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Bateman M, Skeggs A, Whitby E, Fletcher-Barrett V, Stephens G, Dawes M, Davis D, Beckhelling J, Cooper K, Saunders B, Littlewood C, Vicenzino B, Foster NE, Hill JC. Optimising physiotherapy for people with lateral elbow tendinopathy - Results of a mixed-methods pilot and feasibility randomised controlled trial (OPTimisE). Musculoskelet Sci Pract 2024; 69:102905. [PMID: 38194841 PMCID: PMC10843168 DOI: 10.1016/j.msksp.2023.102905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/14/2023] [Accepted: 12/26/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND The OPTimisE intervention was developed to address uncertainty regarding the most effective physiotherapy treatment strategy for people with Lateral Elbow Tendinopathy (LET). OBJECTIVES To assess the feasibility of conducting a fully-powered randomised controlled trial (RCT) evaluating whether the OPTimisE intervention is superior to usual physiotherapy treatment for adults with LET. DESIGN A mixed-methods multi-centred, parallel pilot and feasibility RCT, conducted in three outpatient physiotherapy departments in the UK. METHOD Patients were independently randomised 1:1 in mixed blocks, stratified by site, to the OPTimisE intervention or usual care. Outcomes were assessed using pre-defined feasibility progression criteria. RESULTS 50 patients were randomised (22 Female, 28 Male), mean age 48 years (range 27-75). Consent rate was 71% (50/70), fidelity to intervention 89% (16/18), attendance rate in the OPTimisE group 82% (55/67) vs 85% (56/66) in usual care, outcome measure completion 81% (39/48) at six-month follow-up. There were no related adverse events. Patients and physiotherapists reported that the OPTimisE intervention was acceptable but suggested improvements to the trial design. 49 patients were recruited from physiotherapy referrals vs one from primary care records. Outcome measure return rates were higher when completed online (74%) compared to postal questionnaire (50%). Exploratory analysis showed improvements in both groups over time. CONCLUSIONS It is methodologically feasible to conduct a fully powered RCT comparing the clinical and cost-effectiveness of the OPTimisE intervention versus usual physiotherapy treatment. Considering the similar improvements observed in both groups, careful consideration is needed regarding the priority research question to be addressed in future research.
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Affiliation(s)
- M Bateman
- University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK; School of Medicine, Keele University, UK.
| | - A Skeggs
- Derby Clinical Trials Support Unit, Derby, UK
| | - E Whitby
- University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
| | | | - G Stephens
- Royal Orthopaedic Hospital, Birmingham, UK
| | - M Dawes
- Royal Orthopaedic Hospital, Birmingham, UK
| | - D Davis
- Derby Clinical Trials Support Unit, Derby, UK
| | | | - K Cooper
- Patient Representative, Derby, UK
| | - B Saunders
- School of Medicine, Keele University, UK
| | | | - B Vicenzino
- University of Queensland, Brisbane, Australia
| | - N E Foster
- School of Medicine, Keele University, UK; STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Brisbane, Australia
| | - J C Hill
- School of Medicine, Keele University, UK
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2
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Mufti N, Chappell J, O'Brien P, Attilakos G, Irzan H, Sokolska M, Narayanan P, Gaunt T, Humphries PD, Patel P, Whitby E, Jauniaux E, Hutchinson JC, Sebire NJ, Atkinson D, Kendall G, Ourselin S, Vercauteren T, David AL, Melbourne A. Use of super resolution reconstruction MRI for surgical planning in Placenta accreta spectrum disorder: Case series. Placenta 2023; 142:36-45. [PMID: 37634372 PMCID: PMC10937261 DOI: 10.1016/j.placenta.2023.08.066] [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: 04/16/2023] [Revised: 07/23/2023] [Accepted: 08/17/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION Comprehensive imaging using ultrasound and MRI of placenta accreta spectrum (PAS) aims to prevent catastrophic haemorrhage and maternal death. Standard MRI of the placenta is limited by between-slice motion which can be mitigated by super-resolution reconstruction (SRR) MRI. We applied SRR in suspected PAS cases to determine its ability to enhance anatomical placental assessment and predict adverse maternal outcome. METHODS Suspected PAS patients (n = 22) underwent MRI at a gestational age (weeks + days) of (32+3±3+2, range (27+1-38+6)). SRR of the placental-myometrial-bladder interface involving rigid motion correction of acquired MRI slices combined with robust outlier detection to reconstruct an isotropic high-resolution volume, was achieved in twelve. 2D MRI or SRR images alone, and paired data were assessed by four radiologists in three review rounds. All radiologists were blinded to results of the ultrasound, original MR image reports, case outcomes, and PAS diagnosis. A Random Forest Classification model was used to highlight the most predictive pathological MRI markers for major obstetric haemorrhage (MOH), bladder adherence (BA), and placental attachment depth (PAD). RESULTS At delivery, four patients had placenta praevia with no abnormal attachment, two were clinically diagnosed with PAS, and six had histopathological PAS confirmation. Pathological MRI markers (T2-dark intraplacental bands, and loss of retroplacental T2-hypointense line) predicting MOH were more visible using SRR imaging (accuracy 0.73), in comparison to 2D MRI or paired imaging. Bladder wall interruption, predicting BA, was only easily detected by paired imaging (accuracy 0.72). Better detection of certain pathological markers predicting PAD was found using 2D MRI (placental bulge and myometrial thinning (accuracy 0.81)), and SRR (loss of retroplacental T2-hypointense line (accuracy 0.82)). DISCUSSION The addition of SRR to 2D MRI potentially improved anatomical assessment of certain pathological MRI markers of abnormal placentation that predict maternal morbidity which may benefit surgical planning.
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Affiliation(s)
- Nada Mufti
- Elizabeth Garret Anderson Institute for Women's Health, University College London, UK; School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, UK.
| | - Joanna Chappell
- School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, UK
| | | | | | - Hassna Irzan
- School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, UK
| | - Magda Sokolska
- Department of Medical Physics and Biomedical Engineering, University College London Hospitals, UK
| | | | - Trevor Gaunt
- University College London Hospital NHS Foundation Trust, UK
| | | | | | | | - Eric Jauniaux
- Elizabeth Garret Anderson Institute for Women's Health, University College London, UK; University College London Hospital NHS Foundation Trust, UK
| | | | | | - David Atkinson
- Centre for Medical Imaging, University College London, UK
| | - Giles Kendall
- Elizabeth Garret Anderson Institute for Women's Health, University College London, UK; University College London Hospital NHS Foundation Trust, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, UK
| | - Tom Vercauteren
- School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, UK
| | - Anna L David
- Elizabeth Garret Anderson Institute for Women's Health, University College London, UK; University College London Hospital NHS Foundation Trust, UK; NIHR, University College London Hospitals BRC, UK
| | - Andrew Melbourne
- School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, UK
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3
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Whitby E, Gaunt T. Fetal lung MRI and features predicting post-natal outcome: a scoping review of the current literature. Br J Radiol 2023:20220344. [PMID: 37314838 DOI: 10.1259/bjr.20220344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
The outcome for infants with fetal lung pathologies not only depends on the nature of the pathology, but the impact it has on the developing lungs. The main prognostic factor is the degree of pulmonary hypoplasia, but this is not detectable pre-natally. Imaging techniques aim to simulate these features with a variety of surrogate measurements, including lung volume and MRI signal intensity. Despite the complexity of the various research studies and lack of consistent methodology, this scoping review aims to summarise current applications, and promising techniques requiring further investigation.
