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Paddock M, Johnson PC, Staley A, Halliday K, Offiah AC. The impact of sedation on the quality of initial skeletal surveys performed for suspected physical abuse in children: a comparative two-centre audit. Clin Radiol 2024:S0009-9260(24)00203-4. [PMID: 38772767 DOI: 10.1016/j.crad.2024.04.012] [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] [Received: 12/22/2023] [Revised: 04/09/2024] [Accepted: 04/17/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND The impact of sedation on the quality of initial skeletal surveys performed for suspected physical abuse in children is not known. OBJECTIVE To assess whether sedation influenced the number of, reason for and effective dose of repeat radiographs obtained as part of initial skeletal surveys, and their mean examination times. MATERIALS AND METHODS One hundred consecutive antemortem initial skeletal survey examinations performed for suspected physical abuse in children <2 years were retrieved from two tertiary paediatric hospitals: Centre 1, where sedation is not used for initial skeletal survey imaging; and Centre 2, where sedation is used routinely. RESULTS In total, 4055 radiographic projections were performed, of which 93 (2.3%) were repeats. Comparing centres, there was a significant difference in the total number of repeats (P=0.001) and the number of repeats in children aged <12 months (P=0.008). Mean examination times were significantly shorter in unsedated children (P=0.005), even after outliers were excluded (P=0.002). There was no significant difference between the number of routine projections (P=0.587), incompletely imaged body parts (P=0.254), rotation/suboptimal positioning (P=0.527), repeats in children aged >12 months (P=0.089), routine projections in children aged <12 months (P=0.642) or >12 months (P=0.979) or the effective doses of repeats (P=0.286). CONCLUSION There were fewer repeat projections in sedated children and those aged <12 months but examination times were significantly longer. There was no difference in the effective doses of repeated projections. The routine use of sedation is not supported when performing skeletal survey imaging if the primary considerations are reducing radiation dose and examination time.
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Affiliation(s)
- M Paddock
- SKG Radiology, Subiaco, WA, Australia; School of Medicine, The University of Notre Dame Australia, Perth, WA, Australia; Division of Paediatrics, University of Western Australia, Perth, WA, Australia; Division of Clinical Medicine, University of Sheffield, Damer Street Building, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom.
| | - P C Johnson
- The Medical School, The University of Sheffield, Sheffield, United Kingdom
| | - A Staley
- Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - K Halliday
- Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - A C Offiah
- Division of Clinical Medicine, University of Sheffield, Damer Street Building, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom; Department of Radiology, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom.
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Alshammari AT, Oates AJ, Rigby AS, Offiah AC. Diagnosis of metaphyseal fractures in infants and young children with suspected inflicted injury: a systematic review of cross-sectional imaging techniques. Clin Radiol 2024; 79:221-229. [PMID: 38092647 DOI: 10.1016/j.crad.2023.11.014] [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] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/18/2023] [Accepted: 11/12/2023] [Indexed: 02/15/2024]
Abstract
AIM To compare the diagnostic accuracy, advantages, and disadvantages of different medical imaging techniques for detecting metaphyseal fractures (also known as classic metaphyseal lesions [CMLs]) in infants and young children with suspected inflicted trauma. MATERIALS AND METHODS This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist and Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool criteria. Predefined keywords were used to search online databases for English articles published between 1 January 1980 and 31 March 2023. RESULTS The initial search revealed 83 studies, only five of which met the inclusion criteria. The sensitivity and specificity of positron-emission tomography (PET) were 67% and 99%, respectively. The sensitivity and specificity of ultrasound were 55-61% and 96-97%, respectively. The sensitivity of magnetic resonance imaging (MRI) whole-body screening was 31%. The sensitivity of bone scintigraphy was 17% in one and 35% in a second study. Computed tomography was not used to detect CMLs in any diagnostic accuracy study. CONCLUSION This systematic review has identified only a small number of relevant studies. In addition to the skeletal survey, PET and ultrasound may be helpful for the diagnosis of CMLs in infants and young children with suspected abuse; however, ultrasound has greater potential than PET due to its higher specificity, lack of radiation exposure, low cost, and wider availability.
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Affiliation(s)
- A T Alshammari
- Department of Oncology and Metabolism, the Medical School, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK; Department of Diagnostic Radiology, College of Applied Medical Science, University of Hail, Hail, Saudi Arabia.
| | - A J Oates
- Department of Radiology, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - A S Rigby
- Hull York Medical School, University of Hull, Hull HU6 7RU, UK
| | - A C Offiah
- Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Western Bank, Sheffield S10 2TH, UK; Radiology Department, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield S10 2TH, UK
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Offiah AC. Month 12 musings of a managing editor. Pediatr Radiol 2022; 52:2243-2244. [PMID: 36287233 DOI: 10.1007/s00247-022-05542-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- A C Offiah
- Department of Oncology & Metabolism, University of Sheffield, Room 3, Damer Street Building, Sheffield, UK.
- Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, UK.
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Lewis L, Borg S, Alison L, Hardisty H, Parry-Okeden S, Kerrin D, Chadha L, Roberts K, Shabani K, Offiah AC, Bishop NJ. Parathyroid hormone changes in infants investigated for inflicted injury; an observational retrospective single centre cohort study. Child Abuse Negl 2022; 131:105775. [PMID: 35803027 DOI: 10.1016/j.chiabu.2022.105775] [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] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/09/2022] [Accepted: 06/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Biochemical and haematological testing is recommended in the United Kingdom when inflicted injury is suspected. We examined the associations of test results with radiologically-confirmed fracture(s), and between test results, in a large retrospective observational cohort. METHODS Infants up to age two years presenting with suspected inflicted injury, without clinically or radiologically apparent bone disease, and where a skeletal survey was undertaken during the period 1st August 2013 to 31st December 2020, were included. Biochemical parameters: corrected calcium (cCa); phosphate (P); alkaline phosphatase (ALP); parathyroid hormone (PTH); 25-hydroxyvitamin D (25D); and haematological parameters: haemoglobin (Hb); mean corpuscular haemoglobin (MCH); mean corpuscular haemoglobin content (MCHC); mean corpuscular volume (MCV); platelet count were collated together with the results of the radiological assessments. FINDINGS Of 332 eligible infants (190 male), 142 (84 male) had fracture(s) and/or intracranial injury. Mean PTH in the non-fracture group (n measured 50/190) was 27.3 ng/l; in those with intracranial injury alone (n measured 9/23) was 39.4 ng/l; in those with fracture alone (n measured 62/84) was 45.0 ng/l; and in those with fracture and intracranial injury (n measured 20/35) 51.8 ng/l. F-test of multiple means = 0.0369. There was no difference in 25D between the groups. INTERPRETATION PTH was raised in infants who had fracture(s), intracranial injury or both. A single raised PTH may not necessarily be an indicator of prior disturbed skeletal health in these circumstances. The relevance of vitamin D status and interpretation of data from biochemical testing should be informed by the overall presentation in suspected inflicted injury cases. A single raised PTH may be a consequence of the child's injuries rather than prior disturbed bone health.
