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Powell SJ, Withey SB, Sun Y, Grist JT, Novak J, MacPherson L, Abernethy L, Pizer B, Grundy R, Morgan PS, Jaspan T, Bailey S, Mitra D, Auer DP, Avula S, Arvanitis TN, Peet A. Applying machine learning classifiers to automate quality assessment of paediatric dynamic susceptibility contrast (DSC-) MRI data. Br J Radiol 2023; 96:20201465. [PMID: 36802769 PMCID: PMC10161906 DOI: 10.1259/bjr.20201465] [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: 02/22/2023] Open
Abstract
OBJECTIVE Investigate the performance of qualitative review (QR) for assessing dynamic susceptibility contrast (DSC-) MRI data quality in paediatric normal brain and develop an automated alternative to QR. METHODS 1027 signal-time courses were assessed by Reviewer 1 using QR. 243 were additionally assessed by Reviewer 2 and % disagreements and Cohen's κ (κ) were calculated. The signal drop-to-noise ratio (SDNR), root mean square error (RMSE), full width half maximum (FWHM) and percentage signal recovery (PSR) were calculated for the 1027 signal-time courses. Data quality thresholds for each measure were determined using QR results. The measures and QR results trained machine learning classifiers. Sensitivity, specificity, precision, classification error and area under the curve from a receiver operating characteristic curve were calculated for each threshold and classifier. RESULTS Comparing reviewers gave 7% disagreements and κ = 0.83. Data quality thresholds of: 7.6 for SDNR; 0.019 for RMSE; 3 s and 19 s for FWHM; and 42.9 and 130.4% for PSR were produced. SDNR gave the best sensitivity, specificity, precision, classification error and area under the curve values of 0.86, 0.86, 0.93, 14.2% and 0.83. Random forest was the best machine learning classifier, giving sensitivity, specificity, precision, classification error and area under the curve of 0.94, 0.83, 0.93, 9.3% and 0.89. CONCLUSION The reviewers showed good agreement. Machine learning classifiers trained on signal-time course measures and QR can assess quality. Combining multiple measures reduces misclassification. ADVANCES IN KNOWLEDGE A new automated quality control method was developed, which trained machine learning classifiers using QR results.
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Affiliation(s)
- Stephen J Powell
- Physical Sciences for Health CDT, University of Birmingham, Birmingham, United Kingdom.,Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Stephanie B Withey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom.,Department of Oncology, Birmingham Children's Hospital, Birmingham, United Kingdom.,RRPPS, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Yu Sun
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom.,School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China
| | - James T Grist
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jan Novak
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom.,Department of Oncology, Birmingham Children's Hospital, Birmingham, United Kingdom.,Department of Psychology, Aston Brain Centre, School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Lesley MacPherson
- Radiology, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Laurence Abernethy
- Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Barry Pizer
- Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Richard Grundy
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Paul S Morgan
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, United Kingdom.,Medical Physics, Nottingham University Hospitals, Nottingham, United Kingdom.,NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Tim Jaspan
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, United Kingdom.,Radiology, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Simon Bailey
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Dipayan Mitra
- Neuroradiology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Dorothee P Auer
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom
| | - Shivaram Avula
- Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Theodoros N Arvanitis
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom.,Department of Oncology, Birmingham Children's Hospital, Birmingham, United Kingdom.,Institute of Digital Healthcare, WMG, University of Warwick, Coventry, United Kingdom
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom.,Department of Oncology, Birmingham Children's Hospital, Birmingham, United Kingdom
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2
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Withey SB, MacPherson L, Oates A, Powell S, Novak J, Abernethy L, Pizer B, Grundy R, Morgan PS, Bailey S, Mitra D, Arvanitis TN, Auer DP, Avula S, Peet AC. Dynamic susceptibility-contrast magnetic resonance imaging with contrast agent leakage correction aids in predicting grade in pediatric brain tumours: a multicenter study. Pediatr Radiol 2022; 52:1134-1149. [PMID: 35290489 PMCID: PMC9107460 DOI: 10.1007/s00247-021-05266-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 08/31/2021] [Accepted: 12/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Relative cerebral blood volume (rCBV) measured using dynamic susceptibility-contrast MRI can differentiate between low- and high-grade pediatric brain tumors. Multicenter studies are required for translation into clinical practice. OBJECTIVE We compared leakage-corrected dynamic susceptibility-contrast MRI perfusion parameters acquired at multiple centers in low- and high-grade pediatric brain tumors. MATERIALS AND METHODS Eighty-five pediatric patients underwent pre-treatment dynamic susceptibility-contrast MRI scans at four centers. MRI protocols were variable. We analyzed data using the Boxerman leakage-correction method producing pixel-by-pixel estimates of leakage-uncorrected (rCBVuncorr) and corrected (rCBVcorr) relative cerebral blood volume, and the leakage parameter, K2. Histological diagnoses were obtained. Tumors were classified by high-grade tumor. We compared whole-tumor median perfusion parameters between low- and high-grade tumors and across tumor types. RESULTS Forty tumors were classified as low grade, 45 as high grade. Mean whole-tumor median rCBVuncorr was higher in high-grade tumors than low-grade tumors (mean ± standard deviation [SD] = 2.37±2.61 vs. -0.14±5.55; P<0.01). Average median rCBV increased following leakage correction (2.54±1.63 vs. 1.68±1.36; P=0.010), remaining higher in high-grade tumors than low grade-tumors. Low-grade tumors, particularly pilocytic astrocytomas, showed T1-dominant leakage effects; high-grade tumors showed T2*-dominance (mean K2=0.017±0.049 vs. 0.002±0.017). Parameters varied with tumor type but not center. Median rCBVuncorr was higher (mean = 1.49 vs. 0.49; P=0.015) and K2 lower (mean = 0.005 vs. 0.016; P=0.013) in children who received a pre-bolus of contrast agent compared to those who did not. Leakage correction removed the difference. CONCLUSION Dynamic susceptibility-contrast MRI acquired at multiple centers helped distinguish between children's brain tumors. Relative cerebral blood volume was significantly higher in high-grade compared to low-grade tumors and differed among common tumor types. Vessel leakage correction is required to provide accurate rCBV, particularly in low-grade enhancing tumors.
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Affiliation(s)
- Stephanie B Withey
- RRPPS, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Lesley MacPherson
- Radiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Adam Oates
- Radiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Stephen Powell
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Jan Novak
- Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Psychology, Aston Brain Centre, School of Life and Health Sciences, Aston University, Birmingham, UK
| | | | - Barry Pizer
- Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Richard Grundy
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
| | - Paul S Morgan
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
- Medical Physics, Nottingham University Hospitals, Nottingham, UK
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Simon Bailey
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Dipayan Mitra
- Neuroradiology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Theodoros N Arvanitis
- Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | - Dorothee P Auer
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- Neuroradiology, Nottingham University Hospitals Trust, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Shivaram Avula
- Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Andrew C Peet
- Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
- Children's Brain Tumour Research Team, 4th Floor Institute of Child Health, Birmingham Women's and Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK.
