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Gafner M, Garel C, Leibovitz Z, Valence S, Krajden Haratz K, Oegema R, Mancini GMS, Heron D, Bueltmann E, Burglen L, Rodriguez D, Huisman TAGM, Lequin MH, Arad A, Kidron D, Muqary M, Gindes L, Lev D, Boltshauser E, Lerman-Sagie T. Medullary Tegmental Cap Dysplasia: Fetal and Postnatal Presentations of a Unique Brainstem Malformation. AJNR Am J Neuroradiol 2023; 44:334-340. [PMID: 36822823 PMCID: PMC10187821 DOI: 10.3174/ajnr.a7805] [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: 10/14/2022] [Accepted: 01/09/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND AND PURPOSE Medullary tegmental cap dysplasia is a rare brainstem malformation, first described and defined by James Barkovich in his book Pediatric Neuroimaging from 2005 as an anomalous mass protruding from the posterior medullary surface. We describe the neuroimaging, clinical, postmortem, and genetic findings defining this unique malformation. MATERIALS AND METHODS This is a multicenter, international, retrospective study. We assessed the patients' medical records, prenatal ultrasounds, MR images, genetic findings, and postmortem results. We reviewed the medical literature for all studies depicting medullary malformations and evaluated cases in which a dorsal medullary protuberance was described. RESULTS We collected 13 patients: 3 fetuses and 10 children. The medullary caps had multiple characteristics. Associated brain findings were a rotated position of the medulla, a small and flat pons, cerebellar anomalies, a molar tooth sign, and agenesis of the corpus callosum. Systemic findings included the following: polydactyly, hallux valgus, large ears, and coarse facies. Postmortem analysis in 3 patients revealed that the cap contained either neurons or white matter tracts. We found 8 publications describing a dorsal medullary protuberance in 27 patients. The syndromic diagnosis was Joubert-Boltshauser syndrome in 11 and fibrodysplasia ossificans progressiva in 14 patients. CONCLUSIONS This is the first study to describe a series of 13 patients with medullary tegmental cap dysplasia. The cap has different shapes: distinct in Joubert-Boltshauser syndrome and fibrodysplasia ossificans progressive. Due to the variations in the clinical, imaging, and postmortem findings, we conclude that there are multiple etiologies and pathophysiology. We suggest that in some patients, the pathophysiology might be abnormal axonal guidance.
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Affiliation(s)
- M Gafner
- From the Department of Pediatrics B (M.G.), Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty ofMedicine (M.G., K.K.H., L.G., D.L., T.L.-S.), Tel Aviv University, Tel Aviv, Israel
| | - C Garel
- Department of Radiology (C.G.)
- Reference Center for Cerebellar Malformations and Congenital Diseases (C.G., S.V., D.H., L.B., D.R.), Hôpital d'Enfants Armand-Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Z Leibovitz
- Obstetrics and Gynecology Ultrasound Unit (Z.L.), Bnai-Zion Medical Center, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - S Valence
- Reference Center for Cerebellar Malformations and Congenital Diseases (C.G., S.V., D.H., L.B., D.R.), Hôpital d'Enfants Armand-Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service de Neuropédiatrie (S.V., L.B., D.R.), Hôpital Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - K Krajden Haratz
- Sackler Faculty ofMedicine (M.G., K.K.H., L.G., D.L., T.L.-S.), Tel Aviv University, Tel Aviv, Israel
- Division of Ultrasound in ObGyn (K.K.H.), Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - G M S Mancini
- Department of Clinical Genetics (G.M.S.M.), Erasmus MC University Medical Center, GD Rotterdam, the Netherlands
| | - D Heron
- Reference Center for Cerebellar Malformations and Congenital Diseases (C.G., S.V., D.H., L.B., D.R.), Hôpital d'Enfants Armand-Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service de Génétique Clinique (D.H.), Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - E Bueltmann
- Institute of Diagnostic und Interventional Neuroradiology (E. Bueltmann), Hannover Medical School, Hannover, Germany
| | - L Burglen
- Reference Center for Cerebellar Malformations and Congenital Diseases (C.G., S.V., D.H., L.B., D.R.), Hôpital d'Enfants Armand-Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service de Neuropédiatrie (S.V., L.B., D.R.), Hôpital Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - D Rodriguez
- Reference Center for Cerebellar Malformations and Congenital Diseases (C.G., S.V., D.H., L.B., D.R.), Hôpital d'Enfants Armand-Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service de Neuropédiatrie (S.V., L.B., D.R.), Hôpital Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - T A G M Huisman
- Edward B. Singleton Department of Radiology (T.A.G.M.H.), Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - M H Lequin
- Radiology (M.H.L.), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - A Arad
- Department of Pathology (A.A.), Bnai-Zion Medical Center, Haifa, Israel
| | - D Kidron
- Department of Pathology (D.K.), Meir Medical Center, Kfar Saba, Israel
| | - M Muqary
- Department of Obstetrics and Gynecology (M.M.), Poriya Medical Center, Tiberias, Galilee, Israel
| | - L Gindes
- Sackler Faculty ofMedicine (M.G., K.K.H., L.G., D.L., T.L.-S.), Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology (L.G.)
| | - D Lev
- Sackler Faculty ofMedicine (M.G., K.K.H., L.G., D.L., T.L.-S.), Tel Aviv University, Tel Aviv, Israel
- The Rina Mor Institute of Medical Genetics (D.L.)
- Fetal Neurology Clinic (D.L., T.L.-S.)
| | - E Boltshauser
- Pediatric Neurology (Emeritus) (E. Boltshauser), Children's University Hospital, Zürich, Switzerland
| | - T Lerman-Sagie
- Sackler Faculty ofMedicine (M.G., K.K.H., L.G., D.L., T.L.-S.), Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic (D.L., T.L.-S.)
- Magen Center for Rare Diseases (T.L.-S.)
- Pediatric Neurology Unit (T.L.-S.), Wolfson Medical Center, Holon, Israel
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Tietze A, Mankad K, Lequin MH, Ivarsson L, Mirsky D, Jaju A, Kool M, Hoff KV, Bison B, Löbel U. Imaging Characteristics of CNS Neuroblastoma- FOXR2: A Retrospective and Multi-Institutional Description of 25 Cases. AJNR Am J Neuroradiol 2022; 43:1476-1480. [PMID: 36137662 PMCID: PMC9575542 DOI: 10.3174/ajnr.a7644] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/27/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE The 5th edition of the World Health Organization Classification of CNS tumors defines the CNS neuroblastoma FOXR2 in the group of embryonal tumors. Published clinical outcomes tend to suggest a favorable outcome after resection, craniospinal irradiation, and chemotherapy. This multicenter study aimed to describe imaging features of CNS neuroblastoma-FOXR2, which have been poorly characterized thus far. MATERIALS AND METHODS On the basis of a previously published cohort of tumors molecularly classified as CNS neuroblastoma-FOXR2, patients with available imaging data were identified. The imaging features on preoperative MR imaging and CT data were recorded by 8 experienced pediatric neuroradiologists in consensus review meetings. RESULTS Twenty-five patients were evaluated (13 girls; median age, 4.5 years). The tumors were often large (mean, 115 [ SD, 83] mL), showed no (24%) or limited (60%) perilesional edema, demonstrated heterogeneous enhancement, were often calcified and/or hemorrhagic (52%), were always T2WI-hyperintense to GM, and commonly had cystic and/or necrotic components (96%). The mean ADC values were low (687.8 [SD 136.3] × 10-6 mm2/s). The tumors were always supratentorial. Metastases were infrequent (20%) and, when present, were of nodular appearance and leptomeningeal. CONCLUSIONS In our cohort, CNS neuroblastoma FOXR2 tumors showed imaging features suggesting high-grade malignancy and, at the same time, showed characteristics of less aggressive behavior. There are important differential diagnoses, but the results of this study may assist in considering this diagnosis preoperatively.