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Affiliation(s)
- Elspeth Whitby
- University of Sheffield and Sheffield Teaching Hospitals NHS foundation Trust, England, United Kingdom
| | - Trevor Gaunt
- Department of Maternal and Fetal Medicine, University College London, London, United Kingdom
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
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4
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Alessa H, Peres LC, Ferriman E, Fry A, Whitby E. MRI features of perifibrinous deposits in the placenta due to COVID-19. BJR Case Rep 2023; 9:20220132. [PMID: 36873235 PMCID: PMC9976725 DOI: 10.1259/bjrcr.20220132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 01/13/2023] Open
Abstract
COVID-19 has been linked to pregnancy complications and loss (1). Infection during pregnancy is usually mild (2). The risk is highest in the third trimester with increased hospital admission rates and maternal and fetal compromise (3). Post-COVID placentitis is uncommon but the effect on the placenta and the fetus is extensive (4). We present a case correlating clinical, imaging, and pathological findings. Case Report: A 29-year-old para 2 gravida 1, with a normal fetal anomaly scan at 22 weeks gestational age (GA) contracted COVID at 24 weeks gestation. Fully recovered but reported reduced fetal movements at 27 weeks and 1 day. Imaging: US scan showed bright echoes within the brain, small lungs, and oligohydramnios. MRI showed abnormal brain signals, small lungs, and oligohydramnios but also a very abnormal placenta. Reduced and heterogeneous T2 signal and a marked reduction in the DWI signal intensity. The placental size was markedly reduced (volume 785.6 cm3 expected for GA is 5604.8-5952.4 cm3. The surface area of attachment was 3220 mm2, expected 22180.4-29293.2 mm2). Pathology: The placenta was small (fifth centile) with massive perivillous fibrin deposition and multifocal chronic deciduitis. Histology revealed placental chorionic villi showing diffuse sclerotic changes surrounded by perivillous fibrin deposition in the intervillous space. The basal plate revealed multifocal chronic deciduitis. When imaging the fetus, it is important to examine the placenta and correlate any abnormalities. The placenta is a forgotten organ and should be routinely included and assessed to allow the detection of important abnormalities.
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Affiliation(s)
- Hiba Alessa
- Reproductive and Developmental Medicine, University of Sheffield, Sheffield, United Kingdom
| | | | - Emma Ferriman
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Andrew Fry
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Elspeth Whitby
- Reproductive and Developmental Medicine, University of Sheffield, Sheffield, United Kingdom
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5
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Chambers G, Shelmerdine SC, Aertsen M, Dohna M, Goergen SK, Johnson K, Klein WM, Miller E, Pärtan G, Perry D, Rao P, Robinson C, Stegmann J, Taranath A, Whitby E, van Rijn RR, Arthurs OJ. Current and future funding streams for paediatric postmortem imaging: European Society of Paediatric Radiology survey results. Pediatr Radiol 2023; 53:273-281. [PMID: 36097227 PMCID: PMC9468234 DOI: 10.1007/s00247-022-05485-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/11/2022] [Accepted: 08/16/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Perinatal and childhood postmortem imaging has been accepted as a noninvasive alternative or adjunct to autopsy. However, the variation in funding models from institution to institution is a major factor prohibiting uniform provision of this service. OBJECTIVE To describe current funding models employed in European and non-European institutions offering paediatric postmortem imaging services and to discuss the perceived barriers to future postmortem imaging service provision. MATERIALS AND METHODS A web-based 16-question survey was distributed to members of the European Society of Paediatric Radiology (ESPR) and ESPR postmortem imaging task force over a 6-month period (March-August 2021). Survey questions related to the radiologic and autopsy services being offered and how each was funded within the respondent's institute. RESULTS Eighteen individual responses were received (13/18, 72.2% from Europe). Only one-third of the institutions (6/18, 33.3%) have fully funded postmortem imaging services, with the remainder receiving partial (6/18, 33.3%) or no funding (5/18, 27.8%). Funding (full or partial) was more commonly available for forensic work (13/18, 72%), particularly where this was nationally provided. Where funding was not provided, the imaging and reporting costs were absorbed by the institute. CONCLUSION Increased access is required for the expansion of postmortem imaging into routine clinical use. This can only be achieved with formal funding on a national level, potentially through health care commissioning and acknowledgement by health care policy makers and pathology services of the value the service provides following the death of a fetus or child. Funding should include the costs involved in training, equipment, reporting and image acquisition.
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Affiliation(s)
- Greg Chambers
- Department of Radiology, Clarindon Wing, B Floor, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, LS1 3EX, UK.
| | - Susan C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Michael Aertsen
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - Martha Dohna
- Department of Paediatric Radiology, Hannover Medical School, Hannover, Germany
| | - Stacy K Goergen
- Monash Health Imaging, Clayton, VIC, Australia.,Department of Imaging, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Karl Johnson
- Radiology Department, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Willemijn M Klein
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Elka Miller
- Department of Medical Imaging, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Gerald Pärtan
- Department of Radiology, Danube Hospital, Vienna, Austria
| | - David Perry
- Radiology Department, National Women's Health and Starship Children's Hospital, Auckland City Hospital, Auckland, New Zealand
| | - Padma Rao
- Department of Medical Imaging, Royal Children's Hospital, Melbourne, Australia
| | - Claire Robinson
- Department of Imaging, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Joachim Stegmann
- Department of Radiology, Children's Hospital Wilhelmstift gGmbH, Hamburg, Germany
| | - Ajay Taranath
- Department of Medical Imaging, Women's and Children's Hospital, North Adelaide, South Australia.,Faculty of Health and Medical Sciences, University of Adelaide, South Adelaide, Adelaide, Australia
| | - Elspeth Whitby
- University of Sheffield and Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
| | - Rick R van Rijn
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Owen J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
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6
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Clarkson C, Gibbons Y, Roe A, Whitby E, Carter H, Williamson A, Yerburgh R, Smith R, Smith B. An evaluation of the safety of telephone first consultations in physiotherapy MSK practice. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.012] [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: 11/29/2022]
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7
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Goodall AF, Barrett A, Whitby E, Fry A. T2*-weighted MRI produces viable fetal "Black-Bone" contrast with significant benefits when compared to current sequences. Br J Radiol 2021; 94:20200940. [PMID: 33989027 DOI: 10.1259/bjr.20200940] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Fetal "black bone" MRI could be useful in the diagnosis of various skeletal conditions during pregnancy without exposure to ionizing radiation. Previously suggested susceptibility-weighted imaging (SWI) is not available in the suggested form on all scanners leading to long imaging times that are susceptible to motion artefacts. We aimed to assess if an optimized T2*-weighted GRE sequence can provide viable "black bone" contrast and compared it to other sequences in the literature. METHODS A retrospective study was conducted on 17 patients who underwent fetal MRI. Patients were imaged with an optimized T2*-weighted GRE sequence, as well as at least one other "black-bone" sequence. Image quality was scored by four blinded observers on a five-point scale. RESULTS The T2*-weighted GRE sequence offered adequate to excellent image quality in 63% of cases and scored consistently higher than the three other comparison sequences when comparing images from the same patient. Image quality was found to be dependent on gestational age with good image quality achieved on almost all patients after 26 weeks. CONCLUSIONS T2*-weighted GRE imaging can provide adequate fetal "black bone" contrast and performs at least as well as other sequences in the literature due to good bone to soft tissue contrast and minimal motion artefacts. ADVANCES IN KNOWLEDGE T2*-weighted fetal "black-bone" imaging can provide excellent bone to soft tissue contrast without using ionizing radiation. It is as good as other "black bone" sequences and may be simpler and more widely implemented, with less motion artefacts.
