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Bedeschi MF, Mora S, Antoniazzi F, Boero S, Ravasio R, Scarano G, Selicorni A, Sessa M, Verdoni F, Zampino G, Maghnie M. The clinical management of children with achondroplasia in Italy: results of clinician and parent/caregiver surveys. J Endocrinol Invest 2024; 47:345-356. [PMID: 37466810 DOI: 10.1007/s40618-023-02151-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE This study aimed to assess the real-world management of achondroplasia in Italy. METHODS Two online surveys addressed to (1) parents/caregivers of individuals with achondroplasia and (2) Italian clinicians managing individuals with achondroplasia were conducted to assess real-world perspectives on achondroplasia management. Both surveys collected data on either patient or clinician demographics, details on diagnoses and referrals, disease complications, and views/experiences with limb lengthening surgery. RESULTS In total, 42 parents/caregivers and 19 clinicians (from 18 hospitals) completed the surveys. According to parents/caregivers, achondroplasia diagnosis was most commonly made in the third trimester of gestation (55% of respondents), with a genetic test performed to confirm the diagnosis in all but one case. In contrast, the clinicians indicated that, while achondroplasia was typically suspected during the prenatal period (78%), diagnosis was more frequently confirmed postnatally (72%). Parents/caregivers reported that the greatest impact of achondroplasia-related complications occurred in their children between the ages of 2-5 years. The most significant complications were otitis, sleep apnoea, stenosis of the foramen magnum or pressure on the spinal cord, and hearing difficulties. Lengthening surgery had been presented as a treatment option to 92% of responding parents/caregivers, with 76% of clinicians viewing surgery favourably. Typically, clinicians' reasons for suggesting limb lengthening surgery were to improve patient quality of life, increase patient autonomy and self-acceptance, improve trunk-limb disproportion, short stature and walking, and ensure that all possible treatment options had been presented to the parents/caregivers. CONCLUSION This survey provides insight into the real-world management of individuals with achondroplasia in Italy.
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Affiliation(s)
- M F Bedeschi
- Department of Woman-Child-Newborn, Medical Genetic Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Mora
- Laboratory of Paediatric Endocrinology, Department of Paediatrics, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - F Antoniazzi
- UO of Paediatrics, University of Verona, Verona, Italy
| | - S Boero
- Orthopaedics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - R Ravasio
- PharmaLex Italy S.p.A., Milan, Italy
| | - G Scarano
- Azienda Ospedaliera di Rilievo Nazionale "San Pio". P.O. "Gaetano Rummo", Benevento, Italy
| | - A Selicorni
- UOC Pediatria, Centro Fondazione Mariani per il bambino fragile, ASST Lariana, Como, Italy
| | - M Sessa
- Associazione per l'Informazione e lo Studio dell'Acondroplasia (AISAC), Milan, Italy
| | - F Verdoni
- IRCCS Istituto Galeazzi di Milano, Milan, Italy
| | - G Zampino
- UOC Pediatria, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
- Dipartimento di Scienza della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Maghnie
- Paediatric Clinic and Endocrinology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy
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Ozdemir O, Aksoy F, Sen C. Fetal autopsy for the diagnosis of skeletal dysplasia and comparison with prenatal ultrasound findings over a 16-year period. J Perinat Med 2022; 50:1239-1247. [PMID: 35771677 DOI: 10.1515/jpm-2022-0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/03/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the relationship between prenatal ultrasonography (USG) and fetal autopsy findings. METHODS Among 453 pregnancy terminations performed because of fetal anomalies on prenatal USG, 54 with skeletal dysplasia on fetal autopsy were included in this retrospective study. RESULTS The most common diagnoses among the 54 fetal autopsies were osteogenesis imperfecta (n=12), dysostosis (n=10), achondroplasia (n=9), arthrogryposis (n=6), and thanatophoric dysplasia (n=6). The prenatal USG and fetal autopsy findings showed complete agreement in 35 cases (64.8%), partial agreement in nine cases (16.6%), and disagreement in 10 cases (18.5%). CONCLUSIONS Fetal autopsy via perinatal pathology is essential for precise identification of the type of skeletal dysplasia; it should be routinely performed to confirm the diagnosis of prenatally detected fetal anomalies. Autopsy is vital for accurate prenatal diagnosis and the 'gold standard' technique for the identification of clinically important abnormalities.
