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Mahabee-Gittens EM, Priyanka Illapani VS, Merhar SL, Kline-Fath B, Harun N, He L, Parikh NA. Prenatal Opioid Exposure and Risk for Adverse Brain and Motor Outcomes in Infants Born Premature. J Pediatr 2024; 267:113908. [PMID: 38220065 DOI: 10.1016/j.jpeds.2024.113908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/26/2023] [Accepted: 01/09/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVE To compare brain magnetic resonance imaging (MRI) biomarkers and neurodevelopmental test scores in infants born preterm with and without prenatal opioid exposure (POE). STUDY DESIGN We examined 395 preterm infants (≤32 weeks gestational age) who had term-equivalent brain MRIs, composite scores from the Bayley Scales of Infant and Toddler Development-III at 2 years corrected age, and POE data. MRI parameters included total/regional brain volumes and severe punctate white matter lesions (PWMLs). We conducted bivariable analysis and multivariable logistic regression analyses. RESULTS The mean ± SD gestational age was 29.3 ± 2.5 weeks; 35 (8.9%) had POE and 20 (5.1%) had severe PWML. Compared with unexposed infants, those with POE exhibited higher rates of severe PWML (17.1% vs 3.9%, respectively; P = .002); findings remained significant with an OR of 4.16 (95% CI, 1.26-13.68) after adjusting for confounders. On mediation analysis, the significant relationship between POE and severe PWML was not indirectly mediated through preterm birth/gestational age (OR, 0.93; 95% CI, 0.78-1.10), thus suggesting the association was largely driven by a direct adverse effect of POE on white matter. In multivariable analyses, POE was associated with a significantly lower score by -6.2 (95% CI, -11.8 to -0.6) points on the Bayley Scales of Infant and Toddler Development-III Motor subscale compared with unexposed infants. CONCLUSIONS POE was associated with severe PWML; this outcome may be a direct effect of POE rather than being mediated by premature birth. POE was also associated with worse motor development. Continued follow-up to understand the long-term effects of POE is warranted.
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Affiliation(s)
- E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH.
| | - Venkata Sita Priyanka Illapani
- Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Stephanie L Merhar
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH; Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Beth Kline-Fath
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH; Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Nusrat Harun
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Lili He
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH; Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Nehal A Parikh
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH; Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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2
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Mehollin-Ray AR, Stover S, Cassady CI, Zhang B, Calvo-Garcia M, Kline-Fath B. Using MRI-derived observed-to-expected total fetal lung volume to predict lethality in fetal skeletal dysplasia. Pediatr Radiol 2024; 54:43-48. [PMID: 38052986 DOI: 10.1007/s00247-023-05825-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Pulmonary hypoplasia is the primary cause of perinatal death in lethal skeletal dysplasias. The antenatal ultrasound correlates for lethality are indirect, measuring the thorax (thoracic circumference, TC) or femur compared to the abdomen (TC/AC, FL/AC). A single study has correlated lethality with the observed-to-expected total lung volume (O/E-TFLV) on fetal MRI in 23 patients. OBJECTIVE Our aim was to define a cutoff value to predict lethality more specifically using MRI-derived O/E-TFLV. MATERIALS AND METHODS Two large fetal center databases were searched for fetuses with skeletal dysplasia and MRI; O/E-TFLV was calculated. Ultrasound measures were included when available. Each was evaluated as a continuous variable against lethality (stillbirth or death in the first month of life). Logistic regression and receiver operating characteristic (ROC) curve analyses evaluated the prediction ability. AUC, sensitivity, and specificity were calculated. P < 0.05 was considered statistically significant. RESULTS A total of 80 fetuses met inclusion criteria. O/E-TFLV < 0.49 was a significant risk factor in predicting lethality, with sensitivity and specificity of 0.63 and 0.93, respectively, and an AUC of 0.81 (P < 0.001). FL/AC < 0.129 was also a strong variable with sensitivity, specificity, and AUC of 0.73, 0.88, and 0.78, respectively (P < 0.001). TC/AC and TC percentile were not significant risk factors for lethality. An O/E-TFLV of < 0.38 defines a specificity for lethality at 1.00. CONCLUSION MRI-derived O/E-TFLV and US-derived FL/AC are significant predictors of lethality in fetuses with skeletal dysplasia. When prognosis is uncertain after ultrasound, calculation of MRI-derived O/E-TFLV may provide additional useful information for prognosis and delivery planning.
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Affiliation(s)
- Amy R Mehollin-Ray
- Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, 1405 Clifton Rd NE, Atlanta, GA, 30322, USA.
- E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, TX, USA.
| | - Samantha Stover
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christopher I Cassady
- E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, TX, USA
- Department of Radiology, Starship Children's Hospital, Auckland, New Zealand
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Maria Calvo-Garcia
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Beth Kline-Fath
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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3
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Tabacaru C, Braimah A, Kline-Fath B, Parikh N, Merhar S. Diffusion Tensor Imaging to Predict Neurodevelopmental Impairment in Infants after Hypoxic-Ischemic Injury. Am J Perinatol 2023. [PMID: 37040878 DOI: 10.1055/a-2071-3057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) is the standard of care for evaluation of brain injury after hypoxic-ischemic encephalopathy (HIE) in term newborns. This study utilizes diffusion tensor imaging (DTI) to (1) identify infants at highest risk of development of cerebral palsy (CP) following HIE and to (2) identify regions of the brain critical to normal fidgety general movements (GMs) at 3 to 4 months of postterm. Absence of these normal, physiological movements is highly predictive of CP. STUDY DESIGN Term infants treated with hypothermia for HIE from January 2017 to December 2021 were consented for participation and had brain MRI with DTI after rewarming. The Prechtl's General Movements Assessment was performed at 12 to 16 weeks of age. Structural MRIs were reviewed for abnormalities, and DTI data were processed with the FMRIB Software Library. Infants underwent the Bayley Scales of Infant and Toddler Development III test at 24 months. RESULTS Forty-five infant families were consented; three infants died prior to MRI and were excluded, and a fourth infant was excluded due to diagnosis of a neuromuscular disorder. Twenty-one infants were excluded due to major movement artifact on diffusion images. Ultimately, 17 infants with normal fidgety GMs were compared with 3 infants with absent fidgety GMs with similar maternal and infant characteristics. Infants with absent fidgety GMs had decreased fractional anisotropy of several important white matter tracts, including the posterior limb of the internal capsule, optic radiations, and corpus callosum (p < 0.05). All three infants with absent fidgety GMs and two with normal GMs went on to be diagnosed with CP. CONCLUSION This study identifies white matter tracts of the brain critical to development of normal fidgety GMs in infants at 3 to 4 months of postterm using advanced MRI techniques. These findings identify those at highest risk for CP among infants with moderate/severe HIE prior to hospital discharge. KEY POINTS · HIE has devastating impacts on families and infants.. · Diffusion MRI identifies infants at highest risk for developing neurodevelopmental impairment.. · Normal general movements of infancy are generated by key white matter tracts..