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Affiliation(s)
| | - Alex Barrett
- Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK.,The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, UK
| | - Elspeth Whitby
- Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - Andrew Fry
- Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
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8
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Parker VL, Winter MC, Whitby E, Parker WAE, Palmer JE, Tidy JA, Pacey AA, Hancock BW, Harrison RF. Computed tomography chest imaging offers no advantage over chest X-ray in the initial assessment of gestational trophoblastic neoplasia. Br J Cancer 2021; 124:1066-1071. [PMID: 33328608 PMCID: PMC7961138 DOI: 10.1038/s41416-020-01206-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 03/28/2020] [Revised: 10/23/2020] [Accepted: 11/26/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The International Federation of Gynaecology and Obstetrics (FIGO) score identifies gestational trophoblastic neoplasia (GTN) patients as low- or high-risk of single-agent chemotherapy resistance (SACR). Computed tomography (CT) has greater sensitivity than chest X-ray (CXR) in detecting pulmonary metastases, but effects upon outcomes remain unclear. METHODS Five hundred and eighty-nine patients underwent both CXR and CT during GTN assessment. Treatment decisions were CXR based. The number of metastases, risk scores, and risk category using CXR versus CT were compared. CT-derived chest assessment was evaluated as impact upon treatment decision compared to patient outcome, incidence of SACR, time-to-normal human chorionic gonadotrophin hormone (TNhCG), and primary chemotherapy resistance (PCR). RESULTS Metastasis detection (p < 0.0001) and FIGO score (p = 0.001) were higher using CT versus CXR. CT would have increased FIGO score in 188 (31.9%), with 43 re-classified from low- to high-risk, of whom 23 (53.5%) received curative single-agent chemotherapy. SACR was higher when score (p = 0.044) or risk group (p < 0.0001) changed. Metastases on CXR (p = 0.019) but not CT (p = 0.088) lengthened TNhCG. Logistic regression analysis found no difference between CXR (area under the curve (AUC) = 0.63) versus CT (AUC = 0.64) in predicting PCR. CONCLUSIONS CT chest would improve the prediction of SACR, but does not influence overall treatment outcome, TNhCG, or prediction of PCR. Lower radiation doses and cost mean ongoing CXR-based assessment is recommended.
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Affiliation(s)
- Victoria L. Parker
- grid.11835.3e0000 0004 1936 9262Department of Oncology and Metabolism, The Medical School, The University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK
| | - Matthew C. Winter
- grid.11835.3e0000 0004 1936 9262Department of Oncology and Metabolism, The Medical School, The University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK ,grid.31410.370000 0000 9422 8284Sheffield Centre for Trophoblastic Disease, Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Whitham Road, Sheffield, S10 2SJ UK
| | - Elspeth Whitby
- grid.11835.3e0000 0004 1936 9262Department of Oncology and Metabolism, The Medical School, The University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK
| | - William A. E. Parker
- grid.11835.3e0000 0004 1936 9262School of Medicine, The University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK
| | - Julia E. Palmer
- grid.31410.370000 0000 9422 8284Department of Gynaecological Oncology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Room H18, Glossop Road, Sheffield, S10 2JF UK
| | - John A. Tidy
- grid.31410.370000 0000 9422 8284Sheffield Centre for Trophoblastic Disease, Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Whitham Road, Sheffield, S10 2SJ UK ,grid.31410.370000 0000 9422 8284Department of Gynaecological Oncology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Room H18, Glossop Road, Sheffield, S10 2JF UK
| | - Allan A. Pacey
- grid.11835.3e0000 0004 1936 9262Department of Oncology and Metabolism, The Medical School, The University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK
| | - Barry W. Hancock
- grid.11835.3e0000 0004 1936 9262Department of Oncology and Metabolism, The Medical School, The University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK
| | - Robert F. Harrison
- grid.11835.3e0000 0004 1936 9262Department of Automatic Control and Systems Engineering, The University of Sheffield, Mappin Street, Sheffield, S1 3JD UK
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Reed K, Ferazzoli MT, Whitby E. "Why didn't we do it"? Reproductive loss and the problem of post-mortem consent. Soc Sci Med 2021; 276:113835. [PMID: 33780832 DOI: 10.1016/j.socscimed.2021.113835] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/09/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022]
Abstract
Informed consent has been a much debated topic within the social sciences. It often forms a central feature of discussions on research in medical settings and in social research methods more broadly. While sympathetic to its' underlying principles of autonomy and choice, social scientists have tended to argue that these are seldom enacted in research or clinical practice. Rather, such principles are often circumscribed by wider social structures and by a culture of medical dominance. Drawing on data from a qualitative study on perinatal post-mortem, this paper explores informed consent in the emotionally charged clinical arena of perinatal pathology. Our in-depth analysis will provide fresh insight into post-mortem decision-making in the sensitive arena of baby loss. Our findings show how parents often found it difficult to give consent for post-mortem, and also for professionals to take consent from parents. It was also not uncommon for parents to experience regret over non-consent later on. One of our key findings, however, related to the sense of emotional and diagnostic closure often afforded by post-mortem when consent had been given. We conclude by arguing that, although we cannot resolve the tension between the principles of consent and their enactment in practice, we can develop a reflexive approach with which to navigate the process. In doing so, the paper contributes to wider sociological discussions on the meaning and use of informed consent in various settings beyond medical contexts.
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Affiliation(s)
- Kate Reed
- Department of Sociological Studies, University of Sheffield, Elmfield Building, Northumberland Road, Sheffield, S10 2TU, UK.
| | - Maria Teresa Ferazzoli
- University of Sheffield, Department of Sociological Studies, Elmfield, Northumberland Road, Sheffield, S10 2TU, UK.
| | - Elspeth Whitby
- Clinical Senior Lecturer/Honorary Consultant, University of Sheffield, Department of Oncology and Metabolism, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK.
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10
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Whitby E, Offiah AC, Shelmerdine SC, van Rijn RR, Aertsen M, Klein WM, Perry D, Goergen SK, Abel C, Taranath A, Gascho D, Miller E, Arthurs OJ. Current state of perinatal postmortem magnetic resonance imaging: European Society of Paediatric Radiology questionnaire-based survey and recommendations. Pediatr Radiol 2021; 51:792-799. [PMID: 33367939 PMCID: PMC8055569 DOI: 10.1007/s00247-020-04905-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/02/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postmortem magnetic resonance imaging (MRI) in perinatal and childhood deaths is increasingly used as a noninvasive adjunct or alternative to autopsy. Imaging protocols vary between centres and consensus guidelines do not exist. OBJECTIVE Our aim was to develop practical, standardised recommendations for perinatal postmortem MRI. MATERIALS AND METHODS Recommendations were based on the results of two surveys regarding local postmortem MRI practices sent electronically to all 14 members of the European Society of Paediatric Radiology (ESPR) Postmortem Imaging Task Force and 17 members of the International Society of Forensic Radiology and Imaging Task Force (25 different centres). RESULTS Overall, 11/14 (78.6%) respondents from different institutions perform postmortem MRI. All of these centres perform postmortem MRI for perinatal and neonatal deaths, but only 6/11 (54.5%) perform imaging in older children. CONCLUSION We propose a clinical standard for postmortem MRI sequences plus optional sequences for neuroimaging and cardiac anatomy depending on available scanning time and referral indications.