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Affiliation(s)
- Ozge Ozdemir
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Figen Aksoy
- Department of Pathology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Cihat Sen
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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Hypochondrogenesis: A pictorial assay combining ultrasound, MRI and low-dose computerized tomography. Clin Imaging 2020; 69:363-368. [PMID: 33070083 DOI: 10.1016/j.clinimag.2020.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/26/2020] [Accepted: 10/07/2020] [Indexed: 11/20/2022]
Abstract
We present a case of hypochondrogenesis, a rare autosomal dominant skeletal dysplasia that often results in infant death shortly after birth. Hypochondrogenesis can present similarly to other skeletal dysplasia diseases, notably achondrogenesis type II. The diagnosis of hypochondrogenesis was given during the prenatal stage after fetal imaging was performed using ultrasound, magnetic resonance imaging (MRI), and low-dose computerized tomography (CT). To the best of our knowledge, this is the first known case that reported the use of low-dose CT to assist in the prenatal diagnosis of hypochondrogenesis.
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Waratani M, Ito F, Tanaka Y, Mabuchi A, Mori T, Kitawaki J. Prenatal diagnosis of fetal skeletal dysplasia using 3-dimensional computed tomography: a prospective study. BMC Musculoskelet Disord 2020; 21:662. [PMID: 33032557 PMCID: PMC7545947 DOI: 10.1186/s12891-020-03663-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/20/2020] [Indexed: 02/04/2023] Open
Abstract
Background Fetal skeletal dysplasia (FSD) comprises a complex group of systemic bone and cartilage disorders. Many FSD phenotypes have indistinct definitions, making definitive prenatal diagnosis difficult. The condition is typically diagnosed using sonography; however, three-dimensional computed tomography (3D-CT) also aids in making a prenatal diagnosis. This study aimed to examine the efficacy of 3D-CT in the prenatal diagnosis of FSD by comparing the diagnostic accuracy of fetal sonography and 3D-CT. Methods On suspicion of FSD based on ultrasound examination, we performed 3D-CT prenatally to obtain detailed skeletal information on FSD. To minimize exposure of the fetuses to radiation without compromising image quality, we used predetermined 3D-CT settings for volume acquisition. Results Nineteen fetuses were suspected of having skeletal dysplasia based on ultrasonography findings. Of these, 17 were diagnosed with FSD using 3D-CT. All 17 fetuses diagnosed with FSD prenatally were confirmed postnatally to have the condition. The postnatal diagnosis (campomelic dysplasia) differed from the prenatal diagnosis (osteogenesis imperfecta) in only one infant. Sixteen cases (94.1%) were diagnosed both prenatally and postnatally with FSD. Five infants had lethal skeletal dysplasia; one died in utero, and four died as neonates. We determined the appropriate delivery method for each infant based on the prenatal diagnosis. Conclusions 3D-CT is a valuable tool for augmenting ultrasound examinations in the diagnosis of FSD. While improving the diagnostic tool of sonography is essential in cases of suspected FSD, 3D-CT imaging is indispensable for diagnosis and classification, enabling better planning for resuscitation of the infant after birth. Trial registration University Hospital Medical Information Network (UMIN) Center trial registration number is UMIN000034744. Registered 1 October, 2018 – Retrospectively registered.