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Affiliation(s)
- L Lewis
- Sheffield Children's NHS Foundation Trust, Sheffield, UK; Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, UK
| | - S Borg
- Sheffield Children's NHS Foundation Trust, Sheffield, UK; Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - L Alison
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - H Hardisty
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - S Parry-Okeden
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - D Kerrin
- Barnsley NHS Foundation Trust, UK
| | - L Chadha
- Doncaster and Bassetlaw NHS Foundation Trust, UK
| | - K Roberts
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - K Shabani
- The Rotherham NHS Foundation Trust, UK
| | - A C Offiah
- Sheffield Children's NHS Foundation Trust, Sheffield, UK; Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - N J Bishop
- Sheffield Children's NHS Foundation Trust, Sheffield, UK; Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
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Wadanamby S, El Garwany S, Connolly D, Arundel P, Bishop NJ, DeVile CJ, Calder AD, Crowe B, Burren CP, Saraff V, Offiah AC. Monitoring Skull Base Abnormalities in Children with Osteogenesis Imperfecta - Review of Current Practice and a Suggested Clinical Pathway. Bone 2022; 154:116235. [PMID: 34688943 DOI: 10.1016/j.bone.2021.116235] [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: 08/08/2021] [Revised: 10/11/2021] [Accepted: 10/16/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES In the context of a lack of national consensus on the benefits of skull base imaging in children with osteogenesis imperfecta (OI), this study aims to analyse and correlate the clinical symptoms and radiological images of children with severe OI. METHODS A retrospective case notes and image analysis was carried out on children with complex OI between 2012 and 2018 at a specialist tertiary centre. Data were collected on patient demographic factors, clinical data, imaging findings (presence of Wormian bones, platybasia, basilar impression (McGregor's technique) and basilar invagination (McRae's technique)), and clinical features at the time of imaging. RESULTS Of the 127 patients in the OI database, 94 were included. A total of 321 radiographs, 21 CT scans and 39 MRI scans were analysed. Average frequency of radiographs was 8 per 10 years. Of the 94 patients, 58 (62%), 10 (11%), 1 (1%) demonstrated platybasia, basilar impression, and basilar invagination, respectively. Of the radiographs analysed, platybasia, basilar impression, basilar invagination, and the presence of Wormian bones, could not be evaluated in 71 (22.3%), 48 (15.2%), 61 (19.5%) and 28 (9.4%) radiographs respectively (due to poor positioning, anatomical abnormalities, and poor image quality). Of the 140 radiographs with platybasia, 17 (12%) also demonstrated basilar impression compared to only 3 (2.9%) out of the 99 without platybasia (p = 0.03). No significant associations were seen between the presence of Wormian bones and basilar impression. Of the 39 MRIs, additional information on CSF flow rate, spinal cord signal and cerebellar morphology was reported in 14 (36%). There was a lack of concordance between MRI and matched radiographs in 7.1% (1/14) and 36% (5/14) for platybasia and basilar impression respectively, with full concordance for basilar invagination. Fewer than 5% had positive clinical symptoms/signs at the time of imaging; 2% (7/321) had macrocephaly, 0.6% (2/321) headache, all other neurological features were absent). Clinical features were not documented in >85% of patients. CONCLUSION The apparent low prevalence of clinical symptoms and signs and of radiologically identified cranio-cervical abnormalities, suggests that current levels of serial imaging may be excessive. Until larger prospective studies clarify these issues, we suggest a clinical pathway for base of skull imaging which proposes a risk stratification approach to radiographic frequency and suggests parameters for proceeding to MRI.
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Affiliation(s)
- S Wadanamby
- Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Sheffield, S10 2TH, UK.