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Affiliation(s)
- A Tietze
- From the Institute of Neuroradiology (A.T.)
| | - K Mankad
- Department of Radiology (K.M., U.L.), Great Ormond Street Hospital, London, UK
| | - M H Lequin
- Department of Radiology (M.H.L.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - L Ivarsson
- Department of Pediatric Radiology (L.I.), Queen Silvias Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - D Mirsky
- Department of Pediatric Radiology and Imaging (D.M.), Children's Hospital Colorado, Denver, Colorado
| | - A Jaju
- Department of Medical Imaging (A.J.), Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - M Kool
- Hopp Children's Cancer Center (M.K.), Heidelberg, Germany
- Division of Pediatric Neurooncology (M.K.), German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany
- Princess Máxima Center for Pediatric Oncology (M.K.), Utrecht, the Netherlands
| | - K V Hoff
- Department of Pediatric Oncology and Hematology (K.V.H.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - B Bison
- Department of Neuroradiology (B.B.), University Hospital Augsburg, Ausburg, Germany
| | - U Löbel
- Department of Radiology (K.M., U.L.), Great Ormond Street Hospital, London, UK
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Van Schaik J, Burghard M, Lequin MH, van Maren EA, van Dijk AM, Takken T, Rehorst-Kleinlugtenbelt LB, Bakker B, Meijer L, Hoving EW, Fiocco M, Schouten-van Meeteren AYN, Tissing WJE, van Santen HM. Resting energy expenditure in children at risk of hypothalamic dysfunction. Endocr Connect 2022; 11:EC-22-0276. [PMID: 35904233 PMCID: PMC9346331 DOI: 10.1530/ec-22-0276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/14/2022] [Accepted: 06/27/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Children with suprasellar brain damage are at risk of hypothalamic dysfunction (HD). HD may lead to decreased resting energy expenditure (REE). Decreased REE, however, is not present in all children with HD. Our aim was to assess which children suspect for HD have low REE, and its association with clinical severity of HD or radiological hypothalamic damage. PATIENTS AND METHODS A retrospective cohort study was performed. Measured REE (mREE) of children at risk of HD was compared to predicted REE (pREE). Low REE was defined as mREE <90% of predicted. The mREE/pREE quotient was associated to a clinical score for HD symptoms and to radiological hypothalamic damage. RESULTS In total, 67 children at risk of HD (96% brain tumor diagnosis) with a mean BMI SDS of +2.3 ± 1.0 were included. Of these, 45 (67.2%) had low mREE. Children with severe HD had a significant lower mean mREE/pREE quotient compared to children with no, mild, or moderate HD. Mean mREE/pREE quotient of children with posterior hypothalamic damage was significantly lower compared to children with no or anterior damage. Tumor progression or tumor recurrence, severe clinical HD, and panhypopituitarism with diabetes insipidus (DI) were significant risk factors for reduced REE. CONCLUSION REE may be lowered in children with hypothalamic damage and is associated to the degree of clinical HD. REE is, however, not lowered in all children suspect for HD. For children with mild or moderate clinical HD symptoms, REE measurements may be useful to distinguish between those who may benefit from obesity treatment that increases REE from those who would be better helped using other obesity interventions.
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Affiliation(s)
- J Van Schaik
- Division of Pediatric Endocrinology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Correspondence should be addressed to J Van Schaik:
| | - M Burghard
- Division of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Exercise Physiology, Child Development & Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M H Lequin
- Division of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Radiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E A van Maren
- Division of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Radiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A M van Dijk
- Department of Dietetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T Takken
- Division of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Exercise Physiology, Child Development & Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - B Bakker
- Division of Pediatric Endocrinology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - L Meijer
- Division of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - E W Hoving
- Division of Neurosurgery, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - M Fiocco
- Division of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Institute of Mathematics, Leiden University, Leiden, The Netherlands
| | | | - W J E Tissing
- Division of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Division of Pediatric Oncology, University Medical Centre Groningen, Groningen, The Netherlands
| | - H M van Santen
- Division of Pediatric Endocrinology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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van Urk PR, Bollen CW, Lequin MH, Kruyt MC. The atonic stomach: a dangerous condition prior to scoliosis surgery. Spine Deform 2022; 10:965-967. [PMID: 34990007 DOI: 10.1007/s43390-021-00469-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
Abstract
A dilated atonic stomach as part of neuromuscular or syndromic disorders can have devastating results after scoliosis surgery. Patients can be asymptomatic preoperatively and non-clinical signs can be easily overlooked. Awareness of the condition, however, can prevent severe complications such as aspiration.
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Affiliation(s)
- P R van Urk
- Department of Orthopedics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - C W Bollen
- Department of Pediatrics, Wilhelmina Children's Hospital (WKZ) University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - M H Lequin
- Department of Radiology, Wilhelmina Children's Hospital (WKZ)University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - M C Kruyt
- Department of Orthopedics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Meys KME, de Vries LS, Groenendaal F, Vann SD, Lequin MH. The Mammillary Bodies: A Review of Causes of Injury in Infants and Children. AJNR Am J Neuroradiol 2022; 43:802-812. [PMID: 35487586 PMCID: PMC9172959 DOI: 10.3174/ajnr.a7463] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/22/2021] [Indexed: 12/20/2022]
Abstract
Despite their small size, the mammillary bodies play an important role in supporting recollective memory. However, they have typically been overlooked when assessing neurologic conditions that present with memory impairment. While there is increasing evidence of mammillary body involvement in a wide range of neurologic disorders in adults, very little attention has been given to infants and children. Literature searches of PubMed and EMBASE were performed to identify articles that describe mammillary body pathology on brain MR imaging in children. Mammillary body pathology is present in the pediatric population in several conditions, indicated by signal change and/or atrophy on MR imaging. The main causes of mammillary body pathology are thiamine deficiency, hypoxia-ischemia, direct damage due to masses or hydrocephalus, or deafferentation resulting from pathology within the wider Papez circuit. Optimizing scanning protocols and assessing mammillary body status as a standard procedure are critical, given their role in memory processes.
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Affiliation(s)
- K M E Meys
- From the Department of Radiology (K.M.E.M., F.G., M.H.L.), Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - L S de Vries
- Department of Neonatology (L.S.D.V.), Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - F Groenendaal
- From the Department of Radiology (K.M.E.M., F.G., M.H.L.), Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - S D Vann
- School of Psychology (S.D.V.), Cardiff University, Cardiff, UK
| | - M H Lequin
- From the Department of Radiology (K.M.E.M., F.G., M.H.L.), Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
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Doerga PN, Rijken BFM, Bredero-Boelhouwer H, Joosten KFM, Neuteboom RF, Tasker RC, Dremmen MHG, Lequin MH, van Veelen MLC, Mathijssen IMJ. Neurological deficits are present in syndromic craniosynostosis patients with and without tonsillar herniation. Eur J Paediatr Neurol 2020; 28:120-125. [PMID: 32782184 DOI: 10.1016/j.ejpn.2020.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/01/2020] [Revised: 05/18/2020] [Accepted: 06/23/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Children with syndromic craniosynostosis (sCS) have a higher incidence of cerebellar tonsillar herniation (TH) than the general population. In the general population, TH ≥ 5 mm below the foramen magnum is associated with typical neurological deficits but, in sCS, we do not know whether this degree of TH is required before such deficits occur. OBJECTIVE This prospective cohort study aimed to determine the association between findings on neurological assessment and cerebellar tonsillar position. METHODS Magnetic resonance imaging (MRI) was used to determine TH ≥ 5 mm and the presence of syringomyelia. In regard to the outcome of neurological deficits, these were categorized according to: A, cerebellar function; B, cranial nerve abnormalities; and C, sensory or motor dysfunction. RESULTS Twenty of 63 patients with sCS (32% [95% confidence interval 21-45%]) had TH ≥ 5 mm and/or syringomyelia. There was no significant difference in proportion between individual forms of sCS: 16/34 Crouzon, 2/11 Muenke, 2/12 Apert, and 0/7 Saethre-Chotzen patients. Neurological deficits were prevalent (73% [95% confidence interval 60-83%]), and as frequent in patients with TH ≥ 5 mm and/or syringomyelia as those without. Surgery occurred in 3 patients overall, and only in Crouzon patients. CONCLUSION Determining the effect of TH ≥ 5 mm on neurologic functioning in sCS patients is used to better determine when surgical intervention is warranted. However, we have found that neurological deficits are prevalent in sCS patients, irrespective of cerebellar tonsillar position, suggesting that such findings are developmental and, in part, syndrome-specific central nervous system features.