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3
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Grist JT, Withey S, Bennett C, Rose HEL, MacPherson L, Oates A, Powell S, Novak J, Abernethy L, Pizer B, Bailey S, Clifford SC, Mitra D, Arvanitis TN, Auer DP, Avula S, Grundy R, Peet AC. Combining multi-site magnetic resonance imaging with machine learning predicts survival in pediatric brain tumors. Sci Rep 2021; 11:18897. [PMID: 34556677 PMCID: PMC8460620 DOI: 10.1038/s41598-021-96189-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 07/27/2021] [Indexed: 12/02/2022] Open
Abstract
Brain tumors represent the highest cause of mortality in the pediatric oncological population. Diagnosis is commonly performed with magnetic resonance imaging. Survival biomarkers are challenging to identify due to the relatively low numbers of individual tumor types. 69 children with biopsy-confirmed brain tumors were recruited into this study. All participants had perfusion and diffusion weighted imaging performed at diagnosis. Imaging data were processed using conventional methods, and a Bayesian survival analysis performed. Unsupervised and supervised machine learning were performed with the survival features, to determine novel sub-groups related to survival. Sub-group analysis was undertaken to understand differences in imaging features. Survival analysis showed that a combination of diffusion and perfusion imaging were able to determine two novel sub-groups of brain tumors with different survival characteristics (p < 0.01), which were subsequently classified with high accuracy (98%) by a neural network. Analysis of high-grade tumors showed a marked difference in survival (p = 0.029) between the two clusters with high risk and low risk imaging features. This study has developed a novel model of survival for pediatric brain tumors. Tumor perfusion plays a key role in determining survival and should be considered as a high priority for future imaging protocols.
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Affiliation(s)
- James T Grist
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Stephanie Withey
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- RRPPS, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Christopher Bennett
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Heather E L Rose
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Lesley MacPherson
- Radiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Adam Oates
- Radiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Stephen Powell
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jan Novak
- Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- Psychology, College of Health and Life Sciences Aston University, Birmingham, UK
- Aston Neuroscience Institute, Aston University, Birmingham, UK
| | | | - Barry Pizer
- Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Simon Bailey
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Steven C Clifford
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, University of Newcastle, Newcastle upon Tyne, UK
| | - Dipayan Mitra
- Neuroradiology, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Theodoros N Arvanitis
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | - Dorothee P Auer
- Sir Peter Mansfield Imaging Centre, University of Nottingham Biomedical Research Centre, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Shivaram Avula
- Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Richard Grundy
- The Children's Brain Tumor Research Centre, University of Nottingham, Nottingham, UK
| | - Andrew C Peet
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
- Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
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4
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Novak J, Zarinabad N, Rose H, Arvanitis T, MacPherson L, Pinkey B, Oates A, Hales P, Grundy R, Auer D, Gutierrez DR, Jaspan T, Avula S, Abernethy L, Kaur R, Hargrave D, Mitra D, Bailey S, Davies N, Clark C, Peet A. Classification of paediatric brain tumours by diffusion weighted imaging and machine learning. Sci Rep 2021; 11:2987. [PMID: 33542327 PMCID: PMC7862387 DOI: 10.1038/s41598-021-82214-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 11/08/2019] [Accepted: 01/12/2021] [Indexed: 01/23/2023] Open
Abstract
To determine if apparent diffusion coefficients (ADC) can discriminate between posterior fossa brain tumours on a multicentre basis. A total of 124 paediatric patients with posterior fossa tumours (including 55 Medulloblastomas, 36 Pilocytic Astrocytomas and 26 Ependymomas) were scanned using diffusion weighted imaging across 12 different hospitals using a total of 18 different scanners. Apparent diffusion coefficient maps were produced and histogram data was extracted from tumour regions of interest. Total histograms and histogram metrics (mean, variance, skew, kurtosis and 10th, 20th and 50th quantiles) were used as data input for classifiers with accuracy determined by tenfold cross validation. Mean ADC values from the tumour regions of interest differed between tumour types, (ANOVA P < 0.001). A cut off value for mean ADC between Ependymomas and Medulloblastomas was found to be of 0.984 × 10−3 mm2 s−1 with sensitivity 80.8% and specificity 80.0%. Overall classification for the ADC histogram metrics were 85% using Naïve Bayes and 84% for Random Forest classifiers. The most commonly occurring posterior fossa paediatric brain tumours can be classified using Apparent Diffusion Coefficient histogram values to a high accuracy on a multicentre basis.
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Affiliation(s)
- Jan Novak
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Department of Psychology, School of Life and Health Sciences, Aston University, Birmingham, UK.,Aston Neuroscience Institute, School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Niloufar Zarinabad
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Heather Rose
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Theodoros Arvanitis
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | - Lesley MacPherson
- Radiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Benjamin Pinkey
- Radiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Adam Oates
- Radiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Patrick Hales
- Developmental Imaging & Biophysics Section, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Richard Grundy
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
| | - Dorothee Auer
- Sir Peter Mansfield Imaging Centre, University of Nottingham Biomedical Research Centre, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Daniel Rodriguez Gutierrez
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK.,Medical Physics, Nottingham University Hospital, Queen's Medical Centre, Nottingham, UK
| | - Tim Jaspan
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK.,Neuroradiology, Nottingham University Hospital, Queen's Medical Centre, Nottingham, UK
| | - Shivaram Avula
- Department of Radiology, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Laurence Abernethy
- Department of Radiology, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Ramneek Kaur
- Developmental Imaging & Biophysics Section, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Darren Hargrave
- Haematology and Oncology Department, Great Ormond Street Children's Hospital, London, UK
| | - Dipayan Mitra
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Simon Bailey
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Nigel Davies
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Radiation Protection Services, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Christopher Clark
- Developmental Imaging & Biophysics Section, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. .,Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
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5
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Grist JT, Withey S, Bennett C, Rose H, MacPherson L, Oates A, Powell S, Novak J, Abernethy L, Pizer B, Bailey S, Mitra D, Arvanitis TN, Auer DP, Avula S, Grundy R, Peet AC. IMG-06. PREDICTING SURVIVAL FROM PERFUSION AND DIFFUSION MRI BY MACHINE LEARNING. Neuro Oncol 2020. [PMCID: PMC7715839 DOI: 10.1093/neuonc/noaa222.342] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Magnetic Resonance Imaging (MRI) is routinely used in the assessment of children’s brain tumours. Reduced diffusion and increased perfusion on MRI are commonly associated with higher grade but there is a lack of quantitative data linking these parameters to survival. Machine learning is increasingly being used to develop diagnostic tools but its use in survival analysis is rare. In this study we combine quantitative parameters from diffusion and perfusion MRI with machine learning to develop a model of survival for paediatric brain tumours. METHOD: 69 children from 4 centres (Birmingham, Liverpool, Nottingham, Newcastle) underwent MRI with diffusion and perfusion (dynamic susceptibility contrast) at diagnosis. Images were processed to form ADC, cerebral blood volume (CBV) and vessel leakage correction (K2) parameter maps. Parameter mean, standard deviation and heterogeneity measures (skewness and kurtosis) were calculated from tumour and whole brain and used in iterative Bayesian survival analysis. The features selected were used for k-means clustering and differences in survival between clusters assessed by Kaplan-Meier and Cox-regression. RESULTS Bayesian analysis revealed the 5 top features determining survival to be tumour volume, ADC kurtosis, CBV mean, K2 mean and whole brain CBV mean. K-means clustering using these features showed two distinct clusters (high- and low-risk) which bore significantly different survival characteristics (Hazard Ratio = 5.6). DISCUSSION AND CONCLUSION Diffusion and perfusion MRI can be used to aid the prediction of survival in children’s brain tumours. Tumour perfusion played a particularly important role in predicting survival despite being less routinely measured than diffusion.