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Affiliation(s)
- Christa Tabacaru
- Department of Neonatal-Perinatal Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Adebayo Braimah
- Department of Radiology, Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Beth Kline-Fath
- Department of Radiology, Fetal and Neonatal Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Nehal Parikh
- Department of Neonatal-Perinatal Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Stephanie Merhar
- Department of Neonatal-Perinatal Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Kline JE, Dudley J, Illapani VSP, Li H, Kline-Fath B, Tkach J, He L, Yuan W, Parikh NA. Diffuse excessive high signal intensity in the preterm brain on advanced MRI represents widespread neuropathology. Neuroimage 2022; 264:119727. [PMID: 36332850 PMCID: PMC9908008 DOI: 10.1016/j.neuroimage.2022.119727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
Preterm brains commonly exhibit elevated signal intensity in the white matter on T2-weighted MRI at term-equivalent age. This signal, known as diffuse excessive high signal intensity (DEHSI) or diffuse white matter abnormality (DWMA) when quantitatively assessed, is associated with abnormal microstructure on diffusion tensor imaging. However, postmortem data are largely lacking and difficult to obtain, and the pathological significance of DEHSI remains in question. In a cohort of 202 infants born preterm at ≤32 weeks gestational age, we leveraged two newer diffusion MRI models - Constrained Spherical Deconvolution (CSD) and neurite orientation dispersion and density index (NODDI) - to better characterize the macro and microstructural properties of DWMA and inform the ongoing debate around the clinical significance of DWMA. With increasing DWMA volume, fiber density broadly decreased throughout the white matter and fiber cross-section decreased in the major sensorimotor tracts. Neurite orientation dispersion decreased in the centrum semiovale, corona radiata, and temporal lobe. These findings provide insight into DWMA's biological underpinnings and demonstrate that it is a serious pathology.
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Affiliation(s)
- Julia E Kline
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Jon Dudley
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Venkata Sita Priyanka Illapani
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Hailong Li
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Beth Kline-Fath
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Jean Tkach
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Lili He
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Weihong Yuan
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Nehal A Parikh
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
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Abstract
Pediatric radiology is the only specialty in radiology that is near evenly distributed among genders. Yet the top leadership positions in the field are still mostly occupied by men. In this article we review some of the history of women in pediatric radiology and discuss how to improve women's participation in the highest positions of our subspecialty.
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Affiliation(s)
- Teresa Victoria
- Radiology Department, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA.
| | - Beth Kline-Fath
- Radiology Department, Cincinnati Children’s Hospital, Cincinnati, OH USA
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6
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Venkatesan C, Kline-Fath B, Horn PS, Poisson KE, Hopkin R, Nagaraj UD. Short- and Long-Term Outcomes of Prenatally Diagnosed Dandy-Walker Malformation, Vermian Hypoplasia, and Blake Pouch Cyst. J Child Neurol 2021; 36:1111-1119. [PMID: 34757866 DOI: 10.1177/08830738211049115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dandy-Walker continuum, which includes Dandy-Walker malformation, vermian hypoplasia, and Blake pouch cyst, is among the most commonly diagnosed posterior fossa malformation by fetal magnetic resonance imaging (MRI). The objective of our retrospective study was to evaluate fetal and postnatal MRI scan and clinical outcomes. Seventy-two patients were identified; 40 patients had postnatal imaging and follow-up (7 Dandy-Walker malformation, 26 vermian hypoplasia, and 7 Blake pouch cyst). Although all patients with Dandy-Walker malformation required ventriculoperitoneal shunts and 66% were intubated at birth, none required tracheostomy tube and 2 of 5 surviving children had no neurologic deficits. Vermian hypoplasia was strongly associated with genetic conditions and cardiac malformations; odds of not ambulating normally were 12 times greater if a syndrome or injury was present. Echocardiogram and genetic screening are recommended with vermian hypoplasia. There is a risk for epilepsy in both Dandy-Walker malformation and vermian hypoplasia. Blake pouch cyst can be complicated by hydrocephalus, but outcome is favorable.
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Affiliation(s)
- Charu Venkatesan
- Division of Neurology, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Beth Kline-Fath
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Radiology and Medical Imaging, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Paul S Horn
- Division of Neurology, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kelsey E Poisson
- Division of Neurology, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rob Hopkin
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Human Genetics, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Usha D Nagaraj
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Radiology and Medical Imaging, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA
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7
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Harpster K, Merhar S, Priyanka Illapani VS, Peyton C, Kline-Fath B, Parikh NA. Associations Between Early Structural Magnetic Resonance Imaging, Hammersmith Infant Neurological Examination, and General Movements Assessment in Infants Born Very Preterm. J Pediatr 2021; 232:80-86.e2. [PMID: 33453201 PMCID: PMC8084906 DOI: 10.1016/j.jpeds.2020.12.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate the prevalence and associations between structural magnetic resonance imaging (sMRI) injury/abnormality at term-equivalent age and absent fidgety General Movements Assessment (GMA) and abnormal Hammersmith Infant Neurological Examination (HINE) scores among infants born very preterm at 3-4 months of corrected age. STUDY DESIGN This prospective cohort study enrolled 392 infants born ≤2 weeks of gestation from 5 neonatal intensive care units in the greater Cincinnati area between September 2016 and October 2019. Infants completed sMRI at term-equivalent age and GMA and HINE at 3-4 months of corrected age. All assessors were blinded. RESULTS Of 392 infants, 375 (96%) had complete data. Of these, 44 (12%) exhibited moderate or severe brain abnormalities, 17 (4.5%) had abnormal GMA, and 77 (20.3%) had abnormal HINE. Global and regional abnormality scores on sMRI were significantly correlated with GMA (R2 range 0.05-0.17) and HINE at 3-4 months of corrected age (R2 range 0.01-0.17). These associations remained significant in multivariable analyses after adjusting for gestational age and sex. There was a significant but low correlation (R2 0.14) between GMA and HINE. CONCLUSIONS We observed a low prevalence of moderate or severe brain abnormalities in survivors born very preterm in this geographically defined cohort. The much greater prevalence of abnormal motor examination on the HINE compared with GMA and their low correlation suggests that these tests evaluate different constructs and, thus, should be used in combination with sMRI rather than interchangeably.