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Affiliation(s)
- P N Doerga
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Sophia Children's Hospital, Dutch Craniofacial Center, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
| | - B F M Rijken
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Sophia Children's Hospital, Dutch Craniofacial Center, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - H Bredero-Boelhouwer
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Sophia Children's Hospital, Dutch Craniofacial Center, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - K F M Joosten
- Pediatric Intensive Care Unit, Sophia Children's Hospital, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - R F Neuteboom
- Department of Pediatric Neurology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - R C Tasker
- Department of Anaesthesia (Pediatrics) and Division of Critical Care Medicine, Harvard Medical School and Boston Children's Hospital, 300 Longwood Avenue, Boston, Massachusetts, 02115, USA
| | - M H G Dremmen
- Department of Neurosurgery, Sophia Children's Hospital, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - M H Lequin
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - M L C van Veelen
- Department of Neurosurgery, Sophia Children's Hospital, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - I M J Mathijssen
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Sophia Children's Hospital, Dutch Craniofacial Center, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
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Roelants JA, Koning IV, Raets MMA, Willemsen SP, Lequin MH, Steegers-Theunissen RPM, Reiss IKM, Vermeulen MJ, Govaert P, Dudink J. A New Ultrasound Marker for Bedside Monitoring of Preterm Brain Growth. AJNR Am J Neuroradiol 2016; 37:1516-22. [PMID: 26988817 DOI: 10.3174/ajnr.a4731] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/05/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Preterm neonates are at risk for neurodevelopmental impairment, but reliable, bedside-available markers to monitor preterm brain growth during hospital stay are still lacking. The aim of this study was to assess the feasibility of corpus callosum-fastigium length as a new cranial sonography marker for monitoring of preterm brain growth. MATERIALS AND METHODS In this longitudinal prospective cohort study, cranial ultrasound was planned on the day of birth, days 1, 2, 3, and 7 of life; and then weekly until discharge in preterm infants born before 29 weeks of gestational age. Reproducibility and associations between clinical variables and corpus callosum-fastigium growth trajectories were studied. RESULTS A series of 1-8 cranial ultrasounds was performed in 140 infants (median gestational age at birth, 27(+2) weeks (interquartile range, 26(+1) to 28(+1); 57.9% male infants). Corpus callosum-fastigium measurements showed good-to-excellent agreement for inter- and intraobserver reproducibility (intraclass correlation coefficient >0.89). Growth charts for preterm infants between 24 and 32 weeks of gestation were developed. Male sex and birth weight SD score were positively associated with corpus callosum-fastigium growth rate. CONCLUSIONS Corpus callosum-fastigium length measurement is a new reproducible marker applicable for bedside monitoring of preterm brain growth during neonatal intensive care stay.
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Affiliation(s)
- J A Roelants
- From the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.) Departments of Obstetrics and Gynecology (J.A.R., I.V.K., S.P.W., R.P.M.S.-T.)
| | - I V Koning
- Departments of Obstetrics and Gynecology (J.A.R., I.V.K., S.P.W., R.P.M.S.-T.)
| | - M M A Raets
- From the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.)
| | - S P Willemsen
- Departments of Obstetrics and Gynecology (J.A.R., I.V.K., S.P.W., R.P.M.S.-T.) Biostatistics (S.P.W.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - M H Lequin
- Department of Radiology (M.H.L.), University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - I K M Reiss
- From the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.)
| | - M J Vermeulen
- From the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.)
| | - P Govaert
- From the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.)
| | - J Dudink
- From the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.) Department of Radiology (J.D.) Intensive Care Unit (J.D.), Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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Rijken BFM, Leemans A, Lucas Y, van Montfort K, Mathijssen IMJ, Lequin MH. Diffusion Tensor Imaging and Fiber Tractography in Children with Craniosynostosis Syndromes. AJNR Am J Neuroradiol 2015; 36:1558-64. [PMID: 25953762 DOI: 10.3174/ajnr.a4301] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/02/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Patients with craniosynostosis syndromes caused by mutations in FGFR-2, FGFR-3, and TWIST1 genes are characterized by having prematurely fused skull sutures and skull base synchondroses, which result in a skull deformity and are accompanied by brain anomalies, including altered white matter microarchitecture. In this study, the reliability and reproducibility of DTI fiber tractography was investigated in these patients. The outcomes were compared with those of controls. MATERIALS AND METHODS DTI datasets were acquired with a 1.5T MR imaging system with 25 diffusion gradient orientations (voxel size = 1.8 × 1.8 × 3.0 mm(3), b-value = 1000 s/mm(2)). White matter tracts studied included the following: corpus callosum, cingulate gyrus, fornix, corticospinal tracts, and medial cerebellar peduncle. Tract pathways were reconstructed with ExploreDTI in 58 surgically treated patients with craniosynostosis syndromes and 7 controls (age range, 6-18 years). RESULTS Because of the brain deformity and abnormal ventricular shape and size, DTI fiber tractography was challenging to perform in patients with craniosynostosis syndromes. To provide reliable tracts, we adapted standard tracking protocols. Fractional anisotropy was equal to that in controls (0.44 versus 0.45 ± 0.02, P = .536), whereas mean, axial, and radial diffusivity parameters of the mean white matter were increased in patients with craniosynostosis syndromes (P < .001). No craniosynostosis syndrome-specific difference in DTI properties was seen for any of the fiber tracts studied in this work. CONCLUSIONS Performing DTI fiber tractography in patients with craniosynostosis syndromes was difficult due to partial volume effects caused by an anisotropic voxel size and deformed brain structures. Although these patients have a normal fiber organization, increased diffusivity parameters suggest abnormal microstructural tissue properties of the investigated white matter tracts.
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Affiliation(s)
- B F M Rijken
- From the Departments of Plastic and Reconstructive Surgery and Hand Surgery (B.F.M.R., Y.L., I.M.J.M.)
| | - A Leemans
- Image Sciences Institute (A.L.), University Medical Center, Utrecht, the Netherlands
| | - Y Lucas
- From the Departments of Plastic and Reconstructive Surgery and Hand Surgery (B.F.M.R., Y.L., I.M.J.M.)
| | - K van Montfort
- Department of Biostatics (K.v.M.), Erasmus Medical Center, Rotterdam, the Netherlands
| | - I M J Mathijssen
- From the Departments of Plastic and Reconstructive Surgery and Hand Surgery (B.F.M.R., Y.L., I.M.J.M.)
| | - M H Lequin
- Radiology (M.H.L.), Erasmus Medical Center/Sophia Children's Hospital, Rotterdam, the Netherlands
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9
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Spruijt B, Rijken BFM, Joosten KFM, Bredero-Boelhouwer HH, Pullens B, Lequin MH, Wolvius EB, van Veelen-Vincent MLC, Mathijssen IMJ. Atypical presentation of a newborn with Apert syndrome. Childs Nerv Syst 2015; 31:481-6. [PMID: 25433548 DOI: 10.1007/s00381-014-2601-6] [Citation(s) in RCA: 7] [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: 11/12/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Apert syndrome is a rare syndrome characterized by a consistent phenotype including bilateral coronal suture synostosis with an enlarged anterior fontanel, midface hypoplasia, and complex symmetric syndactyly of hands and feet. CASE REPORT We present a boy with Apert syndrome caused by the pathogenic c.755C > G p.Ser252Trp mutation in the FGFR2 gene with atypical characteristics, including premature fusion of the metopic suture with a small anterior fontanel, hypotelorism, and a massive posterior fontanel. Directly after birth, he showed papilledema, epilepsy, and central apneas. CONCLUSION We present a newborn with Apert syndrome with atypical craniofacial presentation.
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Affiliation(s)
- B Spruijt
- Dutch Craniofacial Center, Sophia Children's Hospital-Erasmus University Medical Center, Wytemaweg 80, Room SK-1202, PO Box 2060, 3015 CN, Rotterdam, The Netherlands,
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10
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Horsch S, Govaert P, Cowan FM, Benders MJNL, Groenendaal F, Lequin MH, Saliou G, de Vries LS. Developmental venous anomaly in the newborn brain. Neuroradiology 2014; 56:579-88. [PMID: 24756165 DOI: 10.1007/s00234-014-1367-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 04/08/2014] [Indexed: 10/25/2022]
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11
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Plaisier A, Pieterman K, Lequin MH, Govaert P, Heemskerk AM, Reiss IKM, Krestin GP, Leemans A, Dudink J. Choice of diffusion tensor estimation approach affects fiber tractography of the fornix in preterm brain. AJNR Am J Neuroradiol 2014; 35:1219-25. [PMID: 24407271 DOI: 10.3174/ajnr.a3830] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Neonatal DTI enables quantitative assessment of microstructural brain properties. Although its use is increasing, it is not widely known that vast differences in tractography results can occur, depending on the diffusion tensor estimation methodology used. Current clinical work appears to be insufficiently focused on data quality and processing of neonatal DTI. To raise awareness about this important processing step, we investigated tractography reconstructions of the fornix with the use of several estimation techniques. We hypothesized that the method of tensor estimation significantly affects DTI tractography results. MATERIALS AND METHODS Twenty-eight DTI scans of infants born <29 weeks of gestation, acquired at 30-week postmenstrual age and without intracranial injury observed, were prospectively collected. Four diffusion tensor estimation methods were applied: 1) linear least squares; 2) weighted linear least squares; 3) nonlinear least squares, and 4) robust estimation of tensors by outlier rejection. Quality of DTI data and tractography results were evaluated for each method. RESULTS With nonlinear least squares and robust estimation of tensors by outlier rejection, significantly lower mean fractional anisotropy values were obtained than with linear least squares and weighted linear least squares. Visualized quality of tract reconstruction was significantly higher by use of robust estimation of tensors by outlier rejection and correlated with quality of DTI data. CONCLUSIONS Quality assessment and choice of processing methodology have considerable impact on neonatal DTI analysis. Dedicated acquisition, quality assessment, and advanced processing of neonatal DTI data must be ensured before performing clinical analyses, such as associating microstructural brain properties with patient outcome.