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Affiliation(s)
- Miyoko Waratani
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, 645 Kaijii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Fumitake Ito
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, 645 Kaijii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yukiko Tanaka
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, 645 Kaijii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Aki Mabuchi
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, 645 Kaijii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Taisuke Mori
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, 645 Kaijii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Jo Kitawaki
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, 645 Kaijii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
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Tang J, Zhou C, Shi H, Mo Y, Tan W, Sun T, Zhu J, Li Q, Li H, Li Y, Wang S, Hong Y, Li N, Zeng Q, Tan J, Ma W, Luo L. Prenatal diagnosis of skeletal dysplasias using whole exome sequencing in China. Clin Chim Acta 2020; 507:187-193. [PMID: 32360156 DOI: 10.1016/j.cca.2020.04.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/04/2020] [Accepted: 04/27/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Skeletal dysplasias account for nearly 10% of fetal structural malformations detected by ultrasonography. This clinically heterogeneous group of genetic anomaly includes at least 461 genetic skeletal disorders with extreme clinical, phenotypic, and genetic heterogeneities, thus, significantly complicates accurate diagnosis. Researches have used whole exome sequencing (WES) for prenatal molecular diagnoses of skeletal dysplasias, however, data are still limited. METHODS DNA extracted from umbilical cord blood or amniocytes from fetuses suspected of skeletal dysplasias based on ultrasound evaluations were analyzed by WES. Blood samples were taken from the parents of the positive fetuses for co-segregation analysis using Sanger sequencing. RESULT Definitive molecular diagnosis was made in 6/8 (75%) cases, comprised of 5 de novo disease-causing changes in 3 genes (FGFR3, COL2A1, and COL1A2) and one proband with a biallelic deficiency for Lamin B Receptor(LBR),and including 3 novel variants. All fetuses had no detectable copy number variation (CNV) from sequencing results. CONCLUSIONS Our study suggests that WES is an efficient approach for prenatal diagnosis of fetuses suspected of skeletal abnormalities and contributes to parental genetics counseling and pregnancy management.
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Affiliation(s)
- Jia Tang
- Medical Genetics Center, Jiangmen Maternity and Child Health Care Hospital, Jiangmen, Guangdong 529000, China; Department of Medical Imaging Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong 510080, China.
| | - Chenglong Zhou
- Medical Genetics Center, Jiangmen Maternity and Child Health Care Hospital, Jiangmen, Guangdong 529000, China; Halo Genetics, Guangzhou, Guangdong 510000, China
| | - Haihong Shi
- Medical Genetics Center, Jiangmen Maternity and Child Health Care Hospital, Jiangmen, Guangdong 529000, China; Halo Genetics, Guangzhou, Guangdong 510000, China
| | - Yuying Mo
- Medical Genetics Center, Jiangmen Maternity and Child Health Care Hospital, Jiangmen, Guangdong 529000, China
| | - Weilan Tan
- Medical Genetics Center, Jiangmen Maternity and Child Health Care Hospital, Jiangmen, Guangdong 529000, China
| | - Tielan Sun
- Medical Genetics Center, Jiangmen Maternity and Child Health Care Hospital, Jiangmen, Guangdong 529000, China
| | - Jinling Zhu
- Department of Biology, School of Basic Medicine, Jiamusi University, Jiamusi, Heilongjiang 154007, China
| | - Qing Li
- Medical Genetics Center, Jiangmen Maternity and Child Health Care Hospital, Jiangmen, Guangdong 529000, China
| | - Hui Li
- Medical Genetics Center, Jiangmen Maternity and Child Health Care Hospital, Jiangmen, Guangdong 529000, China
| | - Yuping Li
- Medical Genetics Center, Jiangmen Maternity and Child Health Care Hospital, Jiangmen, Guangdong 529000, China
| | - Songbai Wang
- Medical Genetics Center, Jiangmen Maternity and Child Health Care Hospital, Jiangmen, Guangdong 529000, China
| | - Yan Hong
- Medical Genetics Center, Jiangmen Maternity and Child Health Care Hospital, Jiangmen, Guangdong 529000, China
| | - Ning Li
- Halo Genetics, Guangzhou, Guangdong 510000, China
| | - Qinlong Zeng
- Medical Genetics Center, Jiangmen Maternity and Child Health Care Hospital, Jiangmen, Guangdong 529000, China
| | - Jieliang Tan
- Medical Genetics Center, Jiangmen Maternity and Child Health Care Hospital, Jiangmen, Guangdong 529000, China
| | - Wei Ma
- Department of Biology, School of Basic Medicine, Jiamusi University, Jiamusi, Heilongjiang 154007, China
| | - Liangping Luo
- Department of Medical Imaging Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong 510080, China.