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Affiliation(s)
- Karen Harpster
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Rehabilitation, Exercise, and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH.
| | - Stephanie Merhar
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | | | - Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences and Department of Pediatrics, Northwestern University, Chicago, IL
| | - Beth Kline-Fath
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, University of Cincinnati, Cincinnati, OH
| | - Nehal A Parikh
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH
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8
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Wisnowski JL, Bluml S, Panigrahy A, Mathur AM, Berman J, Chen PSK, Dix J, Flynn T, Fricke S, Friedman SD, Head HW, Ho CY, Kline-Fath B, Oveson M, Patterson R, Pruthi S, Rollins N, Ramos YM, Rampton J, Rusin J, Shaw DW, Smith M, Tkach J, Vasanawala S, Vossough A, Whitehead MT, Xu D, Yeom K, Comstock B, Heagerty PJ, Juul SE, Wu YW, McKinstry RC. Integrating neuroimaging biomarkers into the multicentre, high-dose erythropoietin for asphyxia and encephalopathy (HEAL) trial: rationale, protocol and harmonisation. BMJ Open 2021; 11:e043852. [PMID: 33888528 PMCID: PMC8070884 DOI: 10.1136/bmjopen-2020-043852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION MRI and MR spectroscopy (MRS) provide early biomarkers of brain injury and treatment response in neonates with hypoxic-ischaemic encephalopathy). Still, there are challenges to incorporating neuroimaging biomarkers into multisite randomised controlled trials. In this paper, we provide the rationale for incorporating MRI and MRS biomarkers into the multisite, phase III high-dose erythropoietin for asphyxia and encephalopathy (HEAL) Trial, the MRI/S protocol and describe the strategies used for harmonisation across multiple MRI platforms. METHODS AND ANALYSIS Neonates with moderate or severe encephalopathy enrolled in the multisite HEAL trial undergo MRI and MRS between 96 and 144 hours of age using standardised neuroimaging protocols. MRI and MRS data are processed centrally and used to determine a brain injury score and quantitative measures of lactate and n-acetylaspartate. Harmonisation is achieved through standardisation-thereby reducing intrasite and intersite variance, real-time quality assurance monitoring and phantom scans. ETHICS AND DISSEMINATION IRB approval was obtained at each participating site and written consent obtained from parents prior to participation in HEAL. Additional oversight is provided by an National Institutes of Health-appointed data safety monitoring board and medical monitor. TRIAL REGISTRATION NUMBER NCT02811263; Pre-result.
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Affiliation(s)
- Jessica L Wisnowski
- Radiology, Children's Hospital of Los Angeles, Los Angeles, California, USA
- Pediatrics, Children's Hospital Los Angeles Division of Neonatology, Los Angeles, California, USA
| | - Stefan Bluml
- Radiology, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Ashok Panigrahy
- Radiology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Amit M Mathur
- Pediatrics, Division of Neonatal-Perinatal Medicine, SSM Health Cardinal Glennon Children's Hospital, Saint Louis, Missouri, USA
- Pediatrics, Division of Neonatal-Perinatal Medicine, Saint Louis University, Saint Louis, Missouri, USA
| | - Jeffrey Berman
- Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - James Dix
- Radiology, Methodist Children's Hospital, San Antonio, Texas, USA
| | - Trevor Flynn
- Radiology, University of California San Francisco, San Francisco, California, USA
| | - Stanley Fricke
- Radiology, Children's National Medical Center, Washington, District of Columbia, USA
- Radiology, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Seth D Friedman
- Radiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Hayden W Head
- Radiology, Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Chang Y Ho
- Radiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Beth Kline-Fath
- Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Michael Oveson
- Radiology, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Richard Patterson
- Radiology, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA
| | - Sumit Pruthi
- Radiology, Vanderbilt University, Nashville, Tennessee, USA
| | - Nancy Rollins
- Radiology, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Yanerys M Ramos
- Radiology, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA
| | - John Rampton
- Radiology, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Jerome Rusin
- Radiology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Dennis W Shaw
- Radiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Mark Smith
- Radiology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jean Tkach
- Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Arastoo Vossough
- Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Matthew T Whitehead
- Radiology, Children's National Medical Center, Washington, District of Columbia, USA
| | - Duan Xu
- Radiology, University of California San Francisco, San Francisco, California, USA
| | - Kristen Yeom
- Radiology, Stanford University, Stanford, California, USA
| | - Bryan Comstock
- Biostatistics, University of Washington, Seattle, Washington, USA
| | - Patrick J Heagerty
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Sandra E Juul
- Pediatrics, Division of Neonatology, University of Washington, Seattle, Washington, USA
| | - Yvonne W Wu
- Neurology, University of California San Francisco, San Francisco, California, USA
| | - Robert C McKinstry
- Radiology, St. Louis Children's Hospital and Washington University, Saint Louis, Missouri, USA
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9
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Riddle A, Nagaraj U, Hopkin RJ, Kline-Fath B, Venkatesan C. Fetal Magnetic Resonance Imaging (MRI) in Holoprosencephaly and Associations With Clinical Outcome: Implications for Fetal Counseling. J Child Neurol 2021; 36:357-364. [PMID: 33226281 DOI: 10.1177/0883073820972290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Holoprosencephaly is the most common malformation of forebrain development and includes a wide spectrum of severity. The objective of this retrospective study was to evaluate fetal magnetic resonance imaging (MRI) associations with outcome. Of the 63 cases identified on antenatal ultrasonography, 28 cases were confirmed on fetal MRI. There were 17 live births; 9 patients died within the first month of life. There were 7 survivors. The vast majority were nonambulatory and required feeding support; none required respiratory support. We found that presence and number of non-holoprosencephaly-associated malformations was also associated with survival. Of 5 patients with 3 or more systemic anomalies, 4 died regardless of holoprosencephaly subtype and 1 was lost to follow-up. Patients with suspected holoprosencephaly on ultrasonography should have full body fetal MRI and echocardiogram to better evaluate systemic anomalies. Counseling should involve pediatric palliative care services to prepare families in caring for babies with limited life span.