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Affiliation(s)
- A Plaisier
- From the Division of Neonatology, Department of Pediatrics (A.P., K.P., P.G., A.M.H., J.D.), Erasmus Medical Center-Sophia, Rotterdam, The NetherlandsDepartments of Radiology (A.P., M.H.L., A.M.H., G.P.K., J.D.)
| | - K Pieterman
- From the Division of Neonatology, Department of Pediatrics (A.P., K.P., P.G., A.M.H., J.D.), Erasmus Medical Center-Sophia, Rotterdam, The Netherlands
| | - M H Lequin
- Departments of Radiology (A.P., M.H.L., A.M.H., G.P.K., J.D.)
| | - P Govaert
- From the Division of Neonatology, Department of Pediatrics (A.P., K.P., P.G., A.M.H., J.D.), Erasmus Medical Center-Sophia, Rotterdam, The NetherlandsDepartment of Pediatrics (P.G.), Koningin Paola Children's Hospital, Antwerp, Belgium
| | - A M Heemskerk
- From the Division of Neonatology, Department of Pediatrics (A.P., K.P., P.G., A.M.H., J.D.), Erasmus Medical Center-Sophia, Rotterdam, The NetherlandsDepartments of Radiology (A.P., M.H.L., A.M.H., G.P.K., J.D.)
| | - I K M Reiss
- Neonatology (I.K.M.R.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - G P Krestin
- Departments of Radiology (A.P., M.H.L., A.M.H., G.P.K., J.D.)
| | - A Leemans
- Image Sciences Institute (A.L.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Dudink
- From the Division of Neonatology, Department of Pediatrics (A.P., K.P., P.G., A.M.H., J.D.), Erasmus Medical Center-Sophia, Rotterdam, The NetherlandsDepartments of Radiology (A.P., M.H.L., A.M.H., G.P.K., J.D.)
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12
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Ebbink BJ, Aarsen FK, van Gelder CM, van den Hout JMP, Weisglas-Kuperus N, Jaeken J, Lequin MH, Arts WFM, van der Ploeg AT. Cognitive outcome of classic infantile Pompe patients receiving enzyme therapy. BMC Musculoskelet Disord 2013. [PMCID: PMC3667093 DOI: 10.1186/1471-2474-14-s2-p14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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13
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Plaisier A, Govaert P, Lequin MH, Dudink J. Optimal timing of cerebral MRI in preterm infants to predict long-term neurodevelopmental outcome: a systematic review. AJNR Am J Neuroradiol 2013; 35:841-7. [PMID: 23639558 DOI: 10.3174/ajnr.a3513] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY Advances in neonatal neuroimaging have improved detection of preterm brain injury responsible for abnormal neuromotor and cognitive development. Increasingly sophisticated MR imaging setups allow scanning during early preterm life. In this review, we investigated how brain MR imaging in preterm infants should be timed to best predict long-term outcome. Given the strong evidence that structural brain abnormalities are related to long-term neurodevelopment, MR imaging should preferably be performed at term-equivalent age. Early MR imaging is promising because it can guide early intervention studies and is indispensable in research on preterm brain injury.
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Affiliation(s)
- A Plaisier
- From the Division of Neonatology (A.P., P.G., J.D.)Department of Pediatrics, and Division of Pediatric Radiology (A.P., M.H.L., J.D.), Department of Radiology, Erasmus Medical Center-Sophia, Rotterdam, the Netherlands
| | - P Govaert
- From the Division of Neonatology (A.P., P.G., J.D.)Department of Pediatrics (P.G.), Koningin Paola Children's Hospital, Antwerp, Belgium
| | - M H Lequin
- Department of Pediatrics, and Division of Pediatric Radiology (A.P., M.H.L., J.D.), Department of Radiology, Erasmus Medical Center-Sophia, Rotterdam, the Netherlands
| | - J Dudink
- From the Division of Neonatology (A.P., P.G., J.D.)Department of Pediatrics, and Division of Pediatric Radiology (A.P., M.H.L., J.D.), Department of Radiology, Erasmus Medical Center-Sophia, Rotterdam, the Netherlands
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14
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Ciet P, Wielopolski P, Manniesing R, Lever S, de Bruijne M, Morana G, Muzzio PC, Lequin MH, Tiddens HAWM. Spirometer-controlled cine magnetic resonance imaging used to diagnose tracheobronchomalacia in paediatric patients. Eur Respir J 2013; 43:115-24. [DOI: 10.1183/09031936.00104512] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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15
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Weber F, Buitenhuis M, Lequin MH. Determination of the optimal length of insertion of central venous catheters in pediatric patients by endovascular ECG. Minerva Anestesiol 2013; 79:379-384. [PMID: 23370122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND In children the position of the tip of central venous catheters (CVC) is most often examined by chest radiography. Endovascular electrocardiography (ECG), using the CVC as an electrode, permits the correct placement of a CVC without the need for a chest X-ray. The use of a commercialised endovascular ECG-system (Alphacard®) for CVC-placement was evaluated in pediatric patients. METHODS ECG-guidance was prospectively applied in 50 children (0-17 years, stratified into 5 age related subgroups). Positioning of the CVC was performed under ECG-guidance and subsequently assessed by chest X-ray. The frequency of correct ECG-guided CVC-placement in one single attempt, duration until confirmation by ECG and X-ray, and body weight-related depth of CVC-insertion were assessed. RESULTS In 44 patients ECG-guidance resulted in a correct placement of the CVC-tip. Duration (median and [IQR] in sec.) to confirmation of correct placement was shorter with the ECG method (78[49-136]) than with X-ray (720[249-1095]) (P<0.0001). In five patients the ECG method failed because the CVC chosen was too short or the anesthetist did not trust the ECG-method. In one patient an unknown anatomical anomaly was present. Depth of insertion of the CVC was positively correlated with body weight (r2 0.68, P<0.0001). Stratification for age had no impact on duration until confirmation of CVC-position. No complications occurred during CVC-placement. CONCLUSION ECG guidance of CVC-placement in children is a reliable technique, preventing children and health care providers from unnecessary X-ray exposure. Depending on local infrastructure and protocols it can furthermore shorten the procedure of CVC placement.
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Affiliation(s)
- F Weber
- Pediatric Anaesthesia Unit, Department of Anesthesia, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands.
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16
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Heemskerk AM, Leemans A, Plaisier A, Pieterman K, Lequin MH, Dudink J. Acquisition guidelines and quality assessment tools for analyzing neonatal diffusion tensor MRI data. AJNR Am J Neuroradiol 2013; 34:1496-505. [PMID: 23518355 DOI: 10.3174/ajnr.a3465] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Diffusion tensor imaging is a valuable measure in clinical settings to assess diagnosis and prognosis of neonatal brain development. However, obtaining reliable images is not straightforward because of the tissue characteristics of the neonatal brain and the high likelihood of motion artifacts. In this review, we present guidelines on how to acquire DTI data of the neonatal brain and recommend high-quality data acquisition and processing as an essential means to obtain accurate and robust parametric maps. Sudden head movements are problematic for DTI in neonates, and these may lead to incorrect values. We describe strategies to minimize the corrupting effects both in terms of acquisition (eg, more gradient directions) and postprocessing (eg, tensor estimation methods). In addition, tools are described that can help assess whether a dataset is of sufficient quality for further assessment.