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Morphometric study of the primary ossification center of the frontal squama in the human fetus. Surg Radiol Anat 2020; 42:733-740. [PMID: 32025797 PMCID: PMC7261738 DOI: 10.1007/s00276-020-02425-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/25/2020] [Indexed: 10/29/2022]
Abstract
PURPOSES Detailed morphometric data on the development of ossification centers in human fetuses is useful in the early detection of skeletal dysplasias associated with a delayed development of ossification centers and their mineralization. Quantitative analysis of primary ossification centers of cranial bones is sporadic due to limited availability of fetal material. MATERIAL AND METHODS The size of the primary ossification center of the frontal squama in 37 human (16 males and 21 females) spontaneously aborted human fetuses aged 18-30 weeks was studied by means of CT, digital-image analysis and statistics. RESULTS With neither sex nor laterality differences, the best-fit growth dynamics for the primary ossification center of the frontal squama was modelled by the following functions: y = 13.756 + 0.021 × (age)2 ± 0.024 for its vertical diameter, y = 0.956 + 0.956 × age ± 0.823 for its transverse diameter, y = 38.285 + 0.889 × (age)2 ± 0.034 for its projection surface area, and y = 90.020 + 1.375 × (age)2 ± 11.441 for its volume. CONCLUSIONS Our findings for the primary ossification center of the frontal squama may be conducive in monitoring normal fetal growth and screening for inherited faults and anomalies of the skull in human fetuses.
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Gueneuc A, Spaggiari E, Millischer AE, Michot C, O'Gorman N, Ville Y. Contribution of three-dimensional ultrasound and three-dimensional helical computed tomography to prenatal diagnosis of Stickler syndrome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:279-280. [PMID: 30251283 DOI: 10.1002/uog.20127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/12/2018] [Accepted: 09/20/2018] [Indexed: 06/08/2023]
Affiliation(s)
- A Gueneuc
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - E Spaggiari
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - A E Millischer
- Department of Pediatrics Radiology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - C Michot
- University Paris Descartes, Sorbonne Paris-Cité, Paris, France
- Department of Medical Genetics, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - N O'Gorman
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - Y Ville
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes, Sorbonne Paris-Cité, Paris, France
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Wiśniewski M, Baumgart M, Grzonkowska M, Szpinda M, Pawlak-Osińska K. Quantitative anatomy of the ulna's shaft primary ossification center in the human fetus. Surg Radiol Anat 2019; 41:431-439. [PMID: 30382328 PMCID: PMC6420898 DOI: 10.1007/s00276-018-2121-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/21/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE There has been little information in the medical literature regarding the growing ulna in the human fetus, though such knowledge appears to be potentially useful in diagnosing skeletal dysplasias, characterized by a disrupted or completely halted growth of the fetus. Therefore, longitudinal measurements of long bones are extremely conducive in assessing both pregnancy and fetal anatomy. MATERIALS AND METHODS Using methods of CT, digital-image analysis and statistics, the size of the ulna's shaft primary ossification center in 48 (26 males and 22 females) spontaneously aborted human fetuses aged 17-30 weeks was studied. RESULTS With no sex differences, the best fit growth dynamics for the ulna's shaft primary ossification center was modeled by the following functions: y = - 8.476 + 1.561 × age ± 0.019 for its length, y = - 2.961 + 0.278 × age ± 0.016 for its proximal transverse diameter, y = - 0.587 + 0.107 × age ± 0.027 for its middle transverse diameter, y = - 2.865 + 0.226 × age ± 0.295 for its distal transverse diameter, y = - 50.758 + 0.251 × (age)2 ± 0.016 for its projection surface area, and y = - 821.707 + 52.578 × age ± 0.018 ± 102.944 for its volume. CONCLUSIONS The morphometric characteristics of the ulna's shaft primary ossification center show neither sex nor bilateral differences. The ulna's shaft primary ossification center grows linearly with respect to its length, transverse dimensions and volume, and follows a quadratic function with respect to its projection surface area. The obtained morphometric data of the ulna's shaft primary ossification center is considered normative for respective prenatal weeks and may be of relevance in both the estimation of fetal ages and the diagnostic process of congenital defects.