| | - S El Garwany
- Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Sheffield, S10 2TH, UK; Suez Canal University, Faculty of Medicine, Department of Radiology, 4.5 Km Ring Road, Ismailia, Egypt
| | - Dja Connolly
- Department of Radiology, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, UK
| | - P Arundel
- Department of Paediatrics, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, UK; Highly Specialised Service for Severe, Complex and Atypical Osteogenesis Imperfecta (NHS England) - Birmingham Women's and Children's Hospital, UK; Bristol Royal Hospital for Children, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, UK; Sheffield Children's Hospital NHS Foundation Trust, UK
| | - N J Bishop
- Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Sheffield, S10 2TH, UK; Department of Paediatrics, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, UK; Highly Specialised Service for Severe, Complex and Atypical Osteogenesis Imperfecta (NHS England) - Birmingham Women's and Children's Hospital, UK; Bristol Royal Hospital for Children, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, UK; Sheffield Children's Hospital NHS Foundation Trust, UK
| | - C J DeVile
- The Wolfson Neurodisability Service, Great Ormond Street Hospital for Children NHS Foundation Trust, UK; Highly Specialised Service for Severe, Complex and Atypical Osteogenesis Imperfecta (NHS England) - Birmingham Women's and Children's Hospital, UK; Bristol Royal Hospital for Children, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, UK; Sheffield Children's Hospital NHS Foundation Trust, UK
| | - A D Calder
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, UK; Highly Specialised Service for Severe, Complex and Atypical Osteogenesis Imperfecta (NHS England) - Birmingham Women's and Children's Hospital, UK; Bristol Royal Hospital for Children, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, UK; Sheffield Children's Hospital NHS Foundation Trust, UK
| | - B Crowe
- The Wolfson Neurodisability Service, Great Ormond Street Hospital for Children NHS Foundation Trust, UK; Highly Specialised Service for Severe, Complex and Atypical Osteogenesis Imperfecta (NHS England) - Birmingham Women's and Children's Hospital, UK; Bristol Royal Hospital for Children, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, UK; Sheffield Children's Hospital NHS Foundation Trust, UK
| | - C P Burren
- Department of Paediatric Endocrinology and Diabetes, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin St, Bristol BS2 8BJ, UK; Highly Specialised Service for Severe, Complex and Atypical Osteogenesis Imperfecta (NHS England) - Birmingham Women's and Children's Hospital, UK; Bristol Royal Hospital for Children, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, UK; Sheffield Children's Hospital NHS Foundation Trust, UK
| | - V Saraff
- Department of Paediatric Endocrinology, Birmingham Women's and Children's Hospital, UK; Highly Specialised Service for Severe, Complex and Atypical Osteogenesis Imperfecta (NHS England) - Birmingham Women's and Children's Hospital, UK; Bristol Royal Hospital for Children, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, UK; Sheffield Children's Hospital NHS Foundation Trust, UK
| | - A C Offiah
- Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Sheffield, S10 2TH, UK; Department of Radiology, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, UK; Highly Specialised Service for Severe, Complex and Atypical Osteogenesis Imperfecta (NHS England) - Birmingham Women's and Children's Hospital, UK; Bristol Royal Hospital for Children, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, UK; Sheffield Children's Hospital NHS Foundation Trust, UK
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6
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Campanini EH, Baker D, Arundel P, Bishop NJ, Offiah AC, Keigwin S, Cadden S, Dall'Ara E, Nicolaou N, Giles S, Fernandes JA, Balasubramanian M. High bone mass phenotype in a cohort of patients with Osteogenesis Imperfecta caused due to BMP1 and C-propeptide cleavage variants in COL1A1. Bone Rep 2021; 15:101102. [PMID: 34277895 PMCID: PMC8264105 DOI: 10.1016/j.bonr.2021.101102] [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: 06/13/2021] [Accepted: 06/27/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Osteogenesis Imperfecta (OI) is a heterogeneous condition mainly characterised by bone fragility; extra-skeletal features in OI include blue sclerae, dentinogenesis imperfecta, skin laxity and joint hyper-extensibility. Most patients with OI are thought to have a low bone mass but contrary to expectations there are certain forms of OI with high bone mass which this study explores in further detail. METHOD A cohort of n = 6 individuals with pathogenic variants in BMP1 and the C-propeptide cleavage variants in COL1A1 were included in this study. Detailed clinical and radiological phenotyping was done and correlated with genotype to identify patterns of clinical presentation and fracture history in this cohort of patients. This data was compared to previously reported literature in this group. RESULTS 2 patients with BMP1 and 4 patients with pathogenic variants in C-propeptide region in COL1A1 were deep-phenotyped as part of this study and 1 patient with C-propeptide variant in COL1A1, showed low bone mineral density. In those with an elevated bone mineral density, this became even more apparent on bisphosphonate therapy. Patients in this cohort had variable clinical presentation ranging from antenatal presentation to more of an insidious course resulting in later confirmation of genetic diagnosis up to 19 years of age. CONCLUSIONS Patients with pathogenic variants in the C-propeptide region of COL1A1/A2 and BMP1 appear to have a high bone mass phenotype with increased sensitivity to bisphosphonate therapy. It is important to closely monitor patients with these genotypes to assess their response to therapy and tailor their treatment regime accordingly.
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Affiliation(s)
- E H Campanini
- Medical School, University of Sheffield, Sheffield, UK
| | - D Baker
- Sheffield Diagnostic Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - P Arundel
- Highly Specialised OI Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - N J Bishop
- Highly Specialised OI Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK.,Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
| | - A C Offiah
- Highly Specialised OI Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK.,Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
| | - S Keigwin
- Sheffield Diagnostic Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - S Cadden
- Sheffield Diagnostic Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - E Dall'Ara
- Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
| | - N Nicolaou
- Department of Orthopaedic Surgery, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - S Giles
- Department of Orthopaedic Surgery, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - J A Fernandes
- Department of Orthopaedic Surgery, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - M Balasubramanian
- Highly Specialised OI Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK.,Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK.,Sheffield Clinical Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
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Altai Z, Viceconti M, Li X, Offiah AC. Investigating rolling as mechanism for humeral fractures in non-ambulant infants: a preliminary finite element study. Clin Radiol 2019; 75:78.e9-78.e16. [PMID: 31590914 DOI: 10.1016/j.crad.2019.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/29/2019] [Indexed: 11/27/2022]
Abstract
AIM To use personalised computed tomography (CT)-based finite element models to quantitatively investigate the likelihood of self-inflicted humeral fracture in non-ambulant infants secondary to rolling. MATERIALS AND METHODS Three whole-body post-mortem CT examinations of children at the age of rolling (two 4-month-old and one 6-month-old) were used. The mechanical moment needed by each infant to perform a rolling manoeuvre was calculated and applied to the finite element model in order to simulate spontaneous rolling from the prone to the supine position. RESULTS The maximum predicted strains were found to be substantially lower (with a difference of >80%) than the elastic limit of the bone. CONCLUSION Results of this study challenge the plausibility of self-inflicted humeral fracture caused by rolling in non-ambulant infants and indicate that it is unlikely for a humeral fracture to result from this mechanism without the assistance of an external force.