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Affiliation(s)
- Artur Riddle
- Division of Neurology, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA.,Division of Human Genetics, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Pediatric Neurology, 6684Oregon Health & Science University, Portland, OR, USA
| | - Usha Nagaraj
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Radiology and Medical Imaging, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Robert J Hopkin
- Division of Human Genetics, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Beth Kline-Fath
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Radiology and Medical Imaging, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Charu Venkatesan
- Division of Neurology, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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10
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Merhar SL, Parikh NA, Braimah A, Poindexter BB, Tkach J, Kline-Fath B. White Matter Injury and Structural Anomalies in Infants with Prenatal Opioid Exposure. AJNR Am J Neuroradiol 2019; 40:2161-2165. [PMID: 31624119 DOI: 10.3174/ajnr.a6282] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/03/2019] [Indexed: 01/24/2023]
Abstract
Previous studies have not found structural injury or brain malformations in infants and children with prenatal opioid exposure. As part of an ongoing study evaluating neuroimaging in infants with prenatal opioid exposure, we reviewed structural brain MR imaging in 20 term infants with prenatal opioid exposure and 20 term controls at 4-8 weeks of age. We found that 8 of the 20 opioid-exposed infants had punctate white matter lesions or white matter signal abnormality on structural MR imaging, and 2 of the opioid-exposed infants had a septopreoptic fusion anomaly. No controls had white matter injury or structural malformations. Our findings underscore the importance of clinical neurodevelopmental follow-up and the need for more comprehensive imaging and long-term outcomes research following prenatal opioid exposure.
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Affiliation(s)
- S L Merhar
- From the Perinatal Institute, Division of Neonatology (S.L.M., N.A.P., B.B.P.)
- Department of Pediatrics (S.L.M., N.A.P., B.B.P.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - N A Parikh
- From the Perinatal Institute, Division of Neonatology (S.L.M., N.A.P., B.B.P.)
- Department of Pediatrics (S.L.M., N.A.P., B.B.P.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - A Braimah
- Pediatric Neuroimaging Research Consortium (A.B.)
| | - B B Poindexter
- From the Perinatal Institute, Division of Neonatology (S.L.M., N.A.P., B.B.P.)
- Department of Pediatrics (S.L.M., N.A.P., B.B.P.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - J Tkach
- Department of Radiology (J.T., B.K.-F.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - B Kline-Fath
- Department of Radiology (J.T., B.K.-F.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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11
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Arroyo MS, Hopkin RJ, Nagaraj UD, Kline-Fath B, Venkatesan C. Fetal brain MRI findings and neonatal outcome of common diagnosis at a tertiary care center. J Perinatol 2019; 39:1072-1077. [PMID: 31213636 DOI: 10.1038/s41372-019-0407-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/10/2019] [Accepted: 05/10/2019] [Indexed: 11/09/2022]
Abstract
UNLABELLED Fetal Magnetic Resonance Imaging (MRI) is increasingly used in prenatal evaluations. OBJECTIVE Identify common brain malformations on fetal MRI and evaluate perinatal course. METHODS Fetal consultations from 10/2016 to 12/2017 reviewed. RESULTS Hundred consultations were requested; 94 were completed. Findings included: posterior fossa malformations (19%), agenesis/dysgenesis of corpus callosum (15%), congenital aqueductal stenosis (CAS) (14%), ventriculomegaly (11%), isolated cortical malformations (8.5%), and holoprosencephaly (6%). Posterior fossa malformations were more likely to be associated with genetic conditions and cardiac malformations. Patients with CAS all required intensive care unit admission. Overall, few patients with congenital brain malformations required feeding or respiratory support at discharge. None had seizures as neonates except two with early epileptic encephalopathy syndromes. CONCLUSIONS Even though long term neurological prognosis is poor for many conditions including high lifetime risk of epilepsy, most are discharged with no feeding or respiratory support. Seizures are rarely seen in the neonatal period.
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Affiliation(s)
- Monica S Arroyo
- Division of Neurology, Cincinnati Children's Hospital, Cincinnati, OH, USA.,Division of Pediatric Neurology, Joe DiMaggio Children's Hospital, Hollywood, CA, USA
| | - Robert J Hopkin
- Division of Human Genetics, Cincinnati Children's Hospital, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Usha D Nagaraj
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Radiology and Medical Imaging, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Beth Kline-Fath
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Radiology and Medical Imaging, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Charu Venkatesan
- Division of Neurology, Cincinnati Children's Hospital, Cincinnati, OH, USA. .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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12
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Dwivedi D, Lin N, Venkatesan C, Kline-Fath B, Holland K, Schapiro M. Clinical, Neuroimaging, and Electrographic Predictors of Phenobarbital Failure in Newborns With Hypoxic Ischemic Encephalopathy and Seizures. J Child Neurol 2019; 34:458-463. [PMID: 30966848 DOI: 10.1177/0883073819838171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many neonates with hypoxic ischemic encephalopathy and seizures do not respond to the first line antiepileptic drug, phenobarbital. Little is known about what factors are associated with its failure. OBJECTIVE To examine factors associated with failure of phenobarbital therapy in neonates with hypoxic ischemic encephalopathy and seizures. DESIGN/METHODS A single-center retrospective review of 50 term (>35 weeks) neonates with hypoxic ischemic encephalopathy and seizures treated with phenobarbital as the first-line antiepileptic. Neonates were classified into either responders (n = 30) or nonresponders (n = 20). Nonresponse was defined as continued seizures after maximum dosing of phenobarbital or an additional antiepileptic. Subjects with acceptable magnetic resonance imaging (MRI) scans obtained within 2 weeks of birth were included in the study and rated using an MRI injury scoring system. Charts were reviewed for demographic, clinical, and laboratory variables. Resuscitation and seizure scores were also calculated. Electroencephalographic (EEG) background activity was reviewed in 2 different time epochs (12-24 hours and 24-36 hours of life) and graded as per ACNS guidelines. RESULTS There were no significant group differences in demographic, clinical, and laboratory variables except nonresponders, who had higher mean seizure score (P = .01) and significantly more injury on MRI scan for white matter (P = .004), parenchymal cortex (P = .027), and watershed (P = .009) regions. Neonates with moderately abnormal or severely abnormal background EEG responded poorly to phenobarbital. CONCLUSION In the presence of above factors, one can anticipate that additional antiepileptic medication may be needed. These data also support that larger studies should be done to look prospectively at using alternative agents first line in patients with severe injury.