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Affiliation(s)
- James T Grist
- University of Birmingham, Birmingham, WM, United Kingdom
| | - Stephanie Withey
- University of Birmingham, Birmingham, WM, United Kingdom
- Oncology - Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Christopher Bennett
- Institute of Cancer and Genomic Sciences - University of Birmingham, Birmingham, WM, United Kingdom
| | - Heather Rose
- Institute of Cancer and Genomic Sciences - University of Birmingham, Birmingham, WM, United Kingdom
| | - Lesley MacPherson
- Radiology - Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Adam Oates
- Radiology - Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Stephen Powell
- University of Birmingham, Birmingham, WM, United Kingdom
| | - Jan Novak
- Neurosciences - Aston University, Birmingham, United Kingdom
| | - Laurence Abernethy
- Radiology - Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Barry Pizer
- Oncology - Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Simon Bailey
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle, United Kingdom
| | - Dipayan Mitra
- Neuroradiology, Royal Victoria Infirmary, Newcastle, United Kingdom
| | - Theodoros N Arvanitis
- Institute of Digital Healthcare, WMG, University of Warwick, Warwick, United Kingdom
| | - Dorothee P Auer
- Sir Peter Mansfield Imaging Centre, University of Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Shivaram Avula
- Radiology, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Richard Grundy
- The Children’s Brain Tumour Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Andrew C Peet
- Institute of Cancer and Genomic Sciences - University of Birmingham, Birmingham, WM, United Kingdom
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6
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Grist J, Withey S, MacPherson L, Oates A, Stephen Powell M, Novak J, Abernethy L, Pizer B, Grundy R, Bailey S, Mitra D, Arvantis T, Auer D, Avula S, Peet A. Utilising functional imaging to predict survival in paediatric brain tumours. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz167.018] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Brain tumours are a common cause of death in the paediatric population. We have previously shown that MR imaging and spectroscopy can be used to non-invasively differentiate between tumour types. Here, we demonstrate that functional imaging can be highly predictive of survival and grade in a paediatric cohort.
Methods
Perfusion (PWI) and diffusion weighted imaging (DWI) were performed in a multi-site (Birmingham Children’s Hospital, Royal Victoria Infirmary, Alder Hey, Nottingham) cohort ([grade, 5-year survival alive:dead number] = [I,15:1],[II, 5:1],[III,2:3],[IV,8:11]). ROIs were drawn on T2 imaging and functional imaging features (mean, standard deviation, skewness, and kurtosis) were derived. Supervised machine learning was used to predict 5-year survival and tumour grade from features. ANOVA and post-hoc tests were used to assess differences in features between grade and 5-year survival status.
Results
5-year survival was predicted with 89%, 85%, and 87% accuracy with all imaging, perfusion, or diffusion features, respectively.
A significant difference in perfusion was found between surviving and diseased participants (1.71 ± 0.82 vs 2.62 ± 1 mL/100g/min, respectively, p < 0.05). A significant difference in ADC (mm2 s-1) between tumour grades was found (1 vs 4 (1533 ± 458 vs 857 ± 239), 4 vs 3 (857 ± 239 vs 1197 ± 137), 4 vs 2 (857 ± 239 vs 1440 ± 557), corrected p < 0.05).
Conclusion
We have shown that perfusion and diffusion imaging features can be used to non-invasively assess tumour grade and estimate 5-year survival status in a cohort of paediatric brain tumours.
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Affiliation(s)
- James Grist
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Stephanie Withey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
- Oncology, Birmingham Women’s and Children’s NHS foundation trust, Birmingham, United Kingdom
- RRPPS, University Hospitals Birmingham NHS foundation trust, Birmingham, United Kingdom
| | - Lesley MacPherson
- Radiology, Birmingham Women’s and Children’s NHS foundation trust, Birmingham, United Kingdom
| | - Adam Oates
- Radiology, Birmingham Women’s and Children’s NHS foundation trust, Birmingham, United Kingdom
| | - Mr Stephen Powell
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jan Novak
- Oncology, Birmingham Women’s and Children’s NHS foundation trust, Birmingham, United Kingdom
- Department of Psychology, School of Life and Health sciences, Aston University, Birmingham, United Kingdom
| | - Laurence Abernethy
- Radiology, Alder Hey Children’s NHS foundation trust, Liverpool, United Kingdom
| | - Barry Pizer
- Oncology, Alder Hey Children’s NHS foundation trust, Liverpool, United Kingdom
| | - Richard Grundy
- The Children’s Brain Tumour Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Simon Bailey
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Dipayan Mitra
- Neuroradiology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Theodoros Arvantis
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
- Oncology, Birmingham Women’s and Children’s NHS foundation trust, Birmingham, United Kingdom
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, United Kingdom
| | - Dorothee Auer
- Sir Peter Mansfield Imaging Centre, University of Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Shivaram Avula
- Radiology, Alder Hey Children’s NHS foundation trust, Liverpool, United Kingdom
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
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7
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Withey S, MacPherson L, Oates A, Powell S, Novak J, Abernethy L, Pizer B, Grundy R, Bailey S, Mitra D, Arvanitis T, Auer D, Avula S, Peet A. Multicentre study of perfusion magnetic resonance imaging in paediatric brain tumours. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz167.041] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Studies in adults have shown that brain tumour perfusion correlates with grade. These studies are dominated by gliomas grade II to IV which are rare in children. The standard method, Dynamic Susceptibility Contrast MRI, provides estimates of relative cerebral blood volume (rCBV) but contrast agent leakage affects rCBV accuracy. The majority of perfusion studies have been conducted at single centres and variation in acquisition protocols makes the generalizability of results questionable. The aim of this study was to compare leakage-corrected rCBV with grade in paediatric brain tumours at multiple centres. Scans were analysed from 85 patients at 4 centres on 6 scanners prior to treatment. MRI protocols varied between centres. Histological diagnoses including grade were obtained. Whole-tumour median rCBV was significantly higher in the 45 high grade than the 40 low grade tumours (2.54 ± 1.63 ml/100ml vs 1.68 ± 1.36 ml/100ml, p=0.010). Low grade tumours, particularly pilocytic astrocytomas (grade I), displayed more contrast agent leakage consistent with their appearance on contrast enhanced images and required more leakage correction than high grade tumours. This finding differs from that in adults where contrast agent uptake is usually associated with higher grade. A cut-off of 1.70 ml/100ml for rCBV gave sensitivity and specificity of 76% and 65% respectively for discriminating grade. In summary, perfusion MRI can be used to help distinguish between low and high grade paediatric brain tumours. This finding is robust across multiple centres and acquisition protocols but correction should be made for leakage of contrast agent from the vessels.