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Affiliation(s)
- Z Altai
- Department of Mechanical Engineering, University of Sheffield, UK; Insigneo Institute for in silico Medicine, University of Sheffield, UK
| | - M Viceconti
- Department of Mechanical Engineering, University of Sheffield, UK; Insigneo Institute for in silico Medicine, University of Sheffield, UK
| | - X Li
- Department of Mechanical Engineering, University of Sheffield, UK; Insigneo Institute for in silico Medicine, University of Sheffield, UK.
| | - A C Offiah
- Insigneo Institute for in silico Medicine, University of Sheffield, UK; Department of Oncology and Metabolism, University of Sheffield, UK
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Castro APG, Altai Z, Offiah AC, Shelmerdine SC, Arthurs OJ, Li X, Lacroix D. Finite element modelling of the developing infant femur using paired CT and MRI scans. PLoS One 2019; 14:e0218268. [PMID: 31211799 PMCID: PMC6581244 DOI: 10.1371/journal.pone.0218268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 01/18/2019] [Accepted: 05/29/2019] [Indexed: 11/19/2022] Open
Abstract
Bone finite element (FE) studies based on infant post-mortem computed tomography (CT) examinations are being developed to provide quantitative information to assist the differentiation between accidental and inflicted injury, and unsuspected underlying disease. As the growing skeleton contains non-ossified cartilaginous regions at the epiphyses, which are not well characterised on CT examinations, it is difficult to evaluate the mechanical behaviour of the developing whole bone. This study made use of paired paediatric post mortem femoral CT and magnetic resonance imaging (MRI) examinations at two different stages of development (4 and 7 months) to provide anatomical and constitutive information for both hard and soft tissues. The work aimed to evaluate the effect of epiphyseal ossification on the propensity to shaft fractures in infants. The outcomes suggest that the failure load of the femoral diaphysis in the models incorporating the non-ossified epiphysis is within the range of bone-only FE models. There may however be an effect on the metaphysis. Confirmation of these findings is required in a larger cohort of children.
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Affiliation(s)
- A. P. G. Castro
- INSIGNEO Institute, Dept. of Mechanical Engineering, University of Sheffield, Sheffield, United Kingdom
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Z. Altai
- INSIGNEO Institute, Dept. of Mechanical Engineering, University of Sheffield, Sheffield, United Kingdom
| | - A. C. Offiah
- Dept. of Oncology and Human Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - S. C. Shelmerdine
- Dept. of Radiology, Great Ormond Street Hospital for Children, London, United Kingdom
- UCL Great Ormond Street Institute for Child Health, University College London, London, United Kingdom
| | - O. J. Arthurs
- Dept. of Radiology, Great Ormond Street Hospital for Children, London, United Kingdom
- UCL Great Ormond Street Institute for Child Health, University College London, London, United Kingdom
| | - X. Li
- INSIGNEO Institute, Dept. of Mechanical Engineering, University of Sheffield, Sheffield, United Kingdom
| | - D. Lacroix
- INSIGNEO Institute, Dept. of Mechanical Engineering, University of Sheffield, Sheffield, United Kingdom
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Oates A, Halliday K, Offiah AC, Landes C, Stoodley N, Jeanes A, Johnson K, Chapman S, Stivaros SM, Fairhurst J, Watt A, Paddock M, Giles K, McHugh K, Arthurs OJ. Shortage of paediatric radiologists acting as an expert witness: position statement from the British Society of Paediatric Radiology (BSPR) National Working Group on Imaging in Suspected Physical Abuse (SPA). Clin Radiol 2019; 74:496-502. [PMID: 31126587 DOI: 10.1016/j.crad.2019.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/12/2019] [Indexed: 11/29/2022]
Abstract
One of the most challenging areas of radiological imaging in children is the diagnosis of physical abuse. There is a dearth of paediatric radiologists willing to act as expert witnesses, particularly in the family courts. There are a number of reasons why radiologists may not be interested or willing to put themselves forward to work as expert witnesses in this field. A group of imaging experts recently formed the "British Society of Paediatric Radiology (BSPR) Working Group on Imaging in Suspected Physical Abuse (SPA)". The group comprises radiologists and neuroradiologists with current or previous experience of providing expert witness reports to the court in cases of SPA. The group met in January 2019 to explore pragmatic solutions to the chronic inefficiencies in both medical and legal practices and the challenges that arise from working in a legal arena with different structures, goals, and assessment criteria. Key issues concerned organisational inefficiencies, variable support from National Health Service Trusts and the Royal College of Radiologists to conduct this work, and the risk/benefit of involvement. This work is important for the patient, parents, and society in general, and highly rewarding for clinical practitioners who are involved, but there are several issues with current practices that discourage active participation. With several members of the group either retired or close to retirement, the shortage of experts is becoming a pressing issue within the UK, which requires an engaged multidisciplinary group to come up with creative solutions. Here, the group provide a consensus opinion highlighting the current barriers and potential facilitators to increasing the number of radiologists willing to provide opinions to the court.
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Affiliation(s)
- A Oates
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - K Halliday
- Nottingham Children's Hospital, Nottingham, UK
| | - A C Offiah
- Academic Unit of Child Health, University of Sheffield, UK
| | - C Landes
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - N Stoodley
- Bristol Children's Hospital, Bristol, UK
| | - A Jeanes
- Leeds Children's Hospital, Leeds Teaching Hospital's NHS Trust, Leeds, UK
| | - K Johnson
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - S Chapman
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - S M Stivaros
- Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Central Manchester University Hospitals, NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK; Division of Informatics, Imaging & Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - J Fairhurst
- Southampton Children's Hospital, Southampton, UK
| | - A Watt
- The Royal Hospital for Children, Glasgow, Scotland, UK
| | - M Paddock
- Barnsley Hospital NHS Foundation Trust, Barnsley, UK
| | - K Giles
- Torbay and South Devon NHS Foundation Trust, UK
| | - K McHugh
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - O J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; NIHR UCL GOS Institute of Child Health Biomedical Research Centre, London, UK.