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Affiliation(s)
- Elspeth Whitby
- University of Sheffield and Sheffield Teaching Hospitals Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield, S10 1SF, UK.
| | - Amaka C. Offiah
- Academic Unit of Child Health, University of Sheffield, Sheffield, UK ,Department of Radiology, Sheffield Children’s NHS Foundation Trust, University of Sheffield, Sheffield, UK
| | - Susan C. Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK ,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Rick R. van Rijn
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael Aertsen
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - Willemijn M. Klein
- Department of Radiology and Nuclear Medicine and Anatomy, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - David Perry
- Radiology Department, National Women’s Health and Starship Children’s Hospital, Auckland City Hospital, Auckland, New Zealand
| | - Stacy K. Goergen
- Monash Imaging, Clayton, Victoria Australia ,School of Clinical Sciences, Monash University, Clayton, Victoria Australia
| | - Christian Abel
- Department of Medical Imaging, John Hunter Hospital, Newcastle, New South Wales Australia
| | - Ajay Taranath
- Department of Medical Imaging, Women’s and Children’s Hospital, North Adelaide, South Australia Australia ,University of Adelaide, Adelaide, South Australia Australia
| | - Dominic Gascho
- Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Elka Miller
- Department of Medical Imaging, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Owen J. Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK ,UCL Great Ormond Street Institute of Child Health, London, UK
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11
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Hyde G, Fry A, Raghavan A, Whitby E. Visualisation of fetal meconium on post-mortem magnetic resonance imaging scans: a retrospective observational study. Acta Radiol Open 2020; 9:2058460120970541. [PMID: 33282338 PMCID: PMC7683848 DOI: 10.1177/2058460120970541] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/13/2020] [Indexed: 11/15/2022] Open
Abstract
Background Less invasive techniques for fetal post-mortems are increasingly used to correlate with parental wishes. With the use of post-mortem magnetic resonance imaging (MRI), normal appearance of the organs must be established. Purpose To investigate the after death appearance of the fetal meconium throughout gestation using the hyperintense appearance of meconium on T1 weighted MRI. Material and Methods This was a retrospective study that took place in a tertiary referral centre radiology department. Sixty-two fetal body post-mortem MRI scans (January 2014 to May 2018) between 12 and 41 weeks gestation were reviewed. Signal intensity of meconium at the rectum, sigmoid colon, splenic flexure and hepatic flexure was evaluated and correlated with gestational age. Interrater reliability was calculated. Results Meconium did not consistently have high signal intensity on T1 scans and was not always obvious. Rectal meconium had the highest intensity, and the more proximal the bowel the lower the intensity. The meconium had higher intensity at earlier gestations. Interrater reliability for rectal meconium gradings was excellent. Conclusion This study provides the first published primary research on the appearance of fetal meconium on post-mortem MRI. Overall, results were variable and suggest an alteration of bowel contents after death, but further investigation is needed to effectively inform practice.
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Affiliation(s)
- Georgia Hyde
- Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield, Sheffield, UK
- Georgia Hyde, 51, Bute Street, Sheffield S10 1UP, UK.
| | - Andrew Fry
- Medical Imaging and Medical Physics, Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Ashok Raghavan
- Department of Radiology, Sheffield Children’s Hospital, Sheffield, UK
| | - Elspeth Whitby
- Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield, Sheffield, UK
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Hyde G, Fry A, Raghavan A, Whitby E. Biometric analysis of the foetal meconium pattern using T1 weighted 2D gradient echo MRI. BJR Open 2020; 2:20200032. [PMID: 33178986 PMCID: PMC7594886 DOI: 10.1259/bjro.20200032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 12/04/2022] Open
Abstract
Objectives: Foetal MRI is used to assess abnormalities after ultrasonography. Bowel anomalies are a significant cause of neonatal morbidity, however there are little data concerning its normal appearance on antenatal MRI. This study aims to investigate the pattern of meconium accumulation throughout gestation using its hyperintense appearance on T1 weighted scans and add to the current published data. Methods: This was a retrospective cohort study in a tertiary referral clinical MRI centre. Foetal body MRI scans of varying gestational ages were obtained dating between October 2011 and March 2018. The bowel was visualised on T1 weighted images. The length of the meconium and the width of the meconium at the rectum, sigmoid colon, splenic flexure and hepatic flexure was measured. Presence or absence of meconium in the small bowel was noted. Inter- and intrarater reliability was assessed. Results: 181 foetal body scans were reviewed. 52 were excluded and 129 analysed. Visualisation of the meconium in the large bowel became increasingly proximal with later gestations, and small bowel visualisation was greater at earlier gestations. There was statistically significant strong (r = 0.6–0.8) or very strong (r = 0.8–1.0) positive correlation of length and width with increasing gestation. Interrater reliability was moderate to excellent (r = 0.4–1.0). Conclusion: This study provides new information regarding the pattern of meconium accumulation throughout gestation. With care, the results can be used in clinical practice to aid diagnosis of bowel pathology. Advances in knowledge: The findings of this study provide further information concerning the normal accumulation of foetal meconium on MR imaging, an area where current research is limited.
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Affiliation(s)
- Georgia Hyde
- Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, United Kingdom
| | - Andrew Fry
- Medical Imaging and Medical Physics, Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Beech Hill Road, S10 2JF, Sheffield, United Kingdom
| | - Ashok Raghavan
- Department of Radiology, Sheffield Children's Hospital, Clarkson Street, Sheffield S10 2TH, United Kingdom
| | - Elspeth Whitby
- Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, United Kingdom
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Dall'Asta A, Paramasivam G, Basheer SN, Whitby E, Tahir Z, Lees C. How to obtain diagnostic planes of the fetal central nervous system using three-dimensional ultrasound and a context-preserving rendering technology. Am J Obstet Gynecol 2019; 220:215-229. [PMID: 30447211 DOI: 10.1016/j.ajog.2018.11.1088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/05/2018] [Accepted: 11/08/2018] [Indexed: 12/26/2022]
Abstract
The antenatal evaluation of the fetal central nervous system (CNS) is among the most difficult tasks of prenatal ultrasound (US), requiring technical skills in relation to ultrasound and image acquisition as well as knowledge of CNS anatomy and how this changes with gestation. According to the International Guidelines for fetal neurosonology, the basic assessment of fetal CNS is most frequently performed on the axial planes, whereas the coronal and sagittal planes are required for the multiplanar evaluation of the CNS within the context of fetal neurosonology. It can be even more technically challenging to obtain "nonaxial" views with 2-dimensional (2D) US. The modality of 3-dimensional (3D) US has been suggested as a panacea to overcome the technical difficulties of achieving nonaxial views. The lack of familiarity of most sonologists with the use of 3D US and its related processing techniques may preclude its use even where it could play an important role in complementing antenatal 2D US assessment. Furthermore, once a 3D volume has been acquired, proprietary software allows it to be processed in different ways, leading to multiple ways of displaying and analyzing the same anatomical imaging or plane. These are difficult to learn and time consuming in the absence of specific training. In this article, we describe the key steps for volume acquisition of a 3D US volume, manipulation, and processing with reference to images of the fetal CNS, using a newly developed context-preserving rendering technique.
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Affiliation(s)
- Andrea Dall'Asta
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, UK; Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Italy
| | - Gowrishankar Paramasivam
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Sheikh Nigel Basheer
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Paediatrics and Neonatal Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Elspeth Whitby
- University of Sheffield and Sheffield Teaching Hospitals Foundation Trust, Jessop Wing, Sheffield, UK
| | - Zubair Tahir
- Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Christoph Lees
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, UK; Department of Development and Regeneration, KU Leuven, Belgium.