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Affiliation(s)
- A M Heemskerk
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
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17
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Ebbink BJ, Aarsen FK, van Gelder CM, van den Hout JMP, Weisglas-Kuperus N, Jaeken J, Lequin MH, Arts WFM, van der Ploeg AT. Cognitive outcome of patients with classic infantile Pompe disease receiving enzyme therapy. Neurology 2012; 78:1512-8. [PMID: 22539577 DOI: 10.1212/wnl.0b013e3182553c11] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Classic infantile Pompe disease affects many tissues, including the brain. Untreated infants die within their first year. Although enzyme-replacement therapy (ERT) significantly increases survival, its potential limitation is that the drug cannot cross the blood-brain barrier. We therefore investigated long-term cognitive development in patients treated with ERT. METHODS We prospectively assessed cognitive functioning in 10 children with classic infantile Pompe disease who had been treated with ERT since 1999. Brain imaging was performed in 6 children. RESULTS During the first 4 years of life, developmental scores in 10 children ranged from above-average development to severe developmental delay; they were influenced by the type of intelligence test used, severity of motor problems, speech/language difficulties, and age at start of therapy. Five of the children were also tested from 5 years onward. Among them were 2 tetraplegic children whose earlier scores had indicated severe developmental delay. These scores now ranged between normal and mild developmental delay and indicated that at young age poor motor functioning may interfere with proper assessment of cognition. We found delayed processing speed in 2 children. Brain imaging revealed periventricular white matter abnormalities in 4 children. CONCLUSIONS Cognitive development at school age ranged between normal and mildly delayed in our long-term survivors with classic infantile Pompe disease treated with ERT. The oldest was 12 years. We found that cognition is easily underestimated in children younger than 5 years with poor motor functioning.
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Affiliation(s)
- B J Ebbink
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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18
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de Jong T, Rijken BFM, Lequin MH, van Veelen MLC, Mathijssen IMJ. Brain and ventricular volume in patients with syndromic and complex craniosynostosis. Childs Nerv Syst 2012; 28:137-40. [PMID: 22011964 PMCID: PMC3252498 DOI: 10.1007/s00381-011-1614-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [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: 09/24/2011] [Accepted: 10/10/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE Brain abnormalities in patients with syndromic craniosynostosis can either be a direct result of the genetic defect or develop secondary to compression due to craniosynostosis, raised ICP or hydrocephalus. Today it is unknown whether children with syndromic craniosynostosis have normal brain volumes. The purpose of this study was to evaluate brain and ventricular volume measurements in patients with syndromic and complex craniosynostosis. This knowledge will improve our understanding of brain development and the origin of raised intracranial pressure in syndromic craniosynostosis. METHODS Brain and ventricular volumes were calculated from MRI scans of patients with craniosynostosis, 0.3 to 18.3 years of age. Brain volume was compared to age matched controls from the literature. All patient charts were reviewed to look for possible predictors of brain and ventricular volume. RESULTS Total brain volume in syndromic craniosynostosis equals that of normal controls, in the age range of 1 to 12 years. Brain growth occurred particularly in the first 5 years of age, after which it stabilized. Within the studied population, ventricular volume was significantly larger in Apert syndrome compared to all other syndromes and in patients with a Chiari I malformation. CONCLUSIONS Patients with syndromic craniosynostosis have a normal total brain volume compared to normal controls. Increased ventricular volume is associated with Apert syndrome and Chiari I malformations, which is most commonly found in Crouzon syndrome. We advice screening of all patients with Apert and Crouzon syndrome for the development of enlarged ventricle volume and the presence of a Chiari I malformation.
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Affiliation(s)
- T. de Jong
- Department of Plastic and Reconstructive Surgery, and Hand Surgery, Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - B. F. M. Rijken
- Department of Plastic and Reconstructive Surgery, and Hand Surgery, Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M. H. Lequin
- Department of Radiology, Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M. L. C. van Veelen
- Department of Neurosurgery, Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - I. M. J. Mathijssen
- Department of Plastic and Reconstructive Surgery, and Hand Surgery, Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
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Meuwissen MEC, de Vries LS, Verbeek HA, Lequin MH, Govaert PP, Schot R, Cowan FM, Hennekam R, Rizzu P, Verheijen FW, Wessels MW, Mancini GMS. Sporadic COL4A1 mutations with extensive prenatal porencephaly resembling hydranencephaly. Neurology 2011; 76:844-6. [DOI: 10.1212/wnl.0b013e31820e7751] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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20
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te Winkel ML, van der Sluis IM, Lequin MH, Pieters R, van den Heuvel-Eibrink MM. Letter to the editor in response to "Prospective bone ultrasound patterns during childhood acute lymphoblastic leukemia" by Mussa et al. Bone 2010; 47:835-6; author reply 837-8. [PMID: 20624504 DOI: 10.1016/j.bone.2010.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 07/07/2010] [Indexed: 11/29/2022]
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Oegema R, de Klein A, Verkerk AJ, Schot R, Dumee B, Douben H, Eussen B, Dubbel L, Poddighe PJ, van der Laar I, Dobyns WB, van der Spek PJ, Lequin MH, de Coo IFM, de Wit MCY, Wessels MW, Mancini GMS. Distinctive Phenotypic Abnormalities Associated with Submicroscopic 21q22 Deletion Including DYRK1A. Mol Syndromol 2010; 1:113-120. [PMID: 21031080 DOI: 10.1159/000320113] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 07/30/2010] [Indexed: 11/19/2022] Open
Abstract
Partial monosomy 21 has been reported, but the phenotypes described are variable with location and size of the deletion. We present 2 patients with a partially overlapping microdeletion of 21q22 and a striking phenotypic resemblance. They both presented with severe psychomotor delay, behavioral problems, no speech, microcephaly, feeding problems with frequent regurgitation, idiopathic thrombocytopenia, obesity, deep set eyes, down turned corners of the mouth, dysplastic ears, and small chin. Brain MRI showed cerebral atrophy mostly evident in frontal and temporal lobes, widened ventricles and thin corpus callosum in both cases, and in one patient evidence of a migration disorder. The first patient also presented with epilepsy and a ventricular septum defect. The second patient had a unilateral Peters anomaly. Microarray analysis showed a partially overlapping microdeletion spanning about 2.5 Mb in the 21q22.1-q22.2 region including the DYRK1A gene and excluding RUNX1. These patients present with a recognizable phenotype specific for this 21q22.1-q22.2 locus. We searched the literature for patients with overlapping deletions including the DYRK1A gene, in order to define other genes responsible for this presentation.
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Affiliation(s)
- R Oegema
- Department of Clinical Genetics, Rotterdam, The Netherlands
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te Winkel ML, Lequin MH, de Bruyn JR, van de Ven CP, de Krijger RR, Pieters R, van den Heuvel-Eibrink MM. Self-limiting sternal tumors of childhood (SELSTOC). Pediatr Blood Cancer 2010; 55:81-4. [PMID: 20213849 DOI: 10.1002/pbc.22454] [Citation(s) in RCA: 20] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND Because a sternal mass is often alarming, it is important to identify the clinical features of benign processes. PROCEDURE Data on clinical presentation, diagnostics, treatment and outcome of pediatric patients presenting with a sternal tumor between 2001 and 2009 were collected from medical records. RESULTS Among the 1,700 children who were referred to our pediatric-oncology center, 14 presented with a rapidly growing sternal mass. All patients (10 males) were Caucasian and median age was 16 (range: 7-50) months. Reported symptoms were local pain (n = 7) and/or raised body temperature (n = 5). No major preceding traumas were reported. Physical examination revealed solid tumors with a median diameter of 3 (range: 1-4.5) cm in a pre-sternal/para-sternal location. Half of the patients showed red/blue discoloration of the skin. On radiology, dumbbell-shaped lesions extended to the area behind the sternal bone, involving the cartilage, leading to increased distance between ossification centers. Histopathology at diagnosis was available from five patients and showed aspecific chronic or acute inflammation (n = 4) and a reactive osteochondromatous lesion (n = 1). Laboratory infection parameters were not/only slightly raised and microbiologic cultures were negative in all patients. All tumors decreased in size within 1 month, in both patients with and without antibiotics. On physical examination the tumors disappeared within 6 months. CONCLUSIONS This study reports 14 young children with a rapidly growing sternal mass due to aseptic inflammation, that we named self-limiting sternal tumor of childhood (SELSTOC). To prevent invasive diagnostic interventions and unnecessary treatment, we advocate a wait-and-see approach with close follow-up in the first weeks.
