 13385 Marseille Cedex 5, France
| | - F Bretelle
- Multidisciplinary Centre for Prenatal Diagnosis, Nord Hospital, chemin des Bourrely, 13015 Marseille, France
| | - S Sigaudy
- Multidisciplinary Department of Prenatal Diagnosis, La Timone Children's Hospital, 264, rue Saint-Pierre, 13385 Marseille Cedex 5, France
| | - C D'Ercole
- Multidisciplinary Centre for Prenatal Diagnosis, Nord Hospital, chemin des Bourrely, 13015 Marseille, France
| | - N Philip
- Multidisciplinary Department of Prenatal Diagnosis, La Timone Children's Hospital, 264, rue Saint-Pierre, 13385 Marseille Cedex 5, France
| | - A Potier
- Multidisciplinary Department of Prenatal Diagnosis, La Timone Children's Hospital, 264, rue Saint-Pierre, 13385 Marseille Cedex 5, France
| | - P Petit
- Department of Pediatric and Prenatal Imaging, La Timone Children's Hospital, 264, rue Saint-Pierre, 13385 Marseille Cedex 5, France
| | - M Panuel
- Department of Medical Imaging, Nord Hospital, chemin des Bourrely, 13015 Marseille, France; Multidisciplinary Centre for Prenatal Diagnosis, Nord Hospital, chemin des Bourrely, 13015 Marseille, France
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16
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Miyazaki O, Sawai H, Murotsuki J, Nishimura G, Horiuchi T. Nationwide radiation dose survey of computed tomography for fetal skeletal dysplasias. Pediatr Radiol 2014; 44:971-9. [PMID: 24737001 DOI: 10.1007/s00247-014-2916-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 11/20/2013] [Accepted: 01/30/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recently, computed tomography (CT) has been used to diagnose fetal skeletal dysplasia. However, no surveys have been conducted to determine the radiation exposure dose and the diagnostic reference level (DRL). OBJECTIVE To collect CT dose index volume (CTDIvol) and dose length product (DLP) data from domestic hospitals implementing fetal skeletal 3-D CT and to establish DRLs for Japan. MATERIALS AND METHODS Scan data of 125 cases of 20 protocols from 16 hospitals were analyzed. The minimum, first-quartile, median, third-quartile and maximum values of CTDIvol and DLP were determined. The time-dependent change in radiation dose setting in hospitals with three or more cases with scans was also examined. RESULTS The minimum, first-quartile, median, third-quartile and maximum CTDIvol values were 2.1, 3.7, 7.7, 11.3 and 23.1 mGy, respectively, and these values for DLP were 69.0, 122.3, 276.8, 382.6 and 1025.6 mGy·cm, respectively. Six of the 12 institutions reduced the dose setting during the implementation period. CONCLUSIONS The DRLs of CTDIvol and DLP for fetal CT were 11.3 mGy and 382.6 mGy·cm, respectively. Institutions implementing fetal CT should use these established DRLs as the standard and make an effort to reduce radiation exposure by voluntarily decreasing the dose.
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Affiliation(s)
- Osamu Miyazaki
- Department of Radiology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan,
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17
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Khalil A, Morales-Roselló J, Morlando M, Bhide A, Papageorghiou A, Thilaganathan B. Widening of the femoral proximal diaphysis--metaphysis angle in fetuses with achondroplasia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:69-75. [PMID: 24623391 DOI: 10.1002/uog.13339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 02/09/2014] [Accepted: 02/11/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES It has recently been reported that fetuses with achondroplasia have a wider than expected femoral proximal diaphysis-metaphysis angle (femoral angle). The aim of this case-control study was to investigate this finding. METHODS Cases with confirmed achondroplasia (n = 6), small-for-gestational-age fetuses (n = 70) and a group of normal fetuses (n = 377) were included in this study. The ultrasound image of the femur was examined by two independent experienced observers blinded to the diagnosis, who measured the femoral angle. These values were converted into multiples of the expected median (MoM), after adjustment for gestational age and femur length. Prevalence of various prenatal ultrasound signs of achondroplasia was determined in affected fetuses. Intra- and interobserver agreement of measurement of femoral angle was assessed using 95% limits of agreement and kappa statistics. RESULTS The femoral angle can be measured accurately by ultrasound, and increases with both increasing gestational age and increasing femur length. The femoral angle-MoM was significantly higher in fetuses with achondroplasia than in the control group (1.36 vs 1.00 MoM, P < 0.001) and in the SGA group (1.36 vs 1.04 MoM, P < 0.001). It measured more than 130° in five of the six cases with achondroplasia (83.3%), which was the most consistent finding other than shortening of the long bones. CONCLUSIONS The femoral angle is wider in fetuses with achondroplasia. This new ultrasound sign appears promising as an additional discriminatory marker when clinicians are faced with a case of short long bones in the third trimester.