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Shelmerdine SC, Gerrard CY, Rao P, Lynch M, Kroll J, Martin D, Miller E, Filograna L, Martinez RM, Ukpo O, Daly B, Hyodoh H, Johnson K, Watt A, Taranath A, Brown S, Perry D, Boel LWT, Borowska-Solonynko A, van Rijn R, Klein W, Whitby E, Arthurs OJ. Joint European Society of Paediatric Radiology (ESPR) and International Society for Forensic Radiology and Imaging (ISFRI) guidelines: paediatric postmortem computed tomography imaging protocol. Pediatr Radiol 2019; 49:694-701. [PMID: 30815716 PMCID: PMC6459792 DOI: 10.1007/s00247-018-04340-x] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 10/29/2018] [Accepted: 12/20/2018] [Indexed: 11/30/2022]
Abstract
Postmortem CT for investigating childhood deaths is increasingly utilised as a noninvasive adjunct or alternative to standard autopsy; however there are no standardised published imaging protocols. This article describes a standardised imaging protocol that has been developed based on current practices of international postmortem imaging practitioners and experts. This recommendation is expected to be useful for postmortem imaging centres wishing to update their existing practices and for those starting paediatric postmortem CT as a new service.
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Affiliation(s)
- Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
| | - Chandra Y Gerrard
- Department of Radiology, University of New Mexico, Albuquerque, NM, USA
| | - Padma Rao
- Department of Medical Imaging, Victorian Institute of Forensic Medicine & Royal Children's Hospital, Melbourne, Australia
| | - Matthew Lynch
- Department of Medical Imaging, Victorian Institute of Forensic Medicine & Royal Children's Hospital, Melbourne, Australia
| | - Jeroen Kroll
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Dan Martin
- Department of Radiology, Gold Coast University Hospital, Gold Coast, Australia
| | - Elka Miller
- Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Laura Filograna
- Department of Diagnostic and Interventional Radiology, "Tor Vergata" University of Rome, Rome, Italy
| | - Rosa Maria Martinez
- Institute of Forensic Medicine (Virtopsy), University of Zurich, Zurich, Switzerland
| | - Odey Ukpo
- Los Angeles County Medical Examiner-Coroner Office, Los Angeles, CA, USA
| | - Barry Daly
- Office of the Chief Medical Examiner, University of Maryland, Baltimore, MD, USA
| | - Hideki Hyodoh
- Center for Cause of Death Investigation, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Karl Johnson
- Department of Radiology, Birmingham Children's Hospital, Birmingham, UK
| | - Andrew Watt
- Department of Diagnostic Imaging & Clinical Physics, The Royal Hospital for Children, Glasgow, Scotland, UK
| | - Ajay Taranath
- Department of Medical Imaging, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Scott Brown
- Department of Medical Imaging, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - David Perry
- Radiology Department, National Women's Health and Starship Children's Hospital, Auckland City Hospital, Auckland, New Zealand
| | | | | | - Rick van Rijn
- Department of Radiology, Emma Children's Hospital, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Willemijn Klein
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Elspeth Whitby
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - Owen J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK.
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK.
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15
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Bateman M, Whitby E, Kacha S, Salt E. Current physiotherapy practice in the management of tennis elbow: A service evaluation. Musculoskeletal Care 2018; 16:322-326. [PMID: 29469176 DOI: 10.1002/msc.1236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/03/2018] [Accepted: 01/09/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Tennis elbow is a common painful condition that may affect daily function and ability to work. Physiotherapy is the most commonly used primary intervention but there is a wide range of treatment options within the umbrella of physiotherapy. Our aim was to report on the treatments that are currently used by physiotherapists in a UK National Health Service (NHS) setting. METHODS A retrospective service evaluation was conducted at two NHS hospital trusts by reviewing patient attendance records over a 1-year period. All patients with tennis elbow were included, except those referred for postoperative rehabilitation. Patient notes were analysed using a predefined assessment template. RESULTS A total of 65 patient records were identified, with patients having a mean age 48 years and mean symptom duration of 5.4 months. The mean treatment duration was 64 days, over 3.7 sessions. The most commonly used treatments were education and exercise, although the type and dosing of exercise varied greatly. Passive modalities such as ice, taping, manual therapy, acupuncture and electrotherapy were still used. CONCLUSIONS Wide variations in treatment approaches were identified. There was no consistency in the choice of modality used, the type of exercise or the dose of exercise prescribed. The use of passive modalities and corticosteroid injections was found to remain commonplace, despite a lack of supporting research evidence. There is a clear need for evidence-based guidance for physiotherapists treating patients with tennis elbow.
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Affiliation(s)
- M Bateman
- Physiotherapy Department, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - E Whitby
- Physiotherapy Department, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - S Kacha
- Physiotherapy Department, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - E Salt
- Physiotherapy Department, Burton Hospital NHS Foundation Trust, Burton on Trent, UK
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16
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Lekadir K, Hoogendoorn C, Armitage P, Whitby E, King D, Dimitri P, Frangi AF. Estimation of trabecular bone parameters in children from multisequence MRI using texture-based regression. Med Phys 2017; 43:3071-3079. [PMID: 27277054 DOI: 10.1118/1.4950713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE This paper presents a statistical approach for the prediction of trabecular bone parameters from low-resolution multisequence magnetic resonance imaging (MRI) in children, thus addressing the limitations of high-resolution modalities such as HR-pQCT, including the significant exposure of young patients to radiation and the limited applicability of such modalities to peripheral bones in vivo. METHODS A statistical predictive model is constructed from a database of MRI and HR-pQCT datasets, to relate the low-resolution MRI appearance in the cancellous bone to the trabecular parameters extracted from the high-resolution images. The description of the MRI appearance is achieved between subjects by using a collection of feature descriptors, which describe the texture properties inside the cancellous bone, and which are invariant to the geometry and size of the trabecular areas. The predictive model is built by fitting to the training data a nonlinear partial least square regression between the input MRI features and the output trabecular parameters. RESULTS Detailed validation based on a sample of 96 datasets shows correlations >0.7 between the trabecular parameters predicted from low-resolution multisequence MRI based on the proposed statistical model and the values extracted from high-resolution HRp-QCT. CONCLUSIONS The obtained results indicate the promise of the proposed predictive technique for the estimation of trabecular parameters in children from multisequence MRI, thus reducing the need for high-resolution radiation-based scans for a fragile population that is under development and growth.