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Affiliation(s)
- Deepak Dwivedi
- 1 Department of Paediatrics, SS Medical College, Rewa, Madhya Pradesh, India
| | - Nan Lin
- 2 Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Charu Venkatesan
- 2 Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - B Kline-Fath
- 3 Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Katherine Holland
- 2 Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mark Schapiro
- 2 Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,4 Department of Paediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA
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13
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DiStasio A, Driver A, Sund K, Donlin M, Muraleedharan RM, Pooya S, Kline-Fath B, Kaufman KM, Prows CA, Schorry E, Dasgupta B, Stottmann RW. Copb2 is essential for embryogenesis and hypomorphic mutations cause human microcephaly. Hum Mol Genet 2017; 26:4836-4848. [PMID: 29036432 PMCID: PMC5886270 DOI: 10.1093/hmg/ddx362] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 11/13/2022] Open
Abstract
Primary microcephaly is a congenital brain malformation characterized by a head circumference less than three standard deviations below the mean for age and sex and results in moderate to severe mental deficiencies and decreased lifespan. We recently studied two children with primary microcephaly in an otherwise unaffected family. Exome sequencing identified an autosomal recessive mutation leading to an amino acid substitution in a WD40 domain of the highly conserved Coatomer Protein Complex, Subunit Beta 2 (COPB2). To study the role of Copb2 in neural development, we utilized genome-editing technology to generate an allelic series in the mouse. Two independent null alleles revealed that Copb2 is essential for early stages of embryogenesis. Mice homozygous for the patient variant (Copb2R254C/R254C) appear to have a grossly normal phenotype, likely due to differences in corticogenesis between the two species. Strikingly, mice heterozygous for the patient mutation and a null allele (Copb2R254C/Zfn) show a severe perinatal phenotype including low neonatal weight, significantly increased apoptosis in the brain, and death within the first week of life. Immunostaining of the Copb2R254C/Zfnbrain revealed a reduction in layer V (CTIP2+) neurons, while the overall cell density of the cortex is unchanged. Moreover, neurospheres derived from animals with Copb2 variants grew less than control. These results identify a general requirement for COPB2 in embryogenesis and a specific role in corticogenesis. We further demonstrate the utility of CRISPR-Cas9 generated mouse models in the study of potential pathogenicity of variants of potential clinical interest.
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Affiliation(s)
- Andrew DiStasio
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Ashley Driver
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Kristen Sund
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Milene Donlin
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Ranjith M Muraleedharan
- Division of Hematology and Oncology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Shabnam Pooya
- Division of Hematology and Oncology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Beth Kline-Fath
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Kenneth M Kaufman
- Division of Rheumatology and Center for Autoimmune Genomics and Etiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Cynthia A Prows
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Division of Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Elizabeth Schorry
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Biplab Dasgupta
- Division of Hematology and Oncology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Rolf W Stottmann
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Division of Developmental Biology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
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14
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Barth R, Victoria T, Kline-Fath B, Estroff J. ISUOG Guidelines for fetal MRI: a response to 3-T fetal imaging and limited fetal exams. Ultrasound Obstet Gynecol 2017; 50:804-805. [PMID: 29205584 DOI: 10.1002/uog.18946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/26/2017] [Indexed: 06/07/2023]
Affiliation(s)
- R Barth
- Stanford University School of Medicine, 725 Welch Road Rm. 1690, Stanford, CA, 94305-5654, USA
| | - T Victoria
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - B Kline-Fath
- Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - J Estroff
- Boston Children's Hospital, Boston, MA, USA
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15
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Nagaraj UD, Hopkin R, Schapiro M, Kline-Fath B. Prenatal and postnatal evaluation of polymicrogyria with band heterotopia. Radiol Case Rep 2017; 12:602-605. [PMID: 28828134 PMCID: PMC5551996 DOI: 10.1016/j.radcr.2017.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/13/2017] [Accepted: 04/26/2017] [Indexed: 11/25/2022] Open
Abstract
The coexistence of band heterotopia and polymicrogyria is extremely rare though it has been reported in the presence of corpus callosum anomalies and megalencephaly. We present prenatal and postnatal MRI findings of a rare case of diffuse cortical malformation characterized by polymicrogyria and band heterotopia. Agenesis of the corpus callosum and megalencephaly were also noted. In addition, bilateral closed-lip schizencephaly was identified on postnatal MRI, which has not been previously reported with this combination of imaging findings. Polymicrogyria with band heterotopia can occur and can be diagnosed with fetal MRI. The coexistence of corpus callosum anomalies and megalencephaly comprises a rare phenotype that has been previously described, suggesting an underlying genetic abnormality.
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Affiliation(s)
- Usha D Nagaraj
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Robert Hopkin
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mark Schapiro
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Beth Kline-Fath
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
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16
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Haws ME, Linscott L, Thomas C, Orscheln E, Radhakrishnan R, Kline-Fath B. A Retrospective Analysis of the Utility of Head Computed Tomography and/or Magnetic Resonance Imaging in the Management of Benign Macrocrania. J Pediatr 2017; 182:283-289.e1. [PMID: 27989412 DOI: 10.1016/j.jpeds.2016.11.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/27/2016] [Accepted: 11/08/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess whether computed tomography (CT), magnetic resonance imaging (MRI), and neurosurgical evaluations altered the diagnosis or management of children diagnosed with benign macrocrania of infancy by ultrasonography (US). STUDY DESIGN We queried our radiology database to identify patients diagnosed with benign macrocrania of infancy by US between 2006 and 2013. Medical records of those with follow-up CT/MRI were reviewed to determine clinical/neurologic status and whether or not CT/MRI imaging resulted in diagnosis of communicating hydrocephalus or required neurosurgical intervention. RESULTS Patients with benign macrocrania of infancy (n = 466) were identified (mean age at diagnosis: 6.5 months). Eighty-four patients (18.0%) received subsequent head CT/MRI; of these, 10 patients had neurologic abnormalities before 2 years of age, of which 3 had significant findings on MRI (temporal lobe white matter changes, dysmorphic ventricles, thinned corpus callosum). One patient without neurologic abnormalities had nonspecific white matter signal abnormality (stable over 6 months) but no change in management. None required neurosurgical intervention. Another 9/84 patients had incidental findings including Chiari I (3), small subdural bleeds (2), arachnoid cyst (1), small cavernous malformation (1), frontal bone dermoid (1), and a linear parietal bone fracture after a fall (1). CONCLUSIONS Children diagnosed with benign macrocrania of infancy on US without focal neurologic findings do not require subsequent brain CT/MRI or neurosurgical evaluation. Decreasing unnecessary imaging would decrease costs, minimize radiation and sedation exposures, and increase clinic availability of neurology and neurosurgery specialists.