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Affiliation(s)
- Stephanie Withey
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, Birmingham, United Kingdom
- Oncology, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
- RRPPS, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Lesley MacPherson
- Radiology, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Adam Oates
- Radiology, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Stephen Powell
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, Birmingham, United Kingdom
| | - Jan Novak
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, Birmingham, United Kingdom
- Department of Psychology, School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Laurence Abernethy
- Radiology, Alder Hey Children’s NHS Foundation Trust, Liverpool, Liverpool, United Kingdom
| | - Barry Pizer
- Oncology, Alder Hey Children’s NHS Foundation Trust, Liverpool, Liverpool, United Kingdom
| | - Richard Grundy
- The Children’s Brain Tumour Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Simon Bailey
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Dipayan Mitra
- Neuroradiology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Theodoros Arvanitis
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, Birmingham, United Kingdom
- Oncology, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, United Kingdom
| | - Dorothee Auer
- Sir Peter Mansfield Imaging Centre, University of Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Shivaram Avula
- Radiology, Alder Hey Children’s NHS Foundation Trust, Liverpool, Liverpool, United Kingdom
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, Birmingham, United Kingdom
- Oncology, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
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Tejada S, Avula S, Pettorini B, Henningan D, Abernethy L, Mallucci C. The impact of intraoperative magnetic resonance in routine pediatric neurosurgical practice-a 6-year appraisal. Childs Nerv Syst 2018; 34:617-626. [PMID: 29460065 DOI: 10.1007/s00381-018-3751-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 02/04/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND The intraoperative magnetic resonance scanner (ioMR) was introduced in our unit in 2009, and has been used routinely since then. OBJECTIVE This study aims to describe indications, radiological features, and clinical outcomes of the patients operated on with ioMRI and analyze our experience. METHODS A retrospective analysis of a prospective surgical database has been performed, including surgical procedure, intent, radiological reports, need for second-look surgery, and complications, supplemented by further review of the clinical notes and the scans. RESULTS From 2009 to 2015, 255 surgical procedures with ioMR were performed: 175 were craniotomies for tumor excision, 65 were epilepsy related, and 15 were biopsies or cyst drainages. The mean age was 9.4 years. One ioMR was performed in 79.5% patients; the mean duration of the MR was 41 min. In 172 cases (67.4%), no actions followed the ioMR. When the aim of the surgery was debulking of the tumor, the percentage of patients in which the ioMR was followed by resection was higher than when complete resection was the aim (56 vs 27.5%). The complication rate was not increased when compared with our previous results (infection 1%, neurological deficits 12%). CONCLUSION This is the largest published series of ioMRI-aided pediatric neurosurgery to date. We have demonstrated that it can be used safely and routinely in pediatric neurosurgical procedures at any age, assisting the surgeon in achieving the best extent of resection and aiding in intra-operative decision-making for tumor- and non-tumor-related intracranial pathology.
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Affiliation(s)
- Sonia Tejada
- Department of Neurosurgery, Clínica Universidad de Navarra, Calle Pio XII, 36, 31008, Pamplona, Spain.
| | - Shivaram Avula
- Department of Radiology, Alder Hey Children's NHS Foundation, Liverpool, UK
| | - Benedetta Pettorini
- Department of Neurosurgery, Alder Hey Children's NHS Foundation, Liverpool, UK
| | - Dawn Henningan
- Department of Neurosurgery, Alder Hey Children's NHS Foundation, Liverpool, UK
| | - Laurence Abernethy
- Department of Radiology, Alder Hey Children's NHS Foundation, Liverpool, UK
| | - Conor Mallucci
- Department of Neurosurgery, Alder Hey Children's NHS Foundation, Liverpool, UK
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Wong KY, Jeeneea R, Healey A, Abernethy L, Corbett HJ, McAndrew HF, Losty PD. Management of paediatric high-grade blunt renal trauma: a 10-year single-centre UK experience. BJU Int 2018; 121:923-927. [PMID: 29359888 DOI: 10.1111/bju.14142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To report the management and outcome of paediatric patients sustaining high-grade blunt renal trauma. PATIENTS AND METHODS Medical records were examined for all American Association for the Surgery of Trauma (AAST) grade III-V blunt renal trauma cases admitted to a paediatric trauma centre from 2005 to 2015. Data collected and analysed included: demographics, imaging modalities, management, length of hospital stay (LOS), complications, and follow-up outcomes. RESULTS In all, 18 children (12 boys, six girls) with mean (range) age 11 (4-15) years were included. According to the AAST grading criteria, 39% (seven of 18) of the patients had grade III, 50% (nine of 18) grade IV, and 11% (two of 18) grade V injuries; 44% (eight of 18) had concomitant injuries. Most of the patients were managed conservatively (89%, 16 of 18), although two of the 16 subsequently needed JJ-stent insertion during inpatient stay for symptomatic urinoma(s). In all, 11% (two of 18) of the patients required interventional radiology service(s), involving selective embolisation for life-threatening renal tract haemorrhage. Blood transfusion for renal injury exclusively was required in 11% (two of 18) of the patients. In all, 89% (16 of 18) of the patients had at least one follow-up imaging study before hospital discharge; most (13 of 16) had ultrasonography and three required computed tomography. The median (range) LOS was 11 (4-31) days. In all, 17% (three of 18) of the patients required hospital re-admission within 30 days for complications and all required interventional procedures: JJ stent for urinoma (one), embolisation of renal arterio-venous fistula (one), and embolisation for a post-traumatic pseudoaneurysm (one). Overall, the median (range) follow-up was 6 (2-60) months. In all, 78% (14 of 18) of the patients had dimercaptosuccinic acid studies, with 11 showing reductions in renal function (range 3-44%). CONCLUSIONS This study supports a care pathway strategy advocating conservative management of high-grade renal injuries in children. However, patients may experience a relative decline in renal function with higher grade injuries indicating the need for monitoring and follow-up.