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Affiliation(s)
- Karim Lekadir
- Center for Computational Imaging and Simulation Technologies in Biomedicine, Universitat Pompeu Fabra, Barcelona 08018, Spain
| | - Corné Hoogendoorn
- The Academic Unit of Radiology, The University of Sheffield, Sheffield S10 2JF, United Kingdom
| | - Paul Armitage
- The Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield, Sheffield S10 2SF, United Kingdom
| | - Elspeth Whitby
- The Academic Unit of Child Health, The University of Sheffield, Sheffield S10 2TH, United Kingdom
| | - David King
- The Mellanby Centre for Bone Research, The University of Sheffield, Sheffield S10 2RX, United Kingdom
| | - Paul Dimitri
- Center for Computational Imaging and Simulation Technologies in Biomedicine, The University of Sheffield, Sheffield S1 3JD, United Kingdom
| | - Alejandro F Frangi
- The Academic Unit of Radiology, The University of Sheffield, Sheffield S10 2JF, United Kingdom
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17
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Abstract
Placental adhesion disorder (PAD) comprises placenta accreta, increta and percreta lesions; these are classified according to the depth of uterine invasion. Although PAD is considered a rare condition, its incidence has increased 10-fold in the last 50 years. Ultrasound is the primary imaging modality for the assessment of the placenta and in the majority of cases, it is sufficient for diagnosis; however, when ultrasound findings are suspicious or inconclusive, MRI is recommended as an adjunct imaging technique. Numerous MRI features of PAD have been described, including dark intraplacental bands, disorganized intraplacental vascularity and abnormal uterine bulging. This pictorial review describes and illustrates these characteristics and discusses their implications in planning delivery. In addition, we present a series of "pitfall" cases to aid the interpreting radiologist and discuss management of PAD. PAD is a clinical and diagnostic challenge that is encountered with increasing frequency, requiring a cohesive multidisciplinary approach to its management.
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Affiliation(s)
- Faye Cuthbert
- 1 Department of Imaging, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Mireia Teixidor Vinas
- 1 Department of Imaging, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Elspeth Whitby
- 2 University of Sheffield and Sheffield Teaching Hospitals Foundation Trust, Jessop Wing, Sheffield, UK
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18
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Abstract
Fetal magnetic resonance imaging (MRI) is currently offered in a limited number of centers but is predominantly used for suspected fetal central nervous system abnormalities. This article concentrates on the role of the different imaging sequences and their value to clinical practice. It also discusses the future of fetal MRI.
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Affiliation(s)
- Elspeth Whitby
- Academic Unit of Reproductive and Developmental Medicine, Sheffield, UK.
| | - Peter Wright
- Medical Imaging and Medical Physics, Radiology, Royal Hallamshire Hospital, Sheffield, UK
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19
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Cohen MC, Whitby E, Fink MA, Collett JM, Offiah AC. Running a postmortem service--a business case and clinical experience. Pediatr Radiol 2015; 45:501-8. [PMID: 25828353 DOI: 10.1007/s00247-014-3156-0] [Citation(s) in RCA: 11] [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: 03/05/2014] [Revised: 07/23/2014] [Accepted: 08/08/2014] [Indexed: 10/23/2022]
Abstract
The purpose of the postmortem examination is to offer answers to explain the cause and manner of death. In the case of perinatal, infant and paediatric postmortem examinations, the goal is to identify unsuspected associated features, to describe pathogenic mechanisms and new conditions, and to evaluate the clinical management and diagnosis. Additionally, the postmortem examination is useful to counsel families regarding the probability of recurrence in future pregnancies and to inform family planning. Worldwide the rate of paediatric autopsy examinations has significantly declined during the last few decades. Religious objections to postmortem dissection and organ retention scandals in the United Kingdom provided some of the impetus for a search for non-invasive alternatives to the traditional autopsy; however, until recently, imaging studies remained an adjunct to, rather than a replacement for, the traditional autopsy. In 2012, Sheffield Children's Hospital National Health Service Foundation Trust set up the service provision of minimally invasive fetal, perinatal and neonatal autopsy, while a postmortem imaging service has been running in Melbourne, Australia, since 2008. Here we summarise the essentials of a business case and practical British and Australian experiences in terms of the pathological and radiologic aspects of setting up a minimally invasive clinical service in the United Kingdom and of developing a clinical postmortem imaging service as a complementary tool to the traditional autopsy in Australia.
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Affiliation(s)
- Marta C Cohen
- Academic Unit of Child Health, Sheffield Children's NHS Foundation Trust, University of Sheffield, Western Bank, Sheffield, S10 2TH, UK
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20
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Hart A, Whitby E, Wilkinson S, Alladi S, Paley M, Smith M. Neuro-developmental outcome at 18 months in premature infants with diffuse excessive high signal intensity on MR imaging of the brain. Pediatr Radiol 2011; 41:1284-92. [PMID: 21681616 DOI: 10.1007/s00247-011-2155-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 01/01/2011] [Accepted: 03/28/2011] [Indexed: 12/01/2022]
Abstract
BACKGROUND Diffuse excessive high signal intensity (DEHSI) may represent damage to the white matter in preterm infants, but may be best studied alongside quantitative markers. Limited published data exists on its neuro-developmental implications. OBJECTIVE The purpose of this study was to assess whether preterm children with DEHSI at term-corrected age have abnormal neuro-developmental outcome. MATERIALS AND METHODS This was a prospective observational study of 67 preterm infants with MRI of the brain around term-equivalent age, including diffusion-weighted imaging (DWI). Images were reported as being normal, overtly abnormal or to show DEHSI. A single observer placed six regions of interest in the periventricular white matter and calculated the apparent diffusion coefficients (ADC). DEHSI was defined as (1) high signal on T2-weighted images alone, (2) high signal with raised ADC values or (3) raised ADC values independent of visual appearances. The neuro-development was assessed around 18 months' corrected age using the Bayley Scales of Infant and Toddler Development (3rd Edition). Standard t tests compared outcome scores between imaging groups. RESULTS No statistically significant difference in neuro-developmental outcome scores was seen between participants with normal MRI and DEHSI, regardless of which definition was used. CONCLUSION Preterm children with DEHSI have similar neuro-developmental outcome to those with normal brain MRI, even if the definition includes objective markers alongside visual appearances.
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Affiliation(s)
- Anthony Hart
- Department of Neonatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
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21
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Affiliation(s)
- Elspeth Whitby
- Unit of Academic Radiology, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
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22
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Chow LS, Cook GG, Whitby E, Paley MNJ. Investigation of axonal magnetic fields in the human corpus callosum using visual stimulation based on MR signal modulation. J Magn Reson Imaging 2007; 26:265-73. [PMID: 17654726 DOI: 10.1002/jmri.21025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To investigate the possibility of detecting visually-evoked axonal currents in the splenium of the human corpus callosum using a 3.0T MRI system. MATERIALS AND METHODS Axonal currents produce weak and transient magnetic fields, and the components of these that lie parallel to the B(0) field of the MRI system can potentially modulate the MR signal, which can be detected as an integrated effect over time. A fast gradient-echo echo-planar imaging (GE-EPI) sequence with short TR and intermediate TE was employed in an attempt to detect such axonal currents using light-emitting diode (LED) visual stimulation paradigms. RESULTS The mean magnitude signal change, expressed relative to the fully relaxed equilibrium signal calculated from the measured value using the known T1 of white matter, was 0.014 +/- 0.004% at TE = 30 msec. This corresponded to a mean axonal field of 0.11 +/- 0.03 nT, according to the hypothesis that the axonal currents create a Lorentzian field distribution within an imaging voxel. CONCLUSION Measured frequency spectra and statistical mapping using the general linear model (GLM) showed evidence of the stimulus localized within the splenium of the corpus callosum, which was not thought to be due to motion artifacts or physiological responses.