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Affiliation(s)
- Marcin Wiśniewski
- Department of Normal Anatomy, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, The Nicolaus Copernicus University in Toruń, Toruń, Poland
| | - Mariusz Baumgart
- Department of Normal Anatomy, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, The Nicolaus Copernicus University in Toruń, Toruń, Poland
| | - Magdalena Grzonkowska
- Department of Normal Anatomy, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, The Nicolaus Copernicus University in Toruń, Toruń, Poland
| | - Michał Szpinda
- Department of Normal Anatomy, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, The Nicolaus Copernicus University in Toruń, Toruń, Poland.
| | - Katarzyna Pawlak-Osińska
- Department of Otolaryngology and Oncology, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, The Nicolaus Copernicus University in Toruń, Toruń, Poland
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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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Mottet N, Chaussy Y, Auber F, Guimiot F, Arbez-Gindre F, Riethmuller D, Cretolle C, Benachi A. How to Explore Fetal Sacral Agenesis Without Open Dysraphism: Key Prenatal Imaging and Clinical Implications. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1807-1820. [PMID: 29377253 DOI: 10.1002/jum.14522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/01/2017] [Accepted: 10/02/2017] [Indexed: 06/07/2023]
Abstract
The estimated prevalence of fetal caudal dysgenesis is 1 per 100,000 births. The functional prognosis of sacral agenesis is dominated by the large spectrum of associated caudal malformations. Except for cases associated with hydrocephalus secondary to open spinal dysraphism or chromosomal anomalies, association with mental deficiency is rare. We propose a systematic prenatal approach to cases of fetal sacral agenesis based on 9 etiologic items: clinical context, type of sacral dysgenesis, associated spinal cord malformations, mobility of lower limbs, investigation of the presacral region, analysis of the gastrointestinal tract, analysis of the genitourinary tract, associated vertebral defects, and cytogenetic analysis.
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Affiliation(s)
- Nicolas Mottet
- Departments of Obstetrics and Gynecology, Jean Minjoz Besançon University Hospital, Université de Franche Comté, Besançon, France
- Department of Obstetrics and Gynecology, Hospital Antoine Béclère, Assistance Publique-Hôpitaux de Paris, Université Paris Sud, Paris, France
| | - Yann Chaussy
- Department of Pediatric Surgery, Jean Minjoz Besançon University Hospital, Université de Franche Comté, Besançon, France
| | - Frederic Auber
- Department of Pediatric Surgery, Jean Minjoz Besançon University Hospital, Université de Franche Comté, Besançon, France
| | - Fabien Guimiot
- Department of Developmental Biology, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Denis Diderot University, Paris, France
| | - Francine Arbez-Gindre
- Unit of Fetal Pathology, Jean Minjoz Besançon University Hospital, Université de Franche Comté, Besançon, France
| | - Didier Riethmuller
- Departments of Obstetrics and Gynecology, Jean Minjoz Besançon University Hospital, Université de Franche Comté, Besançon, France
| | - Célia Cretolle
- National Reference Centre for Rare Diseases on Anorectal Malformations and Rare Pelvic Anomalies, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Université René Descartes, Paris, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, Hospital Antoine Béclère, Assistance Publique-Hôpitaux de Paris, Université Paris Sud, Paris, France
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Robinson AJ, Ederies MA. Fetal neuroimaging: an update on technical advances and clinical findings. Pediatr Radiol 2018; 48:471-485. [PMID: 29550864 DOI: 10.1007/s00247-017-3965-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/14/2017] [Accepted: 08/09/2017] [Indexed: 10/17/2022]
Abstract
This paper is based on a literature review from 2011 to 2016. The paper is divided into two main sections. The first section relates to technical advances in fetal imaging techniques, including fetal motion compensation, imaging at 3.0 T, 3-D T2-weighted MRI, susceptibility-weighted imaging, computed tomography, morphometric analysis, diffusion tensor imaging, spectroscopy and fetal behavioral assessment. The second section relates to clinical updates, including cerebral lamination, migrational anomalies, midline anomalies, neural tube defects, posterior fossa anomalies, sulcation/gyration and hypoxic-ischemic insults.
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Affiliation(s)
- Ashley J Robinson
- Sidra Medical and Research Center, Qatar Foundation, Education City North, Al Luqta Street, Doha, 26999, Qatar. .,Clinical Radiology, Weill-Cornell Medical College, New York, NY, USA.