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Affiliation(s)
- Kee Y Wong
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Ram Jeeneea
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Andrew Healey
- Department ofRadiology, Alder Hey Children's Hospital, Liverpool, UK
| | | | - Harriet J Corbett
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Helen F McAndrew
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Paul D Losty
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK
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Avula S, Tejada S, Abernethy L, Moon C, Pettorini B, Parks C, Pizer B, Mallucci C. RA-09THE USE OF MR SPECTROSCOPY IN INTRAOPERATIVE MR IMAGING DURING PAEDIATRIC BRAIN TUMOUR RESECTION. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now083.08] [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: 11/14/2022] Open
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Novak J, Withey S, MacPherson L, Avula S, Abernethy L, Peet A. RA-15PERFUSION INCREASES WITH GRADE IN PAEDIATRIC BRAIN TUMOURS. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now083.14] [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: 11/14/2022] Open
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Vidyasagar R, Abernethy L, Pizer B, Avula S, Parkes LM. Quantitative measurement of blood flow in paediatric brain tumours-a comparative study of dynamic susceptibility contrast and multi time-point arterial spin labelled MRI. Br J Radiol 2016; 89:20150624. [PMID: 26975495 PMCID: PMC5258143 DOI: 10.1259/bjr.20150624] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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] [Indexed: 11/23/2022] Open
Abstract
Objective: Arterial spin-labelling (ASL) MRI uses intrinsic blood water to quantify the cerebral blood flow (CBF), removing the need for the injection of a gadolinium-based contrast agent used for conventional perfusion imaging such as dynamic susceptibility contrast (DSC). Owing to the non-invasive nature of the technique, ASL is an attractive option for use in paediatric patients. This work compared DSC and multi-timepoint ASL measures of CBF in paediatric brain tumours. Methods: Patients (n = 23; 20 low-grade tumours and 3 high-grade tumours) had DSC and multi-timepoint ASL with and without vascular crushers (VC). VC removes the contribution from larger vessel blood flow. Mean perfusion metrics were extracted from control and T1-enhanced tumour regions of interest (ROIs): arterial arrival time (AAT) and CBF from the ASL images with and without VC, relative cerebral blood flow (rCBF), relative cerebral blood volume, delay time (DT) and mean transit time (MTT) from the DSC images. Results: Significant correlations existed for: AAT and DT (r = 0.77, p = 0.0002) and CBF and rCBF (r = 0.56, p = 0.02) in control ROIs for ASL-noVC. No significant correlations existed between DSC and ASL measures in the tumour region. Significant differences between control and tumour ROI were found for MTT (p < 0.001) and rCBF (p < 0.005) measures. Conclusion: Significant correlations between ASL-noVC and DSC measures in the normal brain suggest that DSC is most sensitive to macrovascular blood flow. The absence of significant correlations within the tumour ROI suggests that ASL is sensitive to different physiological mechanisms compared with DSC measures. Advances in knowledge: ASL provides information which is comparable with that of DSC in healthy tissues, but appears to reflect a different physiology in tumour tissues.
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Affiliation(s)
- Rishma Vidyasagar
- 1 Florey Institute of Neuroscience and Mental Health, Heidelberg, Melbourne, VIC, Australia.,2 Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, VIC, Australia
| | - Laurence Abernethy
- 3 Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Barry Pizer
- 4 Department of Paediatric Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Shivaram Avula
- 3 Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Laura M Parkes
- 5 Centre for Imaging Sciences, Faculty of Medicine and Human Sciences, University of Manchester, Manchester, UK
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Harbron RW, Pearce MS, Salotti JA, McHugh K, McLaren C, Abernethy L, Reed S, O'Sullivan J, Chapple CL. Radiation doses from fluoroscopically guided cardiac catheterization procedures in children and young adults in the United Kingdom: a multicentre study. Br J Radiol 2015; 88:20140852. [PMID: 25654205 DOI: 10.1259/bjr.20140852] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To gather data on radiation doses from fluoroscopically guided cardiac catheterization procedures in patients aged under 22 years at multiple centres and over a prolonged period in the UK. To evaluate and explain variation in doses. To estimate patient-specific organ doses and allow for possible future epidemiological analysis of associated cancer risks. METHODS Patient-specific data including kerma area product and screening times from 10,257 procedures carried out on 7726 patients at 3 UK hospitals from 1994 until 2013 were collected. Organ doses were estimated from these data using a dedicated dosimetry system based on Monte Carlo computer simulations. RESULTS Radiation doses from these procedures have fallen significantly over the past two decades. The organs receiving the highest doses per procedure were the lungs (median across whole cohort, 20.5 mSv), heart (19.7 mSv) and breasts (13.1 mSv). Median cumulative doses, taking into account multiple procedures, were 23.2, 22.2 and 16.7 mSv for these organs, respectively. Bone marrow doses were relatively low (median per procedure, 3.2 mSv; cumulative, 3.6 mSv). CONCLUSION Most modern cardiac catheterizations in children are moderately low-dose procedures. Technological advances appear to be the single most important factor in the fall in doses. Patients undergoing heart transplants undergo the most procedures. An epidemiological assessment of cancer risks following these procedures may be possible, especially using older data when doses were higher. ADVANCES IN KNOWLEDGE This is the first large-scale, patient-specific assessment of organ doses from these procedures in a young population.
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Affiliation(s)
- R W Harbron
- 1 The Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Avula S, Kumar R, Pizer B, Pettorini B, Abernethy L, Garlick D, Mallucci C. Diffusion abnormalities on intraoperative magnetic resonance imaging as an early predictor for the risk of posterior fossa syndrome. Neuro Oncol 2014; 17:614-22. [PMID: 25319997 DOI: 10.1093/neuonc/nou299] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Posterior fossa syndrome (PFS) is an important complication of posterior fossa surgery in children. The pathophysiology of this condition remains unclear, but there is evidence implicating surgical injury of the proximal efferent cerebellar pathway (pECP) and the cerebellar vermis to PFS. We aimed to evaluate if diffusion abnormalities involving these structures on the final intraoperative MRI can predict the development of PFS. METHODS Diffusion-weighted imaging from 31 posterior fossa resections were anonymized and evaluated for abnormalities involving the dentate nucleus, superior cerebellar peduncle, and the mesencephalic tegmentum forming the pECP, vermis, and middle cerebellar peduncle. The case notes were independently evaluated for evidence of PFS. RESULTS The diffusion imaging in 28 cases was of optimal quality for evaluation. Diffusion abnormalities were identified in 10 cases, 7 of which involved the pECP. Retrospective evaluation revealed evidence of PFS in 6 cases. There was a significant association between abnormalities involving pECP structures (P = .001) and development of PFS. Bilateral involvement of pECP (P = .006) was a highly specific risk factor for predicting the development of PFS. Diffusion abnormality of the inferior vermis was significantly associated with PFS (P = .001) but may not represent a risk factor in isolation. CONCLUSION This study demonstrates the feasibility of identifying children at risk for developing PFS at the earliest stage post tumor resection and thus adds to the growing evidence base on its pathophysiology.
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Affiliation(s)
- Shivaram Avula
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK (S.A., L.A., D.G.); Department of Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK (R.K.); Department of Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK (Barry Pizer); Department of Neurosurgery, Alder Hey Children's N.H.S Foundation Trust, Liverpool, UK (Benedetta Pettorini, C.M.)
| | - Ram Kumar
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK (S.A., L.A., D.G.); Department of Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK (R.K.); Department of Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK (Barry Pizer); Department of Neurosurgery, Alder Hey Children's N.H.S Foundation Trust, Liverpool, UK (Benedetta Pettorini, C.M.)
| | - Barry Pizer
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK (S.A., L.A., D.G.); Department of Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK (R.K.); Department of Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK (Barry Pizer); Department of Neurosurgery, Alder Hey Children's N.H.S Foundation Trust, Liverpool, UK (Benedetta Pettorini, C.M.)
| | - Benedetta Pettorini
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK (S.A., L.A., D.G.); Department of Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK (R.K.); Department of Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK (Barry Pizer); Department of Neurosurgery, Alder Hey Children's N.H.S Foundation Trust, Liverpool, UK (Benedetta Pettorini, C.M.)
| | - Laurence Abernethy
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK (S.A., L.A., D.G.); Department of Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK (R.K.); Department of Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK (Barry Pizer); Department of Neurosurgery, Alder Hey Children's N.H.S Foundation Trust, Liverpool, UK (Benedetta Pettorini, C.M.)
| | - Deborah Garlick
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK (S.A., L.A., D.G.); Department of Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK (R.K.); Department of Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK (Barry Pizer); Department of Neurosurgery, Alder Hey Children's N.H.S Foundation Trust, Liverpool, UK (Benedetta Pettorini, C.M.)
| | - Conor Mallucci
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK (S.A., L.A., D.G.); Department of Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK (R.K.); Department of Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK (Barry Pizer); Department of Neurosurgery, Alder Hey Children's N.H.S Foundation Trust, Liverpool, UK (Benedetta Pettorini, C.M.)