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Affiliation(s)
- Li Sze Chow
- Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, UK
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23
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Davies N, Paley M, Griffiths P, Whitby E. Incidence of extracranial hemorrhage in asymptomatic neonates. A MRI study evaluating mode of delivery. Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2006.10.133] [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: 10/23/2022]
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Rickard S, Morris J, Paley M, Griffiths P, Whitby E. In utero magnetic resonance of non-isolated ventriculomegaly: Does ventricular size or morphology reflect pathology? Clin Radiol 2006; 61:844-53. [PMID: 16978979 DOI: 10.1016/j.crad.2006.02.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Revised: 02/12/2006] [Accepted: 02/28/2006] [Indexed: 11/28/2022]
Abstract
AIM To confirm whether ventricular size or morphology reflects the underlying pathology in foetuses referred with a diagnosis of possible ventriculomegaly (Vm) and central nervous system (CNS) pathology. METHODS Retrospective analysis of 40 in utero magnetic resonance (MR) examinations was undertaken. Ventricular size was measured on axial sections by two observers, and morphology was agreed by consensus. Results were analysed according to gestational age at referral, degree of Vm (mild 10-15 mm, moderate/severe >15 mm) and morphology. RESULTS Nine cases had no Vm (mean gestational age 23.6 weeks, range 19-33), 17 had mild Vm (mean age 23.9 weeks, range 20-31), and 14 had moderate/severe Vm (mean age 25.9 weeks, range 20-35). All groups had a mix of morphology and pathology. Eighteen suspected cases of spina bifida were referred and 17 confirmed (mean age 22.6 weeks, range 19-30) using MR. The morphology was mixed, five cases (27.8%) had an angular appearance (this morphology was only seen in cases with spina bifida). Fourteen cases (77.8%) had Vm (eight mild, six severe). Of the thirteen cases of agenesis of the corpus callosum (ACC) suspected on ultrasound, seven were confirmed using MR (mean age 26.5 weeks, range 20-35). Of those seven cases with ACC confirmed on MR, and three additional cases only detected by in utero MR, five had colpocephaly, seven had Vm (four mild, three severe). CONCLUSION Severity of Vm did not reflect the type, or presence, of underlying pathology. Morphology appears an indicator of pathology. Angular ventricles should initiate a search for spinal defects. Colpocephaly may indicate ACC.
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Affiliation(s)
- S Rickard
- Acadamic Radiology, Royal Hallamshire Hospital, Sheffield, UK.
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25
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Chow LS, Cook GG, Whitby E, Paley MNJ. Investigating direct detection of axon firing in the adult human optic nerve using MRI. Neuroimage 2006; 30:835-46. [PMID: 16376108 DOI: 10.1016/j.neuroimage.2005.10.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2005] [Revised: 10/06/2005] [Accepted: 10/10/2005] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to directly detect spectral components of the magnetic fields of ionic currents caused by firing of the axons in the optic nerve in response to visual strobe stimulation. The magnetic field parallel to the main B0 field can potentially alter the local phase and magnitude of the MR signal which can cause signal loss due to intravoxel dephasing. Measured frequency spectra showed evidence of the strobe stimulus localized to regions containing the optic nerve, not thought to be due to motion artifacts, in 30 out of 52 experiments in 5 adult human subjects. The effect was (0.15 +/- 0.05)% of the mean magnitude equilibrium signal from the voxel in the frequency range 0.7-3.3 Hz, corresponding to an estimated field of (1.2 +/- 0.4) nT, at an echo time of TE = 32.4 ms using a 1.5 T MRI scanner. Only 1 of 12 phase image experiments showed effects. These findings provide preliminary evidence for direct detection of axonal firing in the optic nerve.
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Affiliation(s)
- Li Sze Chow
- Department of Electronic and Electrical Engineering, University of Sheffield, Mappin Street, S1 3JD Sheffield, UK
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Chow LS, Cook GG, Whitby E, Paley MNJ. Investigation of MR signal modulation due to magnetic fields from neuronal currents in the adult human optic nerve and visual cortex. Magn Reson Imaging 2006; 24:681-91. [PMID: 16824962 DOI: 10.1016/j.mri.2006.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2005] [Accepted: 01/16/2006] [Indexed: 10/24/2022]
Abstract
Neuronal currents produce weak transient magnetic fields, and the hypothesis being investigated here is that the components of these parallel to the B0 field can potentially modulate the MR signal, thus providing a means of direct detection of nerve impulses. A theory for the phase and amplitude changes of the MR signal over time due to an external magnetic field has been developed to predict this modulation. Experimentally, a fast gradient-echo EPI sequence (TR = 158 ms, TE = 32.4 ms) was employed in an attempt to directly detect these neuronal currents in the adult human optic nerve and visual cortex using a 280-mm quadrature head coil at 1.5 T. A symmetrical intravoxel field distribution, which can be plausibly hypothesized for the axonal fields in the optic nerve and visual cortex, would result in phase cancellation within a voxel, and hence, only amplitude changes would be expected. On the other hand, an asymmetrical intravoxel field distribution would produce both phase and amplitude changes. The in vivo magnitude image data sets show a significant nerve firing detection rate of 56%, with zero detection using the phase image data sets. The percentage magnitude signal changes relative to the fully relaxed equilibrium signal fall within a predicted RMS field range of 1.2-2.1 nT in the optic nerve and 0.4-0.6 nT in the visual cortex, according to the hypothesis that the axonal fields create a symmetrical Lorentzian field distribution within the voxel.
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Affiliation(s)
- Li Sze Chow
- Department of Electronic and Electrical Engineering, University of Sheffield, S1 3JD Sheffield, UK
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Griffiths PD, Widjaja E, Paley MNJ, Whitby E. In utero MR for ventriculomegaly. Cerebrospinal Fluid Res 2005. [DOI: 10.1186/1743-8454-2-s1-s21] [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: 11/10/2022] Open
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Gollop R, Whitby E, Buchanan D, Ketley D. Influencing sceptical staff to become supporters of service improvement: a qualitative study of doctors' and managers' views. Qual Saf Health Care 2004; 13:108-14. [PMID: 15069217 PMCID: PMC1743804 DOI: 10.1136/qshc.2003.007450] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To explore scepticism and resistance towards changes in working practice designed to achieve service improvement. Two principal questions were studied: (1). why some people are sceptical or resistant towards improvement programmes and (2). what influences them to change their minds. METHODS Semi-structured qualitative interviews were conducted with 19 clinicians and 19 managers who held national and regional roles in two national programmes of service improvement within the NHS involving systematic organisational changes in working practices: the National Booking Programme and the Cancer Services Collaborative (now the Cancer Services Collaborative Improvement Partnership). RESULTS Scepticism and resistance exist in all staff groups, especially among medical staff. Reasons include personal reluctance to change, misunderstanding of the aims of improvement programmes, and a dislike of the methods by which programmes have been promoted. Sceptical staff can be influenced to become involved in improvement, but this usually takes time. Newly won support may be fragile, requiring ongoing evidence of benefits to be maintained. CONCLUSIONS The support of health service staff, particularly doctors, is crucial to the spread and sustainability of the modernisation agenda. Scepticism and resistance are seen to hamper progress. Leaders of improvement initiatives need to recognise the impact of scepticism and resistance, and to consider ways in which staff can become positively engaged in change.
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Affiliation(s)
- R Gollop
- Research into Practice Team, NHS Modernisation Agency, Leicester, UK.