| | - M Ashraf Ederies
- Sidra Medical and Research Center, Qatar Foundation, Education City North, Al Luqta Street, Doha, 26999, Qatar.,Clinical Radiology, Weill-Cornell Medical College, New York, NY, USA
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Ossification center of the humeral shaft in the human fetus: a CT, digital, and statistical study. Surg Radiol Anat 2017; 39:1107-1116. [PMID: 28357556 PMCID: PMC5610672 DOI: 10.1007/s00276-017-1849-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 03/16/2017] [Indexed: 12/20/2022]
Abstract
Purpose The knowledge of the development of the humeral shaft ossification center may be useful both in determining the fetal stage and maturity and for detecting congenital disorders, as well. This study was performed to quantitatively examine the humeral shaft ossification center with respect to its linear, planar, and volumetric parameters. Materials and method Using methods of CT, digital image analysis, and statistics, the size of the humeral shaft ossification center in 48 spontaneously aborted human fetuses aged 17–30 weeks was studied. Results With no sex differences, the best-fit growth dynamics for the humeral shaft ossification center was modeled by the following functions: y = −78.568 + 34.114 × ln (age) ± 2.160 for its length, y = −12.733 + 5.654 × ln(age) ± 0.515 for its proximal transverse diameter, y = −4.750 + 2.609 × ln (age) ± 0.294 for its middle transverse diameter, y = −10.037 + 4.648 × ln (age) ± 0.560 for its distal transverse diameter, y = −146.601 + 11.237 × age ± 19.907 for its projection surface area, and y = 121.159 + 0.001 × (age)4 ± 102.944 for its volume. Conclusions With no sex differences, the ossification center of the humeral shaft grows logarithmically with respect to its length and transverse diameters, linearly with respect to its projection surface area, and fourth-degree polynomially with respect to its volume. The obtained morphometric data of the humeral shaft ossification center are considered normative for respective prenatal weeks and may be of relevance in both the estimation of fetal ages and the ultrasonic diagnostics of congenital defects.
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D'Ambrosio V, Pasquali G, Squarcella A, Marcoccia E, De Filippis A, Gatto S, Camilla A, Pizzuti A, La Torre R, Giancotti A. Prenatal diagnosis of proximal focal femoral deficiency: Literature review of prenatal sonographic findings. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:252-259. [PMID: 26408260 DOI: 10.1002/jcu.22306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 08/16/2015] [Indexed: 06/05/2023]
Abstract
Proximal focal femoral deficiency (PFFD) is a rare musculoskeletal malformation that occurs in 0.11-0.2 per 10,000 live births. This congenital anomaly involves the pelvis and proximal femur with widely variable manifestations, from mild femoral shortening and hypoplasia to the absence of any functional femur and acetabular aplasia. Prenatal diagnosis of PFFD is still a challenge, but early recognition of this malformation could provide useful information to both parents and physicians concerning management and therapeutic planning. For this review, we analyzed all the cases of prenatally diagnosed PFFD that were reported in the literature from 1990 to 2014 and provide a description of the most common prenatal sonographic findings.
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Affiliation(s)
- Valentina D'Ambrosio
- Department of Experimental Medicine, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Gaia Pasquali
- Department of Obstetrics, Gynecology and Urologic Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Antonia Squarcella
- Department of Obstetrics, Gynecology and Urologic Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Eleonora Marcoccia
- Department of Obstetrics, Gynecology and Urologic Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Angela De Filippis
- Department of Obstetrics, Gynecology and Urologic Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Silvia Gatto
- Department of Obstetrics, Gynecology and Urologic Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Aliberti Camilla
- Department of Obstetrics, Gynecology and Urologic Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Antonio Pizzuti
- Department of Experimental Medicine, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Renato La Torre
- Department of Obstetrics, Gynecology and Urologic Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Antonella Giancotti
- Department of Obstetrics, Gynecology and Urologic Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
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Watson CM, Crinnion LA, Murphy H, Newbould M, Harrison SM, Lascelles C, Antanaviciute A, Carr IM, Sheridan E, Bonthron DT, Smith A. Deficiency of the myogenic factor MyoD causes a perinatally lethal fetal akinesia. J Med Genet 2016; 53:264-9. [PMID: 26733463 PMCID: PMC4819622 DOI: 10.1136/jmedgenet-2015-103620] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 12/01/2015] [Indexed: 12/30/2022]
Abstract
Background Lethal fetal akinesia deformation sequence (FADS) describes a clinically and genetically heterogeneous phenotype that includes fetal akinesia, intrauterine growth retardation, arthrogryposis and developmental anomalies. Affected babies die as a result of pulmonary hypoplasia. We aimed to identify the underlying genetic cause of this disorder in a family in which there were three affected individuals from two sibships. Methods Autosomal-recessive inheritance was suggested by a family history of consanguinity and by recurrence of the phenotype between the two sibships. We performed exome sequencing of the affected individuals and their unaffected mother, followed by autozygosity mapping and variant filtering to identify the causative gene. Results Five autozygous regions were identified, spanning 31.7 Mb of genomic sequence and including 211 genes. Using standard variant filtering criteria, we excluded all variants as being the likely pathogenic cause, apart from a single novel nonsense mutation, c.188C>A p.(Ser63*) (NM_002478.4), in MYOD1. This gene encodes an extensively studied transcription factor involved in muscle development, which has nonetheless not hitherto been associated with a hereditary human disease phenotype. Conclusions We provide the first description of a human phenotype that appears to result from MYOD1 mutation. The presentation with FADS is consistent with a large body of data demonstrating that in the mouse, MyoD is a major controller of precursor cell commitment to the myogenic differentiation programme.