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Affiliation(s)
- A Khalil
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, London, UK
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18
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Prenatal Diagnosis of Achondroplasia with Ultrasound, Three-Dimensional Computed Tomography and Molecular Methods. J Med Ultrasound 2012. [DOI: 10.1016/j.jmu.2012.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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19
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Prenatal diagnosis of fetal skeletal dysplasia with 3D CT. Pediatr Radiol 2012; 42:842-52. [PMID: 22532233 DOI: 10.1007/s00247-012-2381-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Revised: 11/23/2011] [Accepted: 01/16/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Clinical use of 3D CT for fetal skeletal malformations is controversial. OBJECTIVE The purpose of this study was to evaluate the efficacy of fetal 3D CT using three protocols with different radiation doses and through comparing findings between fetal CT and conventional postnatal radiographic skeletal survey. MATERIALS AND METHODS Seventeen fetuses underwent CT for suspected skeletal dysplasia. A relay of three CT protocols with stepwise dose-reduction were used over the study period. The concordance between the CT diagnosis and the final diagnosis was assessed. Ninety-three radiological findings identifiable on radiographs were compared with CT. RESULTS Fetal CT provided the correct diagnosis in all 17 fetuses, the detectability rate of cardinal findings was 93.5 %. In 59 % of the fetuses an US-based diagnosis was changed prenatally due to CT findings. The estimated fetal radiation dose in the final protocol was 3.4 mSv (50 %) of the initial protocol, and this dose reduction did not result in degraded image quality. CONCLUSION The capability of fetal CT to delineate the skeleton was almost the same as that of postnatal skeletal survey. The perinatal management was altered due to these more specific CT findings, which aided in counseling and in the management of the pregnancy.
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Hatzaki A, Sifakis S, Apostolopoulou D, Bouzarelou D, Konstantinidou A, Kappou D, Sideris A, Tzortzis E, Athanassiadis A, Florentin L, Theodoropoulos P, Makatsoris C, Karadimas C, Velissariou V. FGFR3 related skeletal dysplasias diagnosed prenatally by ultrasonography and molecular analysis: presentation of 17 cases. Am J Med Genet A 2011; 155A:2426-35. [PMID: 21910223 DOI: 10.1002/ajmg.a.34189] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 06/13/2011] [Indexed: 01/29/2023]
Abstract
Fibroblast Growth Factor Receptor 3 (FGFR3) related skeletal dysplasias are caused by mutations in the FGFR3 gene that result in increased activation of the receptors causing alterations in the process of endochondral ossification in all long bones, and include achondroplasia, hypochondroplasia, thanatophoric dysplasia, and SADDAN. Reports of prenatal diagnosis of FGFR3 related skeletal dysplasias are not rare; however, the correlation between 2nd trimester ultrasonographic findings and underlying molecular defect in these cases is relatively poor. There is a need for specific ultrasound (U/S) predictors than can distinguish lethal from non-lethal cases and aid an earlier prenatal diagnosis. Here we present one familial and 16 sporadic cases with FGFR3 related skeletal dysplasia, and we evaluate biometric parameters and U/S findings consistent with the diagnosis of skeletal dysplasia. U/S scan performed even at the 18th week of gestation can indicate a decreased rate of development of the femora (femur length (FL) <5th centile), while the mean gestational age at diagnosis is still around the 26th week. The utility of other biometric parameters and ratios is discussed (foot length, BPD, HC, FL/foot, and FL/AC). Prenatal cytogenetic and molecular genetic analyses were performed. A final diagnosis was reached by molecular analysis. In two cases of discontinued pregnancy, fetal autopsy led to a phenotypic diagnosis and confirmed the prenatal prediction of lethality. We conclude that the combination of U/S and molecular genetic approach is helpful for establishing an accurate diagnosis of FGFR3-related skeletal dysplasias in utero and subsequently for appropriate genetic counselling and perinatal management.
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Affiliation(s)
- Angeliki Hatzaki
- Department of Genetics & Molecular Biology, "MITERA" General, Maternity & Children's Hospital, Athens, Greece.
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21
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Al-Saleem A, Al-Jobair A. Achondroplasia: Craniofacial manifestations and considerations in dental management. Saudi Dent J 2010; 22:195-9. [PMID: 24151409 DOI: 10.1016/j.sdentj.2010.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 02/06/2010] [Accepted: 06/07/2010] [Indexed: 12/14/2022] Open
Abstract
Achondroplasia is the most common form of skeletal dysplasia dwarfism that manifests with stunted stature and disproportionate limb shortening. Achondroplasia is of dental interest because of its characteristic craniofacial features which include relative macrocephaly, depressed nasal bridge and maxillary hypoplasia. Presence of large head, implanted shunt, airway obstruction and difficulty in head control require special precautions during dental management. Craniofacial manifestations and considerations in dental management are presented in 11-year-old female patient with achondroplasia.
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Affiliation(s)
- Afnan Al-Saleem
- Pediatric Dentistry Board Resident, Dental Department, Riyadh Military Hospital, Saudi Arabia
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22
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Current world literature. Curr Opin Obstet Gynecol 2010; 22:166-75. [PMID: 20216348 DOI: 10.1097/gco.0b013e328338c956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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