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Alqahtani FF, Messina F, Kruger E, Gill H, Ellis M, Lang I, Broadley P, Offiah AC. Evaluation of a semi-automated software program for the identification of vertebral fractures in children. Clin Radiol 2017; 72:904.e11-904.e20. [PMID: 28506798 DOI: 10.1016/j.crad.2017.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 02/16/2017] [Revised: 03/24/2017] [Accepted: 04/11/2017] [Indexed: 11/19/2022]
Abstract
AIM To assess observer reliability and diagnostic accuracy in children, of a semi-automated six-point technique developed for vertebral fracture (VF) diagnosis in adults, which records percentage loss of vertebral body height. MATERIALS AND METHODS Using a semi-automated software program, five observers independently assessed T4 to L4 from the lateral spine radiographs of 137 children and adolescents for VF. A previous consensus read by three paediatric radiologists using a simplified algorithm-based qualitative technique (i.e., no software involved) served as the reference standard. RESULTS Of a total of 1,781 vertebrae, 1,187 (67%) were adequately visualised according to three or more observers. Interobserver agreement in vertebral readability for each vertebral level for five observers ranged from 0.05 to 0.47 (95% CI: -0.19, 0.76). Intra-observer agreement using the intraclass correlation coefficient (ICC) ranged from 0.25 to 0.61. The overall sensitivity and specificity were 18% (95% CI: 14-22) and 97% (95% CI: 97-98), respectively. CONCLUSION In contrast to adults, the six-point technique assessing anterior, middle, and posterior vertebral height ratios is neither satisfactorily reliable nor sensitive for VF diagnosis in children. Training of the software on paediatric images is required in order to develop a paediatric standard that incorporates not only specific vertebral body height ratios but also the age-related physiological changes in vertebral shape that occur throughout childhood.
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Affiliation(s)
- F F Alqahtani
- Academic Unit of Child Health, University of Sheffield, Sheffield, UK; Department of Radiological Sciences, College of Applied Medical Sciences, Najran University, Najran, Saudi Arabia.
| | - F Messina
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - E Kruger
- Radiology Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - H Gill
- Sheffield Medical School, University of Sheffield, Sheffield, UK
| | - M Ellis
- Sheffield Medical School, University of Sheffield, Sheffield, UK
| | - I Lang
- Radiology Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - P Broadley
- Radiology Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - A C Offiah
- Academic Unit of Child Health, University of Sheffield, Sheffield, UK; Radiology Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK
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Balasubramanian M, Hurst J, Brown S, Bishop NJ, Arundel P, DeVile C, Pollitt RC, Crooks L, Longman D, Caceres JF, Shackley F, Connolly S, Payne JH, Offiah AC, Hughes D, Parker MJ, Hide W, Skerry TM. Compound heterozygous variants in NBAS as a cause of atypical osteogenesis imperfecta. Bone 2017; 94:65-74. [PMID: 27789416 PMCID: PMC6067660 DOI: 10.1016/j.bone.2016.10.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [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: 09/07/2016] [Revised: 10/17/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Osteogenesis imperfecta (OI), the commonest inherited bone fragility disorder, affects 1 in 15,000 live births resulting in frequent fractures and reduced mobility, with significant impact on quality of life. Early diagnosis is important, as therapeutic advances can lead to improved clinical outcome and patient benefit. REPORT Whole exome sequencing in patients with OI identified, in two patients with a multi-system phenotype, compound heterozygous variants in NBAS (neuroblastoma amplified sequence). Patient 1: NBAS c.5741G>A p.(Arg1914His); c.3010C>T p.(Arg1004*) in a 10-year old boy with significant short stature, bone fragility requiring treatment with bisphosphonates, developmental delay and immunodeficiency. Patient 2: NBAS c.5741G>A p.(Arg1914His); c.2032C>T p.(Gln678*) in a 5-year old boy with similar presenting features, bone fragility, mild developmental delay, abnormal liver function tests and immunodeficiency. DISCUSSION Homozygous missense NBAS variants cause SOPH syndrome (short stature; optic atrophy; Pelger-Huet anomaly), the same missense variant was found in our patients on one allele and a nonsense variant in the other allele. Recent literature suggests a multi-system phenotype. In this study, patient fibroblasts have shown reduced collagen expression, compared to control cells and RNAseq studies, in bone cells show that NBAS is expressed in osteoblasts and osteocytes of rodents and primates. These findings provide proof-of-concept that NBAS mutations have mechanistic effects in bone, and that NBAS variants are a novel cause of bone fragility, which is distinguishable from 'Classical' OI. CONCLUSIONS Here we report on variants in NBAS, as a cause of bone fragility in humans, and expand the phenotypic spectrum associated with NBAS. We explore the mechanism underlying NBAS and the striking skeletal phenotype in our patients.
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Affiliation(s)
- M Balasubramanian
- Sheffield Clinical Genetics Service, Sheffield Children's NHS Foundation Trust, UK; Highly Specialised Service for Severe, Complex and Atypical OI, UK.
| | - J Hurst
- NE Thames Clinical Genetics Service, Great Ormond Street Hospital, UK
| | - S Brown
- Sheffield RNAi Screening Facility, Department of Biomedical Sciences, University of Sheffield, UK
| | - N J Bishop
- Highly Specialised Service for Severe, Complex and Atypical OI, UK; Academic Unit of Child Health, University of Sheffield, UK
| | - P Arundel
- Highly Specialised Service for Severe, Complex and Atypical OI, UK
| | - C DeVile
- Highly Specialised Service for Severe, Complex and Atypical OI, UK
| | - R C Pollitt
- Academic Unit of Child Health, University of Sheffield, UK; Sheffield Diagnostic Genetics Service, Sheffield Children's NHS Foundation Trust, UK
| | - L Crooks