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Zebian B, Stagno V, Parks CJ, Pettorini B, Mallucci C, Pizer B, Abernethy L, Avula S. P08 * INTRA-OPERATIVE MRI: THE ALDER HEY EXPERIENCE SO FAR. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou249.8] [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: 11/14/2022] Open
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Jumani DB, Littlewood R, Iyer A, Fellows G, Healey A, Abernethy L, Spinty S, Sarginson R, Pettorini B. Spontaneous spinal epidural haematoma mimicking meningitis in a 2-year-old child--a case report and literature review. Childs Nerv Syst 2013; 29:1795-8. [PMID: 23708933 DOI: 10.1007/s00381-013-2130-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 03/01/2013] [Accepted: 04/24/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION We report the case of a 2-year-old boy with suspected meningitis who presented with acute onset neck pain and stiffness associated with right-sided weakness and ataxia. MANAGEMENT Despite intravenous antibiotics and antiviral treatment, his condition deteriorated. Magnetic resonance imaging demonstrated spontaneous cervical epidural haematoma (C4-C7) extending down to thoracic (T7) level with associated compression of the spinal cord. He was treated successfully by neurosurgical decompression and made a complete recovery. DISCUSSION Spinal epidural haematoma is a neurosurgical emergency characterised by extravasation of blood in the spinal epidural space. The clinical presentation particularly in young children can masquerade other conditions such as meningitis. In this article, we discuss our case and review the literature on spontaneous spinal epidural hematoma with an aim to improve awareness of this condition which if not recognised and treated early can lead to significant lifelong morbidity.
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Affiliation(s)
- D B Jumani
- Jackson Rees Department of Anaesthesia, Alder Hey Children's Hospital NHS Trust, Eaton Road, West Derby, Liverpool, L12 2AP, UK,
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Avula S, Pettorini B, Abernethy L, Pizer B, Williams D, Mallucci C. High field strength magnetic resonance imaging in paediatric brain tumour surgery--its role in prevention of early repeat resections. Childs Nerv Syst 2013; 29:1843-50. [PMID: 23673720 DOI: 10.1007/s00381-013-2106-8] [Citation(s) in RCA: 15] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 04/05/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study is to compare the surgical and imaging outcome in children who underwent brain tumour surgery with intention of complete tumour resection, prior to and following the start of intra-operative MRI (ioMRI) service. METHODS ioMRI service for brain tumour resection commenced in October 2009. A cohort of patients operated between June 2007 and September 2009 with a pre-surgical intention of complete tumour resection were selected (Group A). A similar number of consecutive cases were selected from a prospective database of patients undergoing ioMRI (Group B). The demographics, imaging, pathology and surgical outcome of both groups were compared. RESULTS Thirty-six of 47 cases from Group A met the inclusion criterion and 36 cases were selected from Group B; 7 of the 36 cases in Group A had unequivocal evidence of residual tumour on the post-operative scan; 5 (14%) of them underwent repeat resection within 6 months post-surgery. In Group B, ioMRI revealed unequivocal evidence of residual tumour in 11 of the 36 cases following initial resection. In 10 of these 11 cases, repeat resections were performed during the same surgical episode and none of these 11 cases required repeat surgery in the following 6 months. Early repeat resection rate was significantly different between both groups (p = 0.003). CONCLUSION Following the advent of ioMRI at our institution, the need for repeat resection within 6 months has been prevented in cases where ioMRI revealed unequivocal evidence of residual tumour.
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Affiliation(s)
- Shivaram Avula
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK,
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Gieseking A, Williams P, Piamjariyakul U, Kelly K, Dobos C, Connor R, Williams A, Sheehan K, Devorin B, Hoeppner C, Lucas M, Barakat L, Hobbie W, Deatrick J, Black K, Beaudoin W, McDonald C, Tulloh R, Montero L, Frias C, Canete A, Pablo M, Rebeca C, Miguel H, Patricia S, Victoria C, Avula S, Abernethy L, Pizer B, Pettorini B, Williams D, Mallucci C, Lafond D, DeLuca H, Steacy K, Cullen P, Moore I, Yeh-Nayre L, Le Floch N, Levy M, Donoghue D, Crawford J, Hoeppner C, Paiva P, Cappellano A, Dias C, Silva N, Clark E, Hemenway M, Madden J, Foreman N, Dorneman L, Rossiter J, Arvanitis T, Natarajan K, Wilson M, Davies N, Gill S, Grazier R, Crouch J, Auer D, Clark C, Grundy R, Hargrave D, Howe F, Jaspan T, Leach M, MacPherson L, Payne G, Saunders D, Peet A, Madden JR, Bess H, Chordas C, LaFond D, Packer R, Hilden J, Smith A, Chi S, Marcus K, Foreman NK, Liu AK, Bess H, Stillwell D, Olavarria G, Thomas D, Smith A. NURSING. Neuro Oncol 2012. [DOI: 10.1093/neuonc/nos105] [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: 11/12/2022] Open
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Abstract
Ependymomas are glial central nervous system (CNS) tumors that arise from the ependymal layer of brain and spinal cord. These are heterogeneous group of tumors with varied histopathological features and prognosis. They frequently relapse at the primary site and may disseminate to other CNS sites. Extraneural metastases are, however, extremely rare. We present a case of ependymoma in a child with widespread metastasis to her bones, a previously unreported event.