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Affiliation(s)
- M L te Winkel
- Department of Pediatric Oncology/Hematology, Erasmus MC, Sophia Children's Hospital, Rotterdam, the Netherlands
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Wessels MW, Kuchinka B, Heydanus R, Smit BJ, Dooijes D, de Krijger RR, Lequin MH, de Jong EM, Husen M, Willems PJ, Casey B. Polyalanine expansion in the ZIC3 gene leading to X-linked heterotaxy with VACTERL association: a new polyalanine disorder? J Med Genet 2010; 47:351-5. [DOI: 10.1136/jmg.2008.060913] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mook-Kanamori DO, Holzhauer S, Hollestein LM, Durmus B, Manniesing R, Koek M, Boehm G, van der Beek EM, Hofman A, Witteman JCM, Lequin MH, Jaddoe VWV. Abdominal fat in children measured by ultrasound and computed tomography. Ultrasound Med Biol 2009; 35:1938-1946. [PMID: 19800165 DOI: 10.1016/j.ultrasmedbio.2009.07.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Revised: 05/28/2009] [Accepted: 07/14/2009] [Indexed: 05/28/2023]
Abstract
The prevalence of childhood obesity is increasing rapidly. Visceral fat plays an important role in the pathogenesis of metabolic and cardiovascular diseases. Currently, computed tomography (CT) is broadly seen as the most accurate method of determining the amount of visceral fat. The main objective was to examine whether measures of abdominal visceral fat can be determined by ultrasound in children and whether CT can be replaced by ultrasound for this purpose. To assess whether preperitoneal fat thickness and area are good approximations of visceral fat at the umbilical level, we first retrospectively examined 47 CT scans of nonobese children (body mass index <30kg/m(2); median age 7.9 y [95% range 1.2 to 16.2]). Correlation coefficients between visceral and preperitoneal fat thickness and area were 0.58 (p<0.001) and 0.76 (p<0.001), respectively. Then, to assess how preperitoneal and subcutaneous fat thicknesses and areas measured by ultrasound compare with these parameters in CT, we examined 34 nonobese children (median age 9.5 [95% range 0.3 to 17.0]) by ultrasound and CT. Ultrasound measurements of preperitoneal and subcutaneous fat were correlated with CT measurements, with correlation coefficients ranging from 0.75-0.97 (all p<0.001). Systematic differences of up to 24.0cm(2) for preperitoneal fat area (95% confidence interval -29.9 to 77.9cm(2)) were observed when analyzing the results described by the Bland-Altman method. Our findings suggest that preperitoneal fat can be used as an approximation for visceral fat in children and that measuring abdominal fat with ultrasound in children is a valid method for epidemiological and clinical studies. However, the exact agreement between the ultrasound and CT scan was limited, which indicates that ultrasound should be used carefully for obtaining exact fat distribution measurements in individual children.
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Affiliation(s)
- D O Mook-Kanamori
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands
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Abstract
Neonatal stroke occurs in 1 in 2300-5000 live births, the incidence of which is lower than that in adults, but still higher than that in childhood. The higher incidence of perinatal stroke in preterm and term infants compared to stroke in childhood may be partly explained by higher detection rates using routine fetal ultrasound and postnatal cranial sonography. In addition, there is greater availability of magnetic resonance imaging (MRI) for neuroimaging in preterm and full-term infants, which is due in part to the availability of MR-compatible incubators and MR systems at or near the neonatal intensive care unit. In addition, the wide range of MR techniques, such as T2-, diffusion- and susceptibility-weighted imaging allows improved visualization and quantification of neonatal stroke or hypoxic-ischemic injury. This chapter reviews the MR neuroimaging modalities that actually assist the clinician in the detection of neonatal stroke.
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Affiliation(s)
- M H Lequin
- Department of Radiology, Erasmus MC - Sophia Children's Hospital, Erasmus University Medical Center, Dr Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands.
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Loeve M, van Hal PTW, Robinson P, de Jong PA, Lequin MH, Hop WC, Williams TJ, Nossent GD, Tiddens HA. The spectrum of structural abnormalities on CT scans from patients with CF with severe advanced lung disease. Thorax 2009; 64:876-82. [DOI: 10.1136/thx.2008.110908] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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de Wit MCY, de Coo IFM, Halley DJJ, Lequin MH, Mancini GMS. Movement disorder and neuronal migration disorder due to ARFGEF2 mutation. Neurogenetics 2009; 10:333-6. [PMID: 19384555 PMCID: PMC2758209 DOI: 10.1007/s10048-009-0192-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [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: 11/03/2008] [Accepted: 03/30/2009] [Indexed: 11/30/2022]
Abstract
We report a child with a severe choreadystonic movement disorder, bilateral periventricular nodular heterotopia (BPNH), and secondary microcephaly based on compound heterozygosity for two new ARFGEF2 mutations (c.2031_2038dup and c.3798_3802del), changing the limited knowledge about the phenotype. The brain MRI shows bilateral hyperintensity of the putamen, BPNH, and generalized atrophy. Loss of ARFGEF2 function affects vesicle trafficking, proliferation/apoptosis, and neurotransmitter receptor function. This can explain BPNH and microcephaly. We hypothesize that the movement disorder and the preferential damage to the basal ganglia, specifically to the putamen, may be caused by an increased sensitivity to degeneration, a dynamic dysfunction due to neurotransmitter receptor mislocalization or a combination of both.
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Affiliation(s)
- M C Y de Wit
- Department of Pediatric Neurology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
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28
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van Engelen SJPM, Krab LC, Moll HA, de Goede-Bolder A, Pluijm SMF, Catsman-Berrevoets CE, Elgersma Y, Lequin MH. Quantitative differentiation between healthy and disordered brain matter in patients with neurofibromatosis type I using diffusion tensor imaging. AJNR Am J Neuroradiol 2008; 29:816-22. [PMID: 18339726 DOI: 10.3174/ajnr.a0921] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Hyperintensities on T2-weighted images are seen in the brains of most patients with neurofibromatosis type I (NF-1), but the origin of these unidentified bright objects (UBOs) remains obscure. In the current study, we examined the diffusion characteristics of brain tissue in children with NF-1 to test the hypothesis that a microstructural abnormality is present in NF-1. MATERIALS AND METHODS Diffusion tensor imaging (DTI) was performed in 50 children with NF-1 and 8 controls. Circular regions of interest were manually placed in 7 standardized locations in both hemispheres, including UBO sites. Apparent diffusion coefficients (ADC), fractional anisotropy (FA), and axial anisotropy (A(m)) were used to differentiate quantitatively between healthy and disordered brain matter. Differences in eigenvalues (lambda(1), lambda(2), lambda(3)) were determined to examine parenchymal integrity. RESULTS We found higher ADC values for UBOs than for normal-appearing sites (P < .01) and higher ADC values for normal-appearing sites than for controls (P < .04 in 5 of 7 regions). In most regions, we found no differences in FA or A(m). Eigenvalues lambda(2) and lambda(3) were higher at UBO sites than in normal-appearing sites (P < .04). CONCLUSION With ADC, it was possible to differentiate quantitatively between normal- and abnormal-appearing brain matter in NF-1 and also between normal-appearing brain matter in NF-1 and healthy brain matter in controls, indicating subtle pathologic damage disrupting the tissue microstructure in the NF-1 brain. Higher diffusivity for lambda(1), lambda(2), and lambda(3) indicates that this disturbance of microstructure is caused by accumulation of fluid or vacuolation.
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Affiliation(s)
- S J P M van Engelen
- Department of Pediatric Radiology, The NF-1 CoRe Team, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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29
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de Wit MCY, de Coo IFM, Julier C, Delépine M, Lequin MH, van de Laar I, Sibbles BJ, Bruining GJ, Mancini GMS. Microcephaly and simplified gyral pattern of the brain associated with early onset insulin-dependent diabetes mellitus. Neurogenetics 2006; 7:259-63. [PMID: 16972080 DOI: 10.1007/s10048-006-0061-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [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: 04/23/2006] [Accepted: 08/10/2006] [Indexed: 11/25/2022]
Abstract
Two families are presented with a child suffering from microcephaly with a simplified gyral pattern of the brain (SGP) and early onset insulin dependent diabetes mellitus (IDDM). The first patient was diagnosed postmortally with Wolcott-Rallison syndrome, after her younger brother developed IDDM, and a homozygous mutation in the eukaryotic translation initiation factor 2-alpha kinase 3 was found. The younger brother did not undergo magnetic resonance imaging (MRI). The patient from the second family has no EIF2AK3 mutation. SGP is considered to arise from decreased neuronal proliferation or increased apoptosis at an early stage of embryonal development, but insight into the pathways involved is minimal. EIF2AK3 is involved in translation initiation. It has been proposed that loss of function mutations reduce the ability of the cell to respond to endoplasmic reticulum stress, resulting in apoptosis of pancreatic Langerhans cells. Our findings suggest that in some cases, early onset IDDM and SGP can arise from common mechanisms leading to increased apoptosis.