- Sheffield Diagnostic Genetics Service, Sheffield Children's NHS Foundation Trust, UK; Department of Biosciences and Chemistry, Sheffield Hallam University, UK
| | - D Longman
- MRC Human Genetics Unit, IGMM, University of Edinburgh, UK
| | - J F Caceres
- MRC Human Genetics Unit, IGMM, University of Edinburgh, UK
| | - F Shackley
- Department of Paediatric Immunology, Sheffield Children's NHS Foundation Trust, UK
| | - S Connolly
- Department of Paediatric Hepatology, Sheffield Children's NHS Foundation Trust, UK
| | - J H Payne
- Department of Paediatric Haematology, Sheffield Children's NHS Foundation Trust, UK
| | - A C Offiah
- Highly Specialised Service for Severe, Complex and Atypical OI, UK; Academic Unit of Child Health, University of Sheffield, UK
| | - D Hughes
- Department of Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - M J Parker
- Sheffield Clinical Genetics Service, Sheffield Children's NHS Foundation Trust, UK
| | - W Hide
- Centre for Computational Biology, Sheffield Institute of Translational Neuroscience, University of Sheffield, UK
| | - T M Skerry
- Mellanby Bone Research Centre, Department of Oncology & Metabolism, University of Sheffield, UK
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Digby MG, Bishop NJ, Paggiosi MA, Offiah AC. HR-pQCT: a non-invasive 'biopsy' to assess bone structure and strength. Arch Dis Child Educ Pract Ed 2016; 101:268-70. [PMID: 27122599 DOI: 10.1136/archdischild-2015-309455] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/06/2016] [Indexed: 01/01/2023]
Affiliation(s)
- M G Digby
- Sheffield Medical School, University of Sheffield, Sheffield, UK
| | - N J Bishop
- Academic Unit of Child Health, University of Sheffield, Sheffield, UK
| | - M A Paggiosi
- Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - A C Offiah
- Academic Unit of Child Health, University of Sheffield, Sheffield, UK
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13
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Adiotomre E, Summers L, Allison A, Walters SJ, Digby M, Broadley P, Lang I, Morrison G, Bishop N, Arundel P, Offiah AC. Diagnostic accuracy of DXA compared to conventional spine radiographs for the detection of vertebral fractures in children. Eur Radiol 2016; 27:2188-2199. [PMID: 27655305 PMCID: PMC5374187 DOI: 10.1007/s00330-016-4556-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 03/15/2016] [Revised: 07/05/2016] [Accepted: 08/09/2016] [Indexed: 10/26/2022]
Abstract
OBJECTIVES In children, radiography is performed to diagnose vertebral fractures and dual energy x-ray absorptiometry (DXA) to assess bone density. In adults, DXA assesses both. We aimed to establish whether DXA can replace spine radiographs in assessment of paediatric vertebral fractures. METHODS Prospectively, lateral spine radiographs and lateral spine DXA of 250 children performed on the same day were independently scored by three radiologists using the simplified algorithm-based qualitative technique and blinded to results of the other modality. Consensus radiograph read and second read of 100 random images were performed. Diagnostic accuracy, inter/intraobserver and intermodality agreements, patient/carer experience and radiation dose were assessed. RESULTS Average sensitivity and specificity (95 % confidence interval) in diagnosing one or more vertebral fractures requiring treatment was 70 % (58-82 %) and 97 % (94-100 %) respectively for DXA and 74 % (55-93 %) and 96 % (95-98 %) for radiographs. Fleiss' kappa for interobserver and average kappa for intraobserver reliability were 0.371 and 0.631 respectively for DXA and 0.418 and 0.621 for radiographs. Average effective dose was 41.9 μSv for DXA and 232.7 μSv for radiographs. Image quality was similar. CONCLUSION Given comparable image quality and non-inferior diagnostic accuracy, lateral spine DXA should replace conventional radiographs for assessment of vertebral fractures in children. KEY POINTS • Vertebral fracture diagnostic accuracy of lateral spine DXA is non-inferior to radiographs. • The rate of unreadable vertebrae for DXA is lower than for radiographs. • Effective dose of DXA is significantly lower than radiographs. • Children prefer DXA to radiographs. • Given the above, DXA should replace radiographs for paediatric vertebral fracture assessment.
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Affiliation(s)
- E Adiotomre
- Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Rd, Sheffield, South Yorkshire, S10 2JF, UK.,Radiology Department, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK
| | - L Summers
- Sheffield Medical School, University of Sheffield, Beech Hill Rd, Sheffield, South Yorkshire, S10 2RX, UK
| | - A Allison
- School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield, South Yorkshire, S1 4DA, UK
| | - S J Walters
- School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield, South Yorkshire, S1 4DA, UK
| | - M Digby
- Sheffield Medical School, University of Sheffield, Beech Hill Rd, Sheffield, South Yorkshire, S10 2RX, UK
| | - P Broadley
- Radiology Department, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK
| | - I Lang
- Radiology Department, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK
| | - G Morrison
- Medical Physics, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Rd, Sheffield, South Yorkshire, S10 2JF, UK
| | - N Bishop
- Academic Unit of Child Health, University of Sheffield, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK
| | - P Arundel
- Academic Unit of Child Health, University of Sheffield, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK
| | - A C Offiah
- Radiology Department, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK. .,Academic Unit of Child Health, University of Sheffield, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK.
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Braithwaite VS, Freeman R, Greenwood CL, Summers DM, Nigdikar S, Lavy CBD, Offiah AC, Bishop NJ, Cashman J, Prentice A. Erratum to: The aetiology of rickets-like lower limb deformities in Malawian children. Osteoporos Int 2016; 27:2889. [PMID: 27349560 PMCID: PMC6828232 DOI: 10.1007/s00198-016-3680-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- V S Braithwaite
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, UK.