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Affiliation(s)
- M Edward Haws
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Luke Linscott
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Cameron Thomas
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | | | - Beth Kline-Fath
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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17
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Radhakrishnan R, Merhar S, Meinzen-Derr J, Haberman B, Lim FY, Burns P, Zorn E, Kline-Fath B. Correlation of MRI Brain Injury Findings with Neonatal Clinical Factors in Infants with Congenital Diaphragmatic Hernia. AJNR Am J Neuroradiol 2016; 37:1745-51. [PMID: 27151752 DOI: 10.3174/ajnr.a4787] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 02/24/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Infants with congenital diaphragmatic hernia are reported to have evidence of brain MR imaging abnormalities. Our study aimed to identify perinatal clinical factors in infants with congenital diaphragmatic hernia that are associated with evidence of brain injury on MR imaging performed before hospital discharge. MATERIALS AND METHODS MRIs performed before hospital discharge in infants with congenital diaphragmatic hernia were scored for brain injury by 2 pediatric neuroradiologists. Perinatal variables and clinical variables from the neonatal intensive care unit stay were analyzed for potential associations with brain MR imaging findings. RESULTS Fifty-three infants with congenital diaphragmatic hernia (31 boys) were included. At least 1 abnormality was seen on MR imaging in 32 infants (60%). The most common MR imaging findings were enlarged extra-axial spaces (36%), intraventricular hemorrhage (23%), ventriculomegaly (19%), white matter injury (17%), and cerebellar hemorrhage (17%). The MR imaging brain injury score was associated with extracorporeal membrane oxygenation (P = .0001), lack of oral feeding at discharge (P = .012), use of inotropes (P = .027), and gastrostomy tube placement before hospital discharge (P = .024). The MR imaging brain injury score was also associated with a large diaphragmatic defect size (P = .011). CONCLUSIONS Most infants with congenital diaphragmatic hernia have at least 1 abnormality identified on MR imaging of the brain performed before discharge. The main predictors of brain injury in this population are a requirement for extracorporeal membrane oxygenation, large diaphragmatic defect size, and lack of oral feeding at discharge.
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Affiliation(s)
| | - S Merhar
- Perinatal Institute (S.M., B.H.), Division of Neonatology
| | | | - B Haberman
- Perinatal Institute (S.M., B.H.), Division of Neonatology
| | - F Y Lim
- Fetal Care Center (F.Y.L., P.B.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - P Burns
- Fetal Care Center (F.Y.L., P.B.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - B Kline-Fath
- From the Departments of Radiology (R.R., B.K.-F.)
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18
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Tkach J, Merhar S, Kline-Fath B. Premature white matter disease. J Pediatr Neuroradiol 2015. [DOI: 10.3233/pnr-13044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jean Tkach
- Departments of Radiology and Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Stephanie Merhar
- Divisions of Neonatology and Pulmonary Biology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Beth Kline-Fath
- Departments of Radiology and Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
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19
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Coleman A, Kline-Fath B, Stanek J, Lim FY. Pleuropulmonary Blastoma in a Neonate Diagnosed Prenatally as Congenital Pulmonary Airway Malformation. Fetal Diagn Ther 2015; 39:234-7. [DOI: 10.1159/000365352] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 06/11/2014] [Indexed: 11/19/2022]
Abstract
Pleuropulmonary blastoma is an extremely rare lung neoplasm exclusive to children under 5 years of age. It presents a diagnostic challenge both prenatally and in early childhood due to its similarity to benign lung cysts, which are managed differently. We present the first case, to our knowledge, of a neonate with pleuropulmonary blastoma and myelomeningocele, though prenatally diagnosed as a congenital pulmonary airway malformation. We detail the prenatal imaging that facilitated counseling and delivery management in addition to the correlating postnatal imaging.
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20
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Phithakwatchara N, Coleman A, Peiro JL, Lee AE, Keswani SG, Kline-Fath B, Lim FY, Shaaban AF. Differential patterns of prenatal ipsilateral and contralateral lung growth in cases of isolated left-sided congenital diaphragmatic hernia. Prenat Diagn 2015; 35:769-76. [DOI: 10.1002/pd.4605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 03/01/2015] [Accepted: 04/14/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Nisarat Phithakwatchara
- Cincinnati Fetal Center; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology; Faculty of Medicine Siriraj Hospital; Bangkok Thailand
| | - Alan Coleman
- Cincinnati Fetal Center; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Pediatric General and Thoracic Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Jose L. Peiro
- Cincinnati Fetal Center; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Pediatric General and Thoracic Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Amanda E. Lee
- Cincinnati Fetal Center; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Pediatric General and Thoracic Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Sundeep G. Keswani
- Cincinnati Fetal Center; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Pediatric General and Thoracic Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Beth Kline-Fath
- Cincinnati Fetal Center; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Pediatric Radiology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Foong-Yen Lim
- Cincinnati Fetal Center; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Pediatric General and Thoracic Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Aimen F. Shaaban
- Cincinnati Fetal Center; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Pediatric General and Thoracic Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
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21
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Abstract
Magnetic resonance imaging (MRI) evaluation of the developing brain has dramatically increased over the last decade. Faster acquisitions and the development of advanced MRI sequences, such as magnetic resonance spectroscopy (MRS), diffusion tensor imaging (DTI), perfusion imaging, functional MR imaging (fMRI), and susceptibility-weighted imaging (SWI), as well as the use of higher magnetic field strengths has made MRI an invaluable tool for detailed evaluation of the developing brain. This article will provide an overview of the use and challenges associated with 1.5-T and 3-T static magnetic fields for evaluation of the developing brain. This review will also summarize the advantages, clinical challenges, and safety concerns specifically related to MRI in the fetus and newborn, including the implications of increased magnetic field strength, logistics related to transporting and monitoring of neonates during scanning, and sedation considerations, and a discussion of current technologies such as MRI conditional neonatal incubators and dedicated small-foot print neonatal intensive care unit (NICU) scanners.
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Affiliation(s)
- Shannon Tocchio
- Pediatric Imaging Research Center, Department of Radiology Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Beth Kline-Fath
- Department of Radiology Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Emanuel Kanal
- Director, Magnetic Resonance Services; Professor of Neuroradiology; Department of Radiology, University of Pittsburgh Medical Center (UPMC)
| | - Vincent J. Schmithorst
- Pediatric Imaging Research Center, Department of Radiology Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ashok Panigrahy
- Pediatric Imaging Research Center, Department of Radiology Children׳s Hospital of Pittsburgh of UPMC, University of Pittsburgh Medical Center, Pittsburgh, PA.