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Affiliation(s)
- Munir Hussain
- Department of Oncology, Alder Hey Children's Hospital, Liverpool, UK
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Tan M, Abernethy L, Cooke R. Improving head growth in preterm infants--a randomised controlled trial II: MRI and developmental outcomes in the first year. Arch Dis Child Fetal Neonatal Ed 2008; 93:F342-6. [PMID: 18285378 DOI: 10.1136/adc.2007.124255] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [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] [Indexed: 11/03/2022]
Abstract
BACKGROUND Very preterm infants are at risk of poor growth and neurodevelopmental outcome. Illness and difficulties overcoming the challenges of feeding these infants often lead to undernutrition in the first few weeks. OBJECTIVE To explore the relationships between early nutrition, post-natal head growth, quantitative magnetic resonance imaging (MRI) and developmental outcome in the first year among infants born before 29 weeks' gestation. DESIGN Infants born before 29 weeks' gestation were randomised to receive hyperalimented or standard feeding regimen from birth to 34 weeks' postmenstrual age (PMA). The primary outcome was occipitofrontal circumference (OFC) at 36 weeks' OFC. Quantitative MRI was performed at 40 weeks' PMA. Developmental assessment using Bayley Scales of Infant Development II (BSID II) was carried out at 3 and 9 months post-term. RESULTS 109 infants survived to the end of the first year PMA. 65 infants underwent MRI scan. 81 and 71 infants were seen at 3 and 9 months post-term. Quantitative MRI findings, mental development index (MDI) and psychomotor development index (PDI) were not statistically different between the two groups. Total brain volume (TBV) at 40 weeks' PMA, MDI and PDI at 3 months post-term correlated significantly with energy deficit at 28 days of age CONCLUSIONS Improving early energy deficit in very preterm infants may promote brain growth. Quantitative MRI may have a role to play in predicting developmental outcome. Post-natal growth at 36 weeks' PMA and quantitative MRI finding at 40 weeks' PMA appear to be closely related to mental outcomes in the first year. TRIAL REGISTRATION NUMBER ISRCTN 19509258.
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Affiliation(s)
- M Tan
- Professor R W I Cooke, Neonatal Unit, Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, UK;
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Jans L, Vlummens P, Van Damme S, Verstraete K, Abernethy L. Hemimyelomeningocele: a rare and complex spinal dysraphism. JBR-BTR 2008; 91:198-199. [PMID: 19051939] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We report a case of hemimyelomeningocele. This is a rare spinal dysraphism, consisting of the association of a split cord malformation with myelomeningocele. MRI demonstrates division of the spinal cord into two hemicords which are separated by a bony spur. The left hemicord forms a myelomeningocele, thus resulting in a hemimyelomeningocele. Accurate and early diagnosis of spinal dysraphisms is essential for optimal, individualised neurosurgical treatment.
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Affiliation(s)
- L Jans
- Department of Radiology and Medical Imaging, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium.
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23
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Ng SM, Turner MA, Gamble C, Didi M, Victor S, Malamateniou C, Parkes LM, Tietze A, Gregory L, Sluming V, Abernethy L, Weindling AM. TIPIT: a randomised controlled trial of thyroxine in preterm infants under 28 weeks gestation: magnetic resonance imaging and magnetic resonance angiography protocol. BMC Pediatr 2008; 8:26. [PMID: 18590560 PMCID: PMC2464591 DOI: 10.1186/1471-2431-8-26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Accepted: 06/30/2008] [Indexed: 11/10/2022] Open
Abstract
Background Infants born at extreme prematurity are at high risk of developmental disability. A major risk factor for disability is having a low level of thyroid hormone described as hypothyroxinaemia, which is recognised to be a frequent phenomenon in these infants. Derangements of critical thyroid function during the sensitive window in prematurity when early development occurs, may have a range of long term effects for brain development. Further research in preterm infants using neuroimaging techniques will increase our understanding of the specificity of the effects of hypothyroxinaemia on the developing foetal brain. This is an explanatory double blinded randomised controlled trial which is aimed to assess the effect of thyroid hormone supplementation on brain size, key brain structures, extent of myelination, white matter integrity and vessel morphology, somatic growth and the hypothalamic-pituitary-adrenal axis. Methods The study is a multi-centred double blinded randomised controlled trial of thyroid hormone supplementation in babies born below 28 weeks' gestation. All infants will receive either levothyroxine or placebo until 32 weeks corrected gestational age. The primary outcomes will be width of the sub-arachnoid space measured using cranial ultrasound and head circumference at 36 weeks corrected gestational age. The secondary outcomes will be thyroid hormone concentrations, the hypothalamic pituitary axis status and auxological data between birth and expected date of delivery; thyroid gland volume, brain size, volumes of key brain structures, extent of myelination and brain vessel morphology at expected date of delivery and markers of morbidity which include duration of mechanical ventilation and/or oxygen requirement and chronic lung disease. Trial registration Current Controlled Trials ISRCTN89493983
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Affiliation(s)
- Sze M Ng
- School of Reproductive and Developmental Medicine, University of Liverpool, Liverpool, UK.
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Bayam L, Bruce CE, Sampath J, Bayam FB, Abernethy L. Importance of communication between medical specialties: a case series. Injury 2008; 39:623-6. [PMID: 18371967 DOI: 10.1016/j.injury.2007.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Revised: 12/17/2007] [Accepted: 12/17/2007] [Indexed: 02/02/2023]
Affiliation(s)
- L Bayam
- Department of Orthopaedics, Royal Bolton Hospital, UK.
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Abstract
PURPOSE We report a case series of seven patients who presented with strabismus and no apparent known neurological deficit. METHODS A retrospective review of notes was performed on all patients presenting at the Royal Liverpool Children's Hospital (Alder Hey) with strabismus, in whom subsequent investigation revealed the presence of periventricular leukomalacia (PVL). RESULTS All seven patients presented with esotropia. One patient also had dissociated vertical deviation. A history of premature birth was elicited in six cases; however, one patient had been born at 42 weeks. Apparently uncomplicated routine surgery produced unexpectedly poor results. CONCLUSIONS Patients with undiagnosed PVL may present to the ophthalmologist with strabismus and no other apparent neurological abnormality. Where it is suspected that the patient may have suffered a significant hypoxic-ischaemic event, the ophthalmologist should have a low threshold for investigating with magnetic resonance imaging, particularly if the patient shows unexpected outcomes following appropriate treatment. Patients and parents should be counselled on possible suboptimal results prior to the offer of surgical correction of strabismus.
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Affiliation(s)
- Wisam J Muen
- Department of Paediatric Ophthalmology, Royal Liverpool Children's Hospital (Alder Hey), Liverpool, UK
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Abernethy L. MRI of the paediatric brain: uncommon disorders – proton MR spectroscopy – diffusion MRI. By R Nuri Sener, pp. 391, 2003 (Warren-Green Inc., St Louis, MO), $55.00 ISBN 0-87527-535-4. Br J Radiol 2004. [DOI: 10.1259/bjr.77.918.770541a] [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: 11/05/2022] Open
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Abernethy L, MacAuley D, McNally O, McCann S. How important is sport and exercise medicine to the accident and emergency specialist? A study in the UK and Ireland. Arch Emerg Med 2003; 20:540-2. [PMID: 14623843 PMCID: PMC1726245 DOI: 10.1136/emj.20.6.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- L Abernethy
- Accident and Emergency Department, The Ulster Hospital, Dundonald, Belfast, UK.