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Affiliation(s)
- Christopher M Watson
- Yorkshire Regional Genetics Service, St. James's University Hospital, Leeds, UK School of Medicine, University of Leeds, St. James's University Hospital, Leeds, UK
| | - Laura A Crinnion
- Yorkshire Regional Genetics Service, St. James's University Hospital, Leeds, UK School of Medicine, University of Leeds, St. James's University Hospital, Leeds, UK
| | - Helen Murphy
- Genomic Medicine, Manchester Academic Health Science Centre, The University of Manchester, St Mary's Hospital, Manchester, UK
| | - Melanie Newbould
- Department of Paediatric Histopathology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Sally M Harrison
- School of Medicine, University of Leeds, St. James's University Hospital, Leeds, UK
| | - Carolina Lascelles
- School of Medicine, University of Leeds, St. James's University Hospital, Leeds, UK
| | - Agne Antanaviciute
- School of Medicine, University of Leeds, St. James's University Hospital, Leeds, UK
| | - Ian M Carr
- School of Medicine, University of Leeds, St. James's University Hospital, Leeds, UK
| | - Eamonn Sheridan
- Yorkshire Regional Genetics Service, St. James's University Hospital, Leeds, UK School of Medicine, University of Leeds, St. James's University Hospital, Leeds, UK
| | - David T Bonthron
- Yorkshire Regional Genetics Service, St. James's University Hospital, Leeds, UK School of Medicine, University of Leeds, St. James's University Hospital, Leeds, UK
| | - Audrey Smith
- Yorkshire Regional Genetics Service, St. James's University Hospital, Leeds, UK
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Oldani E, Garel C, Bucourt M, Carbillon L. Prenatal Diagnosis of Antley-Bixler Syndrome and POR Deficiency. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:882-5. [PMID: 26670660 PMCID: PMC4687943 DOI: 10.12659/ajcr.895526] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patient: Female, fetus Final Diagnosis: Antley-Bixler syndrome Symptoms: Craniosynostosis • midface hypoplasia • femoral bowing • radiohumeral synostosis Medication: None Clinical Procedure: Prenatal diagnosis of severe fetal bone disease using detailed ultrasonography and computed tomography Specialty: Obstetrics and Gynecology • Maternal-Fetal Medicine
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Affiliation(s)
- Elena Oldani
- Department of Obstetrics & Gynecology, Hôpital Jean Verdier, Assistance Publique-Hôpitaux de Paris, Bondy, France
| | - Catherine Garel
- Department of Radiology, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Bondy, France
| | - Martine Bucourt
- Department of Pathology, Hôpital Jean Verdier, Assistance Publique-Hôpitaux de Paris, Bondy, France
| | - Lionel Carbillon
- Department of Obstetrics & Gynecology, Hôpital Jean Verdier, Assistance Publique-Hôpitaux de Paris, Bondy, France
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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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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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Abstract
In this review, we discuss aspects of the prenatal diagnosis of fetal skeletal malformations, concentrating on the advantages offered by different imaging techniques and the approaches that are of value in evaluating a suspected skeletal dysplasia. We also briefly address the findings in some of the commoner malformations of the fetal skeleton that may be encountered.
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Affiliation(s)
- Ann-Edwidge Noel
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Richard N Brown
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
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