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22
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Coleman A, Phithakwatchara N, Shaaban A, Keswani S, Kline-Fath B, Kingma P, Haberman B, Lim FY. Fetal lung growth represented by longitudinal changes in MRI-derived fetal lung volume parameters predicts survival in isolated left-sided congenital diaphragmatic hernia. Prenat Diagn 2014; 35:160-6. [DOI: 10.1002/pd.4510] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 09/04/2014] [Accepted: 09/26/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Alan Coleman
- Cincinnati Fetal Center; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Pediatric, General and Thoracic Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Nisarat Phithakwatchara
- Cincinnati Fetal Center; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine; Siriraj Hospital; Bangkok Thailand
| | - Aimen Shaaban
- Cincinnati Fetal Center; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Pediatric, General and Thoracic Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Sundeep Keswani
- Cincinnati Fetal Center; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Pediatric, General and Thoracic Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Beth Kline-Fath
- Cincinnati Fetal Center; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Pediatric Radiology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Paul Kingma
- Cincinnati Fetal Center; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Neonatology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Beth Haberman
- Division of Neonatology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Foong-Yen Lim
- Cincinnati Fetal Center; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine; Siriraj Hospital; Bangkok Thailand
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23
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Phithakwatchara N, Coleman A, Peiro JL, Lee AE, Keswani SG, Kline-Fath B, Lim FY, Shaaban AF. Expanded intrathoracic space in fetal cases of isolated congenital diaphragmatic hernia contributes to disparity between percent predicted lung volume and observed to expected total lung volume. Prenat Diagn 2014; 35:154-9. [DOI: 10.1002/pd.4508] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 09/24/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Nisarat Phithakwatchara
- Cincinnati Fetal Center; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology; Faculty of Medicine Siriraj Hospital; Bangkok Thailand
| | - Alan Coleman
- Cincinnati Fetal Center; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Pediatric, General and Thoracic Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Jose L. Peiro
- Cincinnati Fetal Center; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Pediatric, General and Thoracic Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Amanda E. Lee
- Cincinnati Fetal Center; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Pediatric, General and Thoracic Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Sundeep G. Keswani
- Cincinnati Fetal Center; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Pediatric, General and Thoracic Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Beth Kline-Fath
- Cincinnati Fetal Center; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Pediatric Radiology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Foong-Yen Lim
- Cincinnati Fetal Center; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Pediatric, General and Thoracic Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Aimen F. Shaaban
- Cincinnati Fetal Center; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Pediatric, General and Thoracic Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
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Weaver KN, Johnson J, Kline-Fath B, Zhang X, Lim FY, Tinkle B, Saal HM, Hopkin RJ. Predictive value of fetal lung volume in prenatally diagnosed skeletal dysplasia. Prenat Diagn 2014; 34:1326-31. [PMID: 25102973 DOI: 10.1002/pd.4475] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/23/2014] [Accepted: 08/02/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Pulmonary hypoplasia is a major cause of death in lethal skeletal dysplasias. We hypothesize that in fetuses with prenatally diagnosed skeletal dysplasia, comparison of observed-to-expected (O/E) lung volume will help predict lethality. STUDY DESIGN We conducted a retrospective chart review of patients referred for evaluation of suspected fetal skeletal anomalies. Twenty-three pregnancies were identified with confirmed fetal diagnosis of skeletal dysplasia for which fetal magnetic resonance imaging (MRI) was performed between 21 and 38 weeks of gestation and ultrasound biometry data were available. Femur length to abdominal circumference ratio (FL/AC) and O/E lung volumes were calculated. The association between O/E lung volume, FL/AC, and lethality was measured using logistic regression. RESULTS Lethality was significantly associated with O/E lung volume (p = 0.002) and FL/AC (p = 0.0476). Analysis with receiver-operating characteristic curves suggested that O/E lung volume of 47.9% or FL/AC of 0.124 could be useful clinical cutoffs in the prediction of lethality. CONCLUSION In fetuses with skeletal dysplasia, fetal MRI-derived O/E lung volume was predictive of lethality. When evaluating a fetal skeletal dysplasia, fetal MRI may be considered in cases for which ultrasound-based lethality prediction is ambiguous or uncertain in order to provide families with the most complete and accurate information.
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Affiliation(s)
- K Nicole Weaver
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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25
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Coleman A, Kline-Fath B, Keswani S, Lim F. Prenatal Solid Tumor Volume Index: Novel Prenatal Predictor of Adverse Outcome in Sacrococcygeal Teratoma. J Surg Res 2013. [DOI: 10.1016/j.jss.2012.10.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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26
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Wolfe K, Lewis D, Witte D, Kline-Fath B, Lim FY, Jaekle R, Habli M, Hostiuck J, Baregamian N, Keswani S, Crombleholme T. Fetal Cervical Teratoma: What Is the Role of Fetal MRI in Predicting Pulmonary Hypoplasia? Fetal Diagn Ther 2013; 33:252-6. [DOI: 10.1159/000342191] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 07/25/2012] [Indexed: 11/19/2022]
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27
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Singh S, Kline-Fath B, Bierbrauer K, Racadio JM, Salisbury S, Macaluso M, Jackson EC, Egelhoff JC. Comparison of standard, prone and cine MRI in the evaluation of tethered cord. Pediatr Radiol 2012; 42:685-91. [PMID: 22143965 DOI: 10.1007/s00247-011-2308-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 10/14/2011] [Accepted: 11/14/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Tethered cord syndrome (TCS) is defined by abnormal traction on the spinal cord that confines its movement. Surgical cord release usually stops neurological deterioration; therefore, early and accurate neuroradiological diagnosis is important. Supine MRI is the imaging modality of choice, but prone MRI and cine MRI can demonstrate cord movement. OBJECTIVE We compared the diagnostic accuracies of standard MRI, prone MRI and cine MRI in patients with clinical suspicion of TCS and evaluated inter-reader reliability for MR imaging. MATERIALS AND METHODS Children who underwent MRI for suspicion of TCS were retrospectively identified. Supine, prone and cine MRI studies were re-read by two pediatric neuroradiologists. Conus level, filum appearance and cord movement were documented. RESULTS Thirteen of 49 children had tethered cord documented at surgery. Conus level had the highest diagnostic accuracy (sensitivity 69-77%, specificity 94%, positive predictive value 82-83%, negative predictive value 89-92%, correct diagnosis 88-90%) and highest between-reader concordance (98%). Prone and cine MRI did not add to the accuracy of the supine imaging. CONCLUSION Conus level provides the highest diagnostic accuracy and inter-reader reliability in TCS. Until a larger series is evaluated, it remains questionable whether prone or cine MRI provides enough additional diagnostic information to warrant routine use.