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Griffiths PD, Wilkinson ID, Variend S, Jones A, Paley MNJ, Whitby E. Differential growth rates of the cerebellum and posterior fossa assessed by post mortem magnetic resonance imaging of the fetus: implications for the pathogenesis of the chiari 2 deformity. Acta Radiol 2004; 45:236-42. [PMID: 15191112 DOI: 10.1080/02841850410003572] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate post mortem magnetic resonance imaging of the fetus to provide data on the rate of growth of the cerebellum, bony posterior fossa, supratentorial bony compartment and cerebrum. MATERIAL AND METHODS Twenty fetuses subsequently shown to have normal brain and spines on autopsy were studied using MRI post mortem. MRI from 20 normal pediatric brain examinations in children aged 6 years or younger were studied for comparison. Post mortem MRI was performed using a high-resolution fast spin echo technique providing T2 weighted images. The area of the cerebellar vermis, posterior fossa, supratentorial skull cavity and cerebral hemispheres was measured in the sagittal plane in all cases. These measurements were compared over the age ranges studied. RESULTS We have shown that there are differences in the rate of growth and the apparent commencement of growth between the structures under study. The cerebellum appeared to start its significant growth at 16.5 weeks with a rate of 16 mm2/week throughout pregnancy, while the cerebral hemisphere appeared to commence significant growth at 13 weeks at a rate of 184 mm2/week throughout pregnancy. This is in contrast to the bony posterior fossa, whose growth paralleled the supratentorial bony compartment at all ages studied. CONCLUSION We interpret our findings as showing relatively late commencement of cerebellar growth compared to the cerebral hemispheres, whereas the growth of the bony posterior fossa appears to be in advance and independent of cerebellar growth. Our results support the hypothesis that posterior fossa development depends on raised hydrostatic pressure in the CSF containing structures of the posterior fossa. When this mechanism fails, as in some cases of myelomeningocoele, a small posterior fossa is formed which characterizes the Chiari 2 malformation.
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Affiliation(s)
- P D Griffiths
- Section of Academic Radiology, University of Sheffield, UK.
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Griffiths PD, Variend D, Evans M, Jones A, Wilkinson ID, Paley MNJ, Whitby E. Postmortem MR imaging of the fetal and stillborn central nervous system. AJNR Am J Neuroradiol 2003; 24:22-7. [PMID: 12533322 PMCID: PMC8148944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2002] [Accepted: 08/15/2002] [Indexed: 02/28/2023]
Abstract
BACKGROUND AND PURPOSE Changes in the public perception of postmortem procedures in the United Kingdom have led to reduced numbers of autopsies being performed in the fetus and neonate. When autopsy is performed in this group, the brain is now usually studied without being formalin-fixed, which limits the available information. We evaluated the diagnostic accuracy of postmortem MR imaging of the fetal brain and spine when compared with the reference standard, autopsy. METHODS We obtained high-spatial-resolution T2-weighted images (in-plane resolution approximately 0.4 mm) of the brain and spine in 40 fetuses and stillborn neonates (14-42 weeks gestational age) who were referred for autopsy. The MR findings were compared with those of autopsy, the reference standard, which had been performed independently. RESULTS In eight cases, the autopsy did not provide structural information of the brain or spine, because assessment of the unfixed tissue was impossible. There was agreement between MR and autopsy findings in 31 (97%) of 32 cases in which comparison could be made. Eleven cases showed normal brain, and 20 cases showed a wide range of developmental and acquired abnormalities. The sensitivity of MR was 100%, specificity 92%, positive predictive value 95%, and negative predictive value 100%. CONCLUSION MR imaging has a useful role in providing structural information of the central nervous system in fetuses and stillborn neonates.
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Affiliation(s)
- Paul D Griffiths
- Section of Academic Radiology, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
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Whitby E, Paley MN, Davies N, Sprigg A, Griffiths PD. Ultrafast magnetic resonance imaging of central nervous system abnormalities in utero in the second and third trimester of pregnancy: comparison with ultrasound. BJOG 2001; 108:519-26. [PMID: 11368139 DOI: 10.1111/j.1471-0528.2001.00115.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the ability of ultrafast magnetic resonance imaging to visualise abnormalities in the central nervous system of third trimester fetuses in utero and to compare the results with the current 'reference standard' of ultrasound and postnatal imaging or post-mortem data. DESIGN A prospective, observational study comparing the diagnostic accuracy of two imaging methods: antenatal ultrasound and antenatal magnetic resonance with each other and postnatal or post mortem data. POPULATION Twenty-one pregnant women of 19-36 weeks of gestation whose fetus were thought to have a central nervous system abnormality on the basis of antenatal ultrasound. The women had either not been offered or had refused a termination and were willing to have a magnetic resonance scan. METHODS A 1.5T magnetic resonance scanner used a single shot fast spin echo sequence, in three image planes. The results were compared with the ultrasound results obtained by an experienced investigator independently. A series of 21 patients, with a range of pathologies of central nervous system, were imaged. Postnatal ultrasound and/or magnetic resonance imaging, or post-mortem data were used for additional confirmation of the pathology in all cases. RESULTS The magnetic resonance report was different to the ultrasound in 10/21 (47.6%), magnetic resonance provided information additional to the ultrasound in 5/21 (23.8%), ultrasound and magnetic resonance results agreed in 6/21 cases (28.6%). CONCLUSION Magnetic resonance in the third trimester provides a useful adjuvant to ultrasound imaging of the fetus when assessing abnormalities of the central nervous system after 19 weeks of gestation particularly if the abnormality involves the posterior fossa.
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Affiliation(s)
- E Whitby
- University of Sheffield, Section of Academic Radiology, Royal Hallamshire Hospital, UK
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Whitby E, Paley MN, Davies N, Sprigg A, Griffiths PD. Ultrafast magnetic resonance imaging of central nervous system abnormalities in utero in the second and third trimester of pregnancy: comparison with ultrasound. ACTA ACUST UNITED AC 2001. [DOI: 10.1016/s0306-5456(00)00115-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Paley M, Mayhew JE, Martindale AJ, McGinley J, Berwick J, Coffey P, Redgrave P, Furness P, Port M, Ham A, Zheng Y, Jones M, Whitby E, van Beek EJ, Wilkinson ID, Darwent G, Griffiths PD. Design and initial evaluation of a low-cost 3-Tesla research system for combined optical and functional MR imaging with interventional capability. J Magn Reson Imaging 2001; 13:87-92. [PMID: 11169808 DOI: 10.1002/1522-2586(200101)13:1<87::aid-jmri1013>3.0.co;2-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A 3-Tesla research system has been developed for functional and interventional magnetic resonance imaging (MRI) procedures on animal models based on a low field niche spectrometer. Use of two stages of fourth harmonic frequency multiplication has allowed us to produce a high-frequency spectrometer with good frequency stability based on a low-frequency direct digital synthesizer. The system has been designed with the ability to introduce interventional tools such as biopsy needles, radiofrequency (RF) electrodes, and fiber optics for optical spectroscopy and thermal ablation as well as drug infusions to allow function to be studied in the presence of external challenges. Full MR-compatible physiologic support capability allows animals to be maintained in a stable condition over extended periods of study. Functional MR images have been acquired by using gradient echoes (TR/TE = 40/12 msec) from the rat whisker barrel cortex using electrical stimulation (5-V, 1.5-mA, 1-msec pulses at 5 Hz via two needle electrodes inserted into the rat whisker pad). Initial results using respiratory gas challenges of 100% N(2), 100% O(2), and 10% CO(2) have shown excellent agreement between single wavelength (633 nm) optical and functional MR time series with subsecond time resolution. The 1-mm copper electrodes for interventional radiofrequency ablation procedures were easily visualized in the superior colliculus by using gradient echo sequences. This novel, low-cost, high field system appears to be a useful research tool for functional and interventional studies of rat brain and allows concurrent optical spectroscopy. J. Magn. Reson. Imaging 2001;13:87-92.
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Affiliation(s)
- M Paley
- Section of Academic Radiology and Department of Psychology, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, England.
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