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Affiliation(s)
- M C Y de Wit
- Department of Pediatric Neurology, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, The Netherlands
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30
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Verbruggen SCAT, Catsman CE, Naghib S, Lequin MH, van Veen LN, Buysse CMP. [Respiratory insufficiency caused by acute disseminated encephalomyelitis in a child]. Ned Tijdschr Geneeskd 2006; 150:1134-8. [PMID: 16756227] [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: 05/10/2023]
Abstract
A 1.5-year-old boy presented with progressive ataxia and meningeal irritation after a period of general malaise and fever. He was eventually admitted to a paediatric intensive care unit for respiratory insufficiency. A diagnosis of acute disseminated encephalomyelitis (ADEM) with pontine involvement was made. The patient was mechanically ventilated and treated with immunoglobulins and corticosteroids, after which he recovered almost completely. ADEM is characterised by rapidly progressive demyelination of the central nervous system. The exact incidence and aetiology are unknown. The disorder is considered to be an autoimmune reaction, and current treatment is aimed at the suppression of this reaction. Despite the dramatic clinical and radiological presentation of ADEM, the prognosis is favourable in most cases.
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de Wit MCY, de Coo IFM, Verbeek E, Schot R, Schoonderwoerd GC, Duran M, de Klerk JBC, Huijmans JGM, Lequin MH, Verheijen FW, Mancini GMS. Brain abnormalities in a case of malonyl-CoA decarboxylase deficiency. Mol Genet Metab 2006; 87:102-6. [PMID: 16275149 DOI: 10.1016/j.ymgme.2005.09.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Revised: 09/08/2005] [Accepted: 09/09/2005] [Indexed: 11/22/2022]
Abstract
Malonyl-CoA decarboxylase (MCD) deficiency is an extremely rare inborn error of metabolism that presents with metabolic acidosis, hypoglycemia, and/or cardiomyopathy. Patients also show neurological signs and symptoms that have been infrequently reported. We describe a girl with MCD deficiency, whose brain MRI shows white matter abnormalities and additionally diffuse pachygyria and periventricular heterotopia, consistent with a malformation of cortical development. MLYCD-gene sequence analysis shows normal genomic sequence but no messenger product, suggesting an abnormality of transcription regulation. Our patient has strikingly low appetite, which is interesting in the light of the proposed role of malonyl-CoA in the regulation of feeding control, but this remains to be confirmed in other patients. Considering the incomplete understanding of the role of metabolic pathways in brain development, patients with MCD deficiency should be evaluated with brain MRI and unexplained malformations of cortical development should be reason for metabolic screening.
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Affiliation(s)
- M C Y de Wit
- Department of Child Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.
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32
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Kampman WA, Kros JM, De Jong THR, Lequin MH. Primitive neuroectodermal tumours (PNETs) located in the spinal canal; the relevance of classification as central or peripheral PNET. J Neurooncol 2005; 77:65-72. [PMID: 16292490 DOI: 10.1007/s11060-005-9006-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [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: 05/19/2005] [Indexed: 10/25/2022]
Abstract
Intraspinal location of central PNET (cPNET) is very rare. We present a case, critically review all publications of primary intraspinal cPNET occurrence and discuss tendencies in clinical presentation. In several previous attempts to summarise, authors often confused cPNET with peripheral PNET (pPNET). cPNET and pPNET are different entities with different immunohistochemical profiles and genetic backgrounds. Clinically, they are both aggressive tumours, but exhibit different characteristics in their local manifestation and metastatic spread. Survival rates are quite similar provided that treatment is applied according to the established protocols. Protocols in cPNET treatment differ from those for pPNET as regards the order of the treatment sub-modalities, specific chemotherapeutic regimen and intensity, radiation dose and its extent and consequently, the side effects. Therefore, failure to distinguish cPNET from pPNET leads to clinical guidance and treatment proposals based on false assumptions, which might effect outcomes. Often, distinguishing between cPNET and pPNET is easy, because they occur in different location. In the case of intraspinal tumour location, however, the differentiation is crucial because both primary cPNET and pPNET can occur intraspinally, even though this is rare. Nowadays, demonstrating the expression of MIC2 glycoprotein by immunocytochemical staining (CD99) showing the specific EWS-FLI1 chimeric gene presence in pPNET, offers an easy way of making a differential diagnosis between cPNET and pPNET.
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MESH Headings
- 12E7 Antigen
- Antigens, CD/metabolism
- Biomarkers, Tumor/metabolism
- Cell Adhesion Molecules/metabolism
- Child, Preschool
- Diagnosis, Differential
- Fatal Outcome
- Humans
- Male
- Neuroectodermal Tumors, Primitive/classification
- Neuroectodermal Tumors, Primitive/diagnosis
- Neuroectodermal Tumors, Primitive/metabolism
- Neuroectodermal Tumors, Primitive/therapy
- Neuroectodermal Tumors, Primitive, Peripheral/classification
- Neuroectodermal Tumors, Primitive, Peripheral/diagnosis
- Neuroectodermal Tumors, Primitive, Peripheral/metabolism
- Neuroectodermal Tumors, Primitive, Peripheral/surgery
- Oncogene Proteins, Fusion/metabolism
- Proto-Oncogene Protein c-fli-1/metabolism
- RNA-Binding Protein EWS
- Spinal Cord Neoplasms/classification
- Spinal Cord Neoplasms/diagnosis
- Spinal Cord Neoplasms/metabolism
- Spinal Cord Neoplasms/surgery
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Affiliation(s)
- W A Kampman
- Academic Hospital of the Vrije Universiteit Brussel (AZVUB), Brussels, Belgium.
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33
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Breedveld G, de Coo IF, Lequin MH, Arts WFM, Heutink P, Gould DB, John SWM, Oostra B, Mancini GMS. Novel mutations in three families confirm a major role of COL4A1 in hereditary porencephaly. J Med Genet 2005; 43:490-5. [PMID: 16107487 PMCID: PMC2593028 DOI: 10.1136/jmg.2005.035584] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Porencephaly (cystic cavities of the brain) is caused by perinatal vascular accidents from various causes. Several familial cases have been described and autosomal dominant inheritance linked to chromosome 13q has been suggested. COL4A1 is an essential component in basal membrane stability. Mouse mutants bearing an in-frame deletion of exon 40 of Col4a1 either die from haemorrhage in the perinatal period or have porencephaly in survivors. A report of inherited mutations in COL4A1 in two families has shown that familial porencephaly may have the same cause in humans. OBJECTIVE To describe three novel COL4A1 mutations. RESULTS The three mutations occurred in three unrelated Dutch families. There were two missense mutations of glycine residues predicted to result in abnormal collagen IV assembly, and one mutation predicted to abolish the traditional COL4A1 start codon. The last mutation was also present in an asymptomatic obligate carrier with white matter abnormalities on brain magnetic resonance imaging. CONCLUSIONS This observation confirms COL4A1 as a major locus for genetic predisposition to perinatal cerebral haemorrhage and porencephaly and suggests variable expression of COL4A1 mutations.
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Affiliation(s)
- G Breedveld
- Department of Clinical Genetics, Erasmus University Medical Centre, PO Box 1738, 3000 DR Rotterdam, Netherlands
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van der Sluijs JW, den Hollander JC, Lequin MH, Nijman RM, Robben SGF. Prenatal testicular torsion: Diagnosis and natural course. An ultrasonographic study. Clin Imaging 2004. [DOI: 10.1016/j.clinimag.2004.04.016] [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: 11/16/2022]
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de Jong PA, Nakano Y, Lequin MH, Mayo JR, Woods R, Paré PD, Tiddens HAWM. Progressive damage on high resolution computed tomography despite stable lung function in cystic fibrosis. Eur Respir J 2004; 23:93-7. [PMID: 14738238 DOI: 10.1183/09031936.03.00006603] [Citation(s) in RCA: 225] [Impact Index Per Article: 11.3] [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: 12/12/2022]
Abstract
For effective clinical management of cystic fibrosis (CF) lung disease it is important to closely monitor the start and progression of lung damage. The aim of this study was to investigate the ability of high-resolution computed tomography (HRCT) scoring systems and pulmonary function tests (PFT) to detect changes in lung disease. CF children (n=48) had two HRCT scans in combination with two PFT 2 yrs apart. Their scans were scored using five scoring systems (Castile, Brody, Helbich, Santamaria and Bhalla). "Sensitivity" was defined as the ability to detect disease progression. In this group of children, HRCT scores worsened. PFT remained unchanged or improved. Of the HRCT parameters, mucous plugging and the severity, extent and peripheral extension of bronchiectasis worsened significantly. Relationships between changes in HRCT scores and PFT were weak. Substantial structural lung damage was evident in some children who had normal lung function. These data show that high-resolution computed tomography is more sensitive than pulmonary function tests in the detection of early and progressive lung disease, and suggest that high-resolution computed tomography may be useful in the follow up of cystic fibrosis children and as an outcome measure in studies that aim to reduce lung damage.