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Abstract
School sport is a major cause of injury in the post-primary age group. The importance of primary prevention in sport has been identified; however secondary prevention of school related sport injury has not been described in Ireland. A random sample of 450 schools in Northern Ireland and the Republic of Ireland was studied using a postal questionnaire. Current management of sport injury, with particular interest in the expertise and training of teachers and coaches, was explored. Replies were received from 333 (74%) schools. There was no physical education teacher with up to date first aid training in 37% schools. Immediate care in terms of mechanisms and equipment to deal with injury was available in 35%-81% of schools responding. Correct response ranged from 65%-90% to four scenarios: commonly presenting yet potentially serious management problems. This study demonstrated deficiencies in sport injury care. In addition to concern about current training, a need for basic life support training is highlighted. These findings have implications for the prevention of school sports injuries.
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Affiliation(s)
- L Abernethy
- Accident and Emergency Department, Ulster Hospital, Dundonald, Belfast, UK.
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Abstract
BACKGROUND Most injuries in school occur during sport. OBJECTIVES To explore the impact of sports injury in supervised school sport. METHOD A prospective study of sports injury in children of secondary school age presenting to the accident and emergency department. Each patient was identified on registration, matched with medical records after discharge, and contacted later by telephone to complete a structured interview. Patients were only included if their injury was sustained during supervised school sport. RESULTS During the study period, 194 patients aged 11-18 attended the accident and emergency department with an injury, 51% of which occurred during school sport. Injuries occurred most commonly in rugby (43%), followed by physical education and games together (17.5%). Most injuries were x rayed (72%). Just over 12% of pupils lost no time from sport, most (71%) were back to sport within three weeks, and 2.7% were injured for more than eight weeks. Almost a third of parents needed to take time off from work to deal with the injured child. CONCLUSION School sports injuries are important. They account for just over half of all injuries in secondary school children. They cause significant disruption to school and sport and have important implications for the wider family.
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Affiliation(s)
- L Abernethy
- The Ulster Hospital Dundonald, Belfast, N Ireland.
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Abstract
BACKGROUND Sport and exercise related injuries are responsible for about 5% of the workload in the accident and emergency (A&E) department, yet training in sports medicine is not a compulsory part of the curriculum for Higher Specialist Training. AIM To determine how A&E medicine consultants and specialist trainees view their role and skill requirements in relation to sports medicine. METHOD A modified Delphi study, consisting of two rounds of a postal questionnaire. Participants were invited to rate the importance of statements relating to the role and training of the A&E specialist in relation to sports injuries (six statements) and the need for knowledge and understanding of defined skills of importance in sports medicine (16 statements). VALUE OF RESEARCH: This provides a consensus of opinion on issues in sport and exercise medicine that have educational implications for A&E specialists, and should be considered in the curriculum for Higher Specialist Training. There is also the potential for improving the health care provision of A&E departments, to the exercising and sporting population.
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Affiliation(s)
- L Abernethy
- Institute of Postgraduate Medical and Health Sciences, University of Ulster, Northern Ireland.
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31
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Abstract
Electrogastrography (EGG) is the transcutaneous measurement of gastric electrical activity. The aims of this study were to validate the electrode placement position in neonatal electrogastrography using ultrasonography to localise the stomach, and to describe the observed EGG frequency characteristics. Fifteen neonates with no known abdominal disorder were studied. Two bipolar EGG recordings were obtained from each subject, the first from electrodes placed at sites localized by ultrasound and the second from electrodes placed at the currently recommended sites. Paired sample t tests were used to compare electrode positioning and electrogastrographic data. There were 15 subjects with a mean age of 36 days (range 1-95). While there was a significant difference in the position of electrodes at each site, the EGG recordings did not differ. The 3-cycle/minute (2.6-3.7cpm) activity ranged from 30% to 84% of recorded time (mean at sites localized with ultrasound was 53%, and at currently recommended sites it was 50%; difference not significant, P = 0.155). Bradygastria (<2.6 cpm) was observed in the range of 2-29% of recorded time (mean at sites localised with ultrasound was 12.9%, and at currently recommended sites it was 11.7%; difference not significant, P = 0.40). Tachygastria (3.2-10 cpm) was shown to be in the range of 10-58% of recorded time (mean at sites localized with ultrasound was 33.3%, and at currently recommended sites it was 38.7%; difference not significant; P = 0.044). In conclusion, there was no significant difference between EGG recordings taken from electrode sites localized by ultrasound and those recommended by manufacturers of the electrogastrogram, thus confirming the validity of the manufacturer's recommended electrode positioning. The pattern of electrical control activity in the normal neonatal stomach appears to be different from that demonstrated in adults. Bradygastria and tachygastria are seen more frequently, with fewer periods of 3 cpm activity.
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Affiliation(s)
- M Patterson
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK
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Settle C, Wilcox MH, Rashid A, Cooke RS, Patterson V, Abernethy L. Acute obstructive hydrocephalus complicating bacterial meningitis. BMJ 1999. [DOI: 10.1136/bmj.318.7176.123b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abernethy L. Acute obstructive hydrocephalus complicating bacterial meningitis. Neuroimaging has limitations. BMJ 1999; 318:124. [PMID: 10068236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Abstract
We describe two girls with abdominal cysts which demonstrated the "double wall" or "muscular rim" sign. On the basis of this, the diagnosis of duplication cyst was made in each case. At surgery, both were found to have ovarian cysts, and histology revealed prominent haemorrhage within the cyst wall. To our knowledge, there has been no previous report of a false-positive "double wall sign".
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Affiliation(s)
- H Godfrey
- Department of Radiology, Royal Liverpool Children's NHS Trust, UK
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Abstract
We report myositis ossificans occurring in a 13-year-old boy with severe and rapidly progressive Guillain-Barré syndrome. This complication should be considered when severe musculoskeletal pain is experienced by such patients. Disodium etidronate may be of benefit in this condition.
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Affiliation(s)
- J C Hung
- Department of Neurology, Royal Liverpool Children's Hospital, Alder Hey, UK
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Pilling D, Abernethy L. Hypoxic-ischaemic encephalopathy: MRI findings. Arch Dis Child Fetal Neonatal Ed 1997; 77:F78-9. [PMID: 9279194 PMCID: PMC1720681 DOI: 10.1136/fn.77.1.f77c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/05/2023]
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Kaye SB, Wright N, Ward A, Abernethy L, Appleton R, Chandna A. Downgaze paresis following severe head trauma in a child. Dev Med Child Neurol 1996; 38:1046-52. [PMID: 8913186 DOI: 10.1111/j.1469-8749.1996.tb15065.x] [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] [Indexed: 02/03/2023]
Abstract
A 4 1/2-year-old girl developed a downgaze paresis following severe head trauma. Magnetic resonance imaging showed evidence of peri-aqueductal lesions in the rostral midbrain in the region of the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF). Twenty five weeks following the injury, the downgaze paresis remained unchanged but she developed convergence retraction nystagmus on attempted upgaze. Repeat imaging did not show any change in the lesions in the rostral midbrain. This report provides further evidence for the riMLF in the control of downgaze, and a synkinesis is postulated for the development of the convergence retraction nystagmus.
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Affiliation(s)
- S B Kaye
- Department of Ophthalmology, Royal Liverpool Children's NHS Trust, Royal Liverpool Children's Hospital, Alder Hey, UK
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Abernethy L. Mistaken identity. NATNEWS 1984; 21:12. [PMID: 6561391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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