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Affiliation(s)
- Sukhjinder Singh
- Department of Radiology, Cohen Children's Medical Center, New Hyde Park, NY, USA
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28
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Lee TC, Lim FY, Keswani SG, Frischer JS, Haberman B, Kingma PS, Habli M, Jaekle RK, Sharp G, Kline-Fath B, Rubio EI, Calvo M, Guimaraes C, Crombleholme TM. Late gestation fetal magnetic resonance imaging-derived total lung volume predicts postnatal survival and need for extracorporeal membrane oxygenation support in isolated congenital diaphragmatic hernia. J Pediatr Surg 2011; 46:1165-71. [PMID: 21683216 PMCID: PMC3870885 DOI: 10.1016/j.jpedsurg.2011.03.046] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 03/26/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Magnetic resonance imaging (MRI) has been used as an imaging modality to assess pulmonary hypoplasia in congenital diaphragmatic hernias (CDHs). The objective of this study was to determine if there is a correlation between late gestational fetal MRI-derived total lung volumes (TLVs) and CDH outcomes. METHODS From 2006 to 2009, 44 patients met criteria of an isolated CDH with a late gestational MRI evaluation. The prenatal TLV (in milliliters) was obtained between 32 and 34 weeks gestation. The measured study outcomes included survival, need for extracorporeal membrane oxygenation (ECMO), and length of stay. RESULTS There were 39 left and 5 right CDH patients. The average TLV was significantly lower for nonsurvivors (P = .01), and there was a significant association between lower TLV and the need for ECMO (P = .0001). When stratified by TLV, patients with a TLV of greater than 40 mL had a 90% survival vs 35% survival for a TLV of less than 20 mL. Furthermore, patients with a TLV greater than 40 mL had a lower rate of ECMO use (10%) than patients with a TLV of less than 20 mL (86%). Shorter length of stay was found to correlate with increasing TLV (P = .022). CONCLUSION Late gestation fetal MRI-derived TLV significantly correlates with postnatal survival and need for ECMO. Fetal MRI may be useful for the evaluation of patients who present late in gestation with a CDH.
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Affiliation(s)
- Timothy C. Lee
- The CDH Team, Division of Pediatric General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA
| | - Foong Y. Lim
- The CDH Team, Division of Pediatric General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA
| | - Sundeep G. Keswani
- The CDH Team, Division of Pediatric General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA
| | - Jason S. Frischer
- The CDH Team, Division of Pediatric General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA
| | - Beth Haberman
- Division of Neonatology, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA
| | - Paul S. Kingma
- Division of Neonatology, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA
| | - Mounira Habli
- Divisions of Maternal-Fetal Medicine, Good Samaritan Hospital and University Hospital, Cincinnati, OH 45229-3039, USA
| | - Ronald K. Jaekle
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH 45229-3039, USA
| | - Gina Sharp
- The CDH Team, Division of Pediatric General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA
| | - Beth Kline-Fath
- Division of Radiology, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA
| | - Eva I. Rubio
- Division of Radiology, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA
| | - Maria Calvo
- Division of Radiology, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA
| | - Carolina Guimaraes
- Division of Radiology, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA
| | - Timothy M. Crombleholme
- The CDH Team, Division of Pediatric General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA,Corresponding author. The Fetal Care Center of Cincinnati, Division of Pediatric General, Thoracic, and Fetal Surgery, Cincinnati Children’s Hospital, Cincinnati, OH 45229-3039, USA. Tel.: +1 513 636 6259; fax: +1 513 636 5959. (T.M. Crombleholme)
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29
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Vuletin JF, Lim FY, Cnota J, Kline-Fath B, Salisbury S, Haberman B, Kingma P, Frischer J, Crombleholme T. Prenatal pulmonary hypertension index: novel prenatal predictor of severe postnatal pulmonary artery hypertension in antenatally diagnosed congenital diaphragmatic hernia. J Pediatr Surg 2010; 45:703-8. [PMID: 20385274 PMCID: PMC3870882 DOI: 10.1016/j.jpedsurg.2009.11.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 11/11/2009] [Accepted: 11/13/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE This study aim to assess the potential of prenatal predictors of postnatal severe pulmonary artery hypertension (PAH) in isolated left congenital diaphragmatic hernia (CDH) and to define a new prenatal pulmonary hypertension index (PPHI). METHODS A retrospective chart review of CDH patients between May 2005 and October 2008 was conducted. Ten patients with systemic/suprasystemic and 9 patients with subsystemic pulmonary hypertension at 3 weeks of age were identified. Diameters of the right pulmonary artery, left pulmonary artery (LPA(d)), aorta, and the length of vermis of the cerebellum were obtained from prenatal magnetic resonance imaging to calculate the PPHI [=(LPA(d)/length of vermis of the cerebellum) x 10] and the modified McGoon index (MGI) [=(diameter of the right pulmonary artery + LPA(d))/diameter of aorta]. Prenatal pulmonary hypertension index and MGI were compared with lung-to-head ratio, percent predicted lung volume, and total lung volume for pulmonary hypertension and survival. RESULTS The PPHI and MGI had a significant, negative correlation with pulmonary hypertension (r = -0.61, P = .005, and r = -0.72, P < .005, respectively). The PPHI and MGI are significantly lower in the systemic/suprasystemic PAH group compared with the subsystemic PAH group (1.11 +/- 0.32 versus 1.63 +/- 0.28, P = .004, and 0.71 +/- 0.15 versus 1.05 +/- 0.11, P < .001, respectively). There were no significant differences between the groups comparing the lung-to-head ratio, percent predicted lung volume, and total lung volume. CONCLUSION Both PPHI and MGI accurately predict the severity of postnatal PAH in isolated left CDH.
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Affiliation(s)
- Jose F. Vuletin
- Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA,Fetal Care Center of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Foong-Yen Lim
- Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA,Fetal Care Center of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - James Cnota
- Fetal Care Center of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA,Heart Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Beth Kline-Fath
- Fetal Care Center of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA,Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Shelia Salisbury
- Departament of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Beth Haberman
- Neonatology & Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Paul Kingma
- Neonatology & Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Jason Frischer
- Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Timothy Crombleholme
- Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA,Fetal Care Center of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA, Corresponding author. Fetal Care Center of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. Tel.: +1 513 636 6259; fax: +1 513 636 2735. (T. Crombleholme)
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