| | - R Freeman
- Department of Paediatric Orthopaedics, Robert Jones Agnes Hunt NHS Foundation Trust, Oswestry, Shropshire, UK
| | - C L Greenwood
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, UK
| | - D M Summers
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - S Nigdikar
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, UK
| | - C B D Lavy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - A C Offiah
- Department of Oncology and Metabolism, Academic Unit of Child Health, University of Sheffield, Sheffield, UK
| | - N J Bishop
- Department of Oncology and Metabolism, Academic Unit of Child Health, University of Sheffield, Sheffield, UK
| | - J Cashman
- Beit Cure Orthopaedic Hospital, Blantyre, Malawi
| | - A Prentice
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, UK
- MRC Keneba, Keneba, The Gambia
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15
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Braithwaite VS, Freeman R, Greenwood CL, Summers DM, Nigdikar S, Lavy CBD, Offiah AC, Bishop NJ, Cashman J, Prentice A. The aetiology of rickets-like lower limb deformities in Malawian children. Osteoporos Int 2016; 27:2367-2372. [PMID: 27059923 PMCID: PMC4901102 DOI: 10.1007/s00198-016-3541-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 10/21/2015] [Accepted: 02/08/2016] [Indexed: 01/23/2023]
Abstract
UNLABELLED Debilitating rickets-like lower limb deformities are common in children throughout the world, particularly in Malawi, Africa where the causes are unknown. We have identified that Blount disease and calcium deficiency rickets are the likely causes of these deformities and propose calcium supplementation as a potential treatment of Malawian rickets. INTRODUCTION Surgical correction of rickets-like lower limb deformities is the most common paediatric operation performed at Beit Cure Orthopaedic Hospital, Malawi. The aim of this study was to investigate the aetiology of these deformities. METHODS Children with a tibio-femoral angle of deformity >20° were enrolled (n = 42, 3.0-15.0 years). Anthropometric and early life and well-being data were collected. Early morning serum and urine samples were collected on the morning of the operation for markers of calcium and phosphate homeostasis. Knee radiographs were obtained, and the children were diagnosed with either Blount (BD, n = 22) or evidence of rickets disease (RD, n = 20). As BD is a mechanical rather than metabolic disease, BD were assumed to be biochemically representative of the local population and thus used as a local reference for RD. RESULTS There were no differences in anthropometry or early life experiences between BD and RD. Parathyroid hormone (PTH), 1,25-dihydroxyvitamin D, total alkaline phosphatase and urinary phosphate were significantly higher and serum phosphate, 25-hydroxyvitamin D (25OHD) and tubular maximal reabsorption of phosphate significantly lower in RD than BD. There was no difference in serum calcium, fibroblast growth factor 23 or markers of iron status between groups. All children had 25OHD > 25 nmol/L. CONCLUSIONS Vitamin D deficiency is not implicated in the aetiology of RD or BD in Malawian children. The cause of RD in Malawi is likely to be dietary calcium deficiency leading to elevated PTH resulting in increased losses of phosphate from the bone and glomerular filtrate. The causes of BD remain unclear; there was no evidence in support of previously suggested risk factors such as being overweight or starting to walk early. Prior to surgical intervention, supplementation with calcium should be considered for children with RD.
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Affiliation(s)
- V S Braithwaite
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, UK.
| | - R Freeman
- Department of Paediatric Orthopaedics, Robert Jones Agnes Hunt NHS Foundation Trust, Oswestry, Shropshire, UK
| | - C L Greenwood
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, UK
| | - D M Summers
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - S Nigdikar
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, UK
| | - C B D Lavy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - A C Offiah
- Department of Oncology and Metabolism, Academic Unit of Child Health, University of Sheffield, Sheffield, UK
| | - N J Bishop
- Department of Oncology and Metabolism, Academic Unit of Child Health, University of Sheffield, Sheffield, UK
| | - J Cashman
- Beit Cure Orthopaedic Hospital, Blantyre, Malawi
| | - A Prentice
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, UK
- MRC Keneba, Keneba, The Gambia
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17
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Arundel P, Ahmed SF, Allgrove J, Bishop NJ, Burren CP, Jacobs B, Mughal MZ, Offiah AC, Shaw NJ. British Paediatric and Adolescent Bone Group's position statement on vitamin D deficiency. BMJ 2012; 345:e8182. [PMID: 23208261 DOI: 10.1136/bmj.e8182] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Davis WR, Halls JE, Offiah AC, Pilkington C, Owens CM, Rosendahl K. Assessment of active inflammation in juvenile dermatomyositis: a novel magnetic resonance imaging-based scoring system. Rheumatology (Oxford) 2011; 50:2237-44. [DOI: 10.1093/rheumatology/ker262] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Leung RS, Fairhurst J, Johnson K, Landes C, Moon L, Sprigg A, Offiah AC. Teleradiology: a modern approach to diagnosis, training, and research in child abuse? Clin Radiol 2011; 66:546-50. [PMID: 21310398 DOI: 10.1016/j.crad.2010.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Revised: 11/22/2010] [Accepted: 11/25/2010] [Indexed: 10/18/2022]
Affiliation(s)
- R S Leung
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
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20
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Offiah AC. Acute osteomyelitis, septic arthritis and discitis: Differences between neonates and older children. Eur J Radiol 2006; 60:221-32. [PMID: 16971078 DOI: 10.1016/j.ejrad.2006.07.016] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [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: 06/22/2006] [Accepted: 07/13/2006] [Indexed: 10/24/2022]
Abstract
There are aetiological, clinical, radiological and therapeutic differences between musculoskeletal infection in the neonate (and infant) and in older children and adults. Due to the anatomy and blood supply in neonates, osteomyelitis often co-exists with septic arthritis. Discitis is more common in infants whereas vertebral body infection is more common in adults. This review article discusses the important clinical and radiological differences that in the past have led many authors to consider neonatal osteomyelitis a separate entity from osteomyelitis in the older child.
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MESH Headings
- Acute Disease
- Age Factors
- Arthritis, Infectious/diagnosis
- Arthritis, Infectious/microbiology
- Arthritis, Infectious/pathology
- Arthritis, Infectious/physiopathology
- Child
- Child, Preschool
- Discitis/diagnosis
- Discitis/microbiology
- Discitis/pathology
- Discitis/physiopathology
- Gram-Negative Bacterial Infections/complications
- Gram-Negative Bacterial Infections/diagnosis
- Gram-Positive Bacterial Infections/complications
- Gram-Positive Bacterial Infections/diagnosis
- Humans
- Infant
- Infant, Newborn
- Magnetic Resonance Imaging
- Osteomyelitis/diagnosis
- Osteomyelitis/microbiology
- Osteomyelitis/pathology
- Osteomyelitis/physiopathology
- Tomography, Emission-Computed, Single-Photon
- Tomography, X-Ray Computed
- Ultrasonography, Interventional
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Affiliation(s)
- A C Offiah
- Department of Radiology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK.
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Offiah AC, Moon L, Hall CM, Todd-Pokropek A. Diagnostic accuracy of fracture detection in suspected non-accidental injury: the effect of edge enhancement and digital display on observer performance. Clin Radiol 2006; 61:163-73. [PMID: 16439222 DOI: 10.1016/j.crad.2005.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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: 03/18/2005] [Revised: 09/13/2005] [Accepted: 09/13/2005] [Indexed: 11/17/2022]
Abstract
AIM To compare the effect of varying degrees of edge enhancement and method of digital image display on fracture detection in suspected non-accidental injury (NAI). MATERIALS AND METHODS Fifty radiographs from post-mortem skeletal surveys in 13 children with suspected NAI were selected. Images were obtained using a Fuji 5000R computed radiography system. Hard copies were printed with edge enhancement factors 0, 0.5 and 1.2. Images (edge enhancement 0.5) were also displayed on a 1K(2) monitor. Six observers independently evaluated all 200 images for the presence of abnormality. Observers also scored each image for visualization of soft tissues, visualization of trabecular markings and overall image quality. The paired Student's t-test and location receiver operating curve (ROC) analysis were used to compare quality scores and diagnostic accuracy of each display method. Individual and pooled true-positive rates (sensitivity) were determined. For the purposes of ROC analysis, histology was taken as the gold standard. RESULTS There was no difference in duration of hard and soft-copy reading sessions (p=0.76). After image manipulation soft-copy radiographs scored significantly better for image quality than hard copy (p<0.0001). Pooled observer sensitivity (at a specificity of 90%) was below 50% for all display methods. Diagnostic accuracy varied significantly between observers. Diagnostic accuracy of individual observers was not affected by display method. CONCLUSION In suspected NAI, diagnostic accuracy of fracture detection is generally low. Diagnostic accuracy appears to be affected more by observer-related factors than by the method of digital image display.
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Affiliation(s)
- A C Offiah
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK.
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Offiah AC, Grehan J, Hall CM, Todd-Pokropek A. Optimal exposure parameters for digital radiography of the infant skull: A pilot study. Clin Radiol 2005; 60:1195-204. [PMID: 16223616 DOI: 10.1016/j.crad.2005.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 09/08/2004] [Revised: 05/11/2005] [Accepted: 06/27/2005] [Indexed: 11/17/2022]
Abstract
AIM To determine optimal exposure parameters when performing digital skull radiographs in infants with suspected non-accidental injury (NAI). METHOD Anteroposterior and lateral post-mortem skull radiographs of six consecutive infants with suspected NAI were made at six exposure levels for each projection. Entrance surface doses ranged from 75-351 microGy. Exposures were made with a Fuji 5000R computed radiography system onto a standard resolution imaging plate. In three patients exposures were repeated using a high-resolution imaging plate. Hard copy images with an edge-enhancement factor of 0.5 were produced. Six observers assessed and scored the radiographs from 1=poor to 5=excellent for visualization of five criteria. The criteria scored included outer table of skull vault, inner table of skull vault, suture margins, vascular markings and soft tissues of the scalp. Radiographs were then ranked in order of overall image quality. Film density and sensitivity values were recorded. Local research committee approval was obtained. RESULTS Current parameters give an average entrance surface dose of 253 microGy and 246 microGy for anteroposterior and lateral radiographs, respectively. The study demonstrated no perceived improvement in image quality above an entrance surface dose of 200 microGy (80% of current dose) or by the use of a high-resolution imaging plate. CONCLUSION The potential exists to reduce radiation exposure in infants. A study has commenced to determine the effects of dose reduction on diagnostic accuracy in suspected NAI.
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Affiliation(s)
- A C Offiah
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
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Offiah AC, Mansour S, Jeffrey I, Nash R, Whittock N, Pyper R, Bewley S, Clayton PT, Hall CM. Greenberg dysplasia (HEM) and lethal X linked dominant Conradi-Hünermann chondrodysplasia punctata (CDPX2): presentation of two cases with overlapping phenotype. J Med Genet 2004; 40:e129. [PMID: 14684697 PMCID: PMC1735332 DOI: 10.1136/jmg.40.12.e129] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
The study aimed to evaluate the Commission of the European Communities (CEC) quality criteria for paediatric lateral spine radiographs, and to use these to assess and compare the quality of film-screen and digital images. 286 paediatric lateral spine radiographs (89 film-screen and 197 digital) were independently analysed by two observers according to the CEC criteria. Based on fulfilment of criteria, images were assigned two scores, an image criteria score and a visual grading analysis score. Sensitivity values (S) on digital radiographs were recorded and correlated with image quality. Variability for assignment of scores between observers was lower for the image criteria than the visual grading analysis technique. Analysis of variance for fulfilment of criteria between techniques, and (for digital images) age and sensitivity values was calculated. Film-screen did significantly better (p<0.05) than digital imaging for Criterion 6 (visually sharp reproduction of the cortex and trabecular markings consistent with age), but significantly worse for Criterion 7 (reproduction of the adjacent soft tissues). There was a significant difference in mean S values for each age group when Criterion 6 was or was not met. Results show that although interpretation between two observers was ambiguous, the CEC criteria were able to detect differences in quality of film-screen and digital images. It is also possible to use them when optimizing target S values.
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Affiliation(s)
- A C Offiah
- Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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Abstract
AIM To document variability in the standard of skeletal surveys received for a second opinion in suspected non-accidental injury (NAI). MATERIALS AND METHODS The skeletal surveys of 50 consecutive infants and children under 2 years of age were reviewed. A simple scoring system was developed based on fulfillment of specific parameters. Each radiograph was then assigned a score reflecting its overall clinical quality. RESULTS There was an average of 10 radiographs per skeletal survey (range 2-13). Of the 50 surveys assessed, there were 37 different combinations. These included five babygrams. No survey complied with the current draft guidelines of the British Society of Paediatric Radiologists (BSPR). CONCLUSIONS There is significant variability in skeletal surveys referred for a second opinion in suspected NAI. Standardization of projections and improvement in the quality of radiographs obtained for this indication is required. The study highlights the need for the development and dissemination of definitive national guidelines.
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Hall CM, Elcioglu NH, MacDermot KD, Offiah AC, Winter RM. Spondyloepimetaphyseal dysplasia with multiple dislocations (Hall type): three further cases and evidence of autosomal dominant inheritance. J Med Genet 2002; 39:666-70. [PMID: 12205110 PMCID: PMC1735246 DOI: 10.1136/jmg.39.9.666] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Offiah AC, Mansour S, McDowall S, Tolmie J, Sim P, Hall CM. Surviving campomelic dysplasia has the radiological features of the previously reported ischio-pubic-patella syndrome. J Med Genet 2002; 39:e50. [PMID: 12205120 PMCID: PMC1735222 DOI: 10.1136/jmg.39.9.e50] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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