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Affiliation(s)
- P A de Jong
- Dept of Paediatric Pulmonology, Sophia Children's Hospital, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
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36
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van Rijn RR, Grootfaam DS, Lequin MH, Boot AM, van Beek RD, Hop WCJ, van Kuijk C. Digital radiogrammetry of the hand in a pediatric and adolescent Dutch Caucasian population: normative data and measurements in children with inflammatory bowel disease and juvenile chronic arthritis. Calcif Tissue Int 2004; 74:342-50. [PMID: 15255071 DOI: 10.1007/s00223-003-0020-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [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: 10/26/2022]
Abstract
We have evaluated the applicability of a new Digital X-ray Radiogrammetry (DXR) system in a Dutch Caucasian pediatric population. For this study we enrolled 535 healthy participants who all signed an informed consent form. In addition, 20 children suffering from inflammatory bowel disease (IBD) and juvenile chronic arthritis (JCA) were enrolled. Radiographs of the left hand were obtained from all participants. From the healthy population a subset of children with a history of forearm fractures were separately analyzed. Measurements consisted of DXR (X-posure; Pronosco-Sectra, Linköping, Sweden). Five hundred thirty-five subjects were enrolled in the study. Twenty-two subjects (4.3%) were discontinued (age 3-10 years), all because of a nonrecognizable radiograph by the DXR system. The short-term coefficient of variation of DXR in this population was 0.59%. Significant differences in DXR-BMD between boys and girls for the ages of 11, 12, 16, 17, and 18 years were found. There were also significant differences in DXR-BMD between the sequential Tanner stages. For 88 subjects repeat radiographs were available (mean interval 1.8 years). In all cases an increase in DXR-BMD was seen. Girls with IBD, JCA, or a history of forearm fractures and boys with IBD showed a significantly lower DXR-BMD compared with healthy controls. We show that DXR is an applicable technique in children. Also, in a small subpopulation it is possible to discriminate children with a high risk of low BMD.
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Affiliation(s)
- R R van Rijn
- Department of Radiology, Academic Medical Centre/Emma Children's Hospital, Amsterdam, The Netherlands.
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Abstract
BACKGROUND/PURPOSE The aim of this study was to add to the experience of slide tracheoplasty in infants with congenital tracheal stenosis (CTS), to review the recent literature on this subject, and to evaluate the diagnostic workup in infants with CTS. METHODS A retrospective review of 3 infants with CTS treated with slide tracheoplasty was conducted at our institution. They all underwent bronchoscopy, tracheobronchography, and echocardiography. Therapy consisted of slide tracheoplasty and simultaneous correction of associated vascular malformations. RESULTS A pulmonary artery sling was missed initially on esophagography in 2 patients. Stridor became worse in 2 patients after tracheobronchography. After surgical therapy, 2 patients survived and were discharged 12 days after surgery. Both are without symptoms at follow-up of 12 and 20 months. One patient had inoperable restenosis and died 27 days after the operation. CONCLUSIONS Esophagography is not a reliable tool to depict associated vascular anomalies for patients with CTS. According to the literature, computer tomography has become more reliable to depict the tracheobronchial tree and is useful to elucidate associated vascular anomalies as well. Compared with other surgical techniques for infants with CTS reported in the literature, slide tracheoplasty has fewer postoperative complications and comparable survival rates.
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Affiliation(s)
- J P Koopman
- Department of Paediatric Otorhinolaryngology, Sophia Children's Hospital/Erasmus Medical Centre, Rotterdam, Netherlands
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Mancini GMS, de Coo IFM, Lequin MH, Arts WF. Hereditary porencephaly: clinical and MRI findings in two Dutch families. Eur J Paediatr Neurol 2004; 8:45-54. [PMID: 15023374 DOI: 10.1016/j.ejpn.2003.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2003] [Revised: 09/11/2003] [Accepted: 10/01/2003] [Indexed: 11/23/2022]
Abstract
Familial porencephaly is a rare disorder causing motor impairment, hemiplegia, mental retardation and epilepsy in variable degrees. Two families with porencephaly and apparently dominant inheritance are reported. Brain MRI findings are reviewed and described in seven affected individuals. Most patients also show white matter abnormalities in the cerebral hemisphere, also contralateral to the cystic lesion. In the first family an obligate carrier was identified who did not have a cystic lesion but clear abnormalities of the white matter. Although a predisposition for thrombophilia has previously been reported, we did not observe any genetic, environmental or epigenetic predisposition for the porencephaly. The lesions are most compatible with a deep venous thrombosis/ischemic event occurring in a late stage of pregnancy, not necessarily aggravated by perinatal asphyxia.
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Affiliation(s)
- G M S Mancini
- Department of Clinical Genetics, Erasmus University Medical Center, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
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39
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Abstract
Arterial stroke in a neonate caused by carotid artery dissection is rare. We report two cases, one with dissection at the level of the skull base, one just distal to the carotid bulb. Non-invasive techniques like MR angiography and sonography demonstrated the dissection accurately. MR imaging, especially the diffusion-weighted images, showed the extension and site of the cerebral infarction. In one case dissection could be suspected following vacuum and forceps extraction. In the other no obvious birth trauma was reported. In conclusion, in a neonate with clinical signs suggestive of cerebral infarction, dissection of the carotid artery should be considered.
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Affiliation(s)
- M H Lequin
- Department of Paediatric Radiology, Sophia Children's Hospital EMC Rotterdam, Dr Molewaterplein 60, 3015 Rotterdam, The Netherlands.
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40
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Abstract
Anatomical studies suggest that normal lungs grow by rapid alveolar addition until about 2 yrs of age followed by a gradual increase in alveolar dimensions. The aim of this study was to examine the hypothesis that normal lung growth can be monitored by computed tomography (CT). Therefore, the gas volume per gram of lung tissue was estimated from measurements of lung density obtained from CT scans performed on children throughout the growth period. CT scans were performed on 17 males and 18 females, ranging in age from 15 days-17.6 yrs. CT-measured lung weight was correlated with predicted post mortem values and CT measured gas volume with predicted values of functional residual capacity. The median value for lung expansion was 1.86 mL x g(-1) at 15 days, decreased to 0.79 mL x g(-1) by 2 yrs and then increased steadily to 5.07 mL x g(-1) at 17 yrs. Computed tomography scans can be used to estimate lung weight, gas volume and expansion of normal lungs during the growth period. The increase in the lung expansion after the age of 2 yrs suggests progressive alveolar expansion with increasing lung volume.
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Affiliation(s)
- P A de Jong
- Dept of Paediatric Pulmonology, Sophia Children's Hospital, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
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41
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van der Sluis IM, de Muinck Keizer-Schrama SMPF, Pols HAP, Lequin MH, Krenning EP, Uitterlinden AG. Collagen Ialpha1 polymorphism is associated with bone characteristics in Caucasian children and young adults. Calcif Tissue Int 2002; 71:393-9. [PMID: 12232678 DOI: 10.1007/s00223-001-2093-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2001] [Accepted: 03/29/2002] [Indexed: 10/27/2022]
Abstract
A large proportion of the variation in bone mass can be explained by genetic factors. We analyzed the G to T substitution in the Sp1 binding site in the first intron of the collagen type Ialpha1 (COLIA1) gene in relation to bone mass. The genotypes GG, GT, and TT were determined in 148 Caucasian children and young adults. We performed dual energy X-ray absorptiometry twice (mean follow-up time 4.4 years), and speed of sound (SOS) was assessed by tibial ultrasonometry at follow-up. Genotype distribution was 104 (70%) GG, 40 (27%) GT and 4 (3%) TT. Carriers of the T-allele had a 0.5 SDS (standard deviation score) decreased bone mineral content (BMC) of total body (P = 0.001), and a 0.4 SDS decreased bone mineral density (BMD) for both lumbar spine (P = 0.04) and total body (P = 0.05). The genotype effect on BMD and BMC decreased after adjustment for height or body mass index. When we calculated apparent BMD, these differences diminished to 0.1 SDS and were no longer significant. T-allele carriers had shorter stature (0.4 SDS; P = 0.04) and smaller bones (0.5 SDS lower width of the lumbar vertebral body; P = 0.01). The T-allele was also associated with lower SOS (P = 0.03), independent of BMD and BMC, and lower lean body mass. Similar associations were found at follow-up. The change in BMD and BMC SDS between the first and second measurement did not differ between the GG and GT&TT group. In conclusion, the COLIA1 polymorphism in children and young adults is associated with several bone characteristics. However, at least a part of the COLIA1 effect on bone mass may be related to differences in frame size.
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Affiliation(s)
- I M van der Sluis
- Department of Pediatrics, Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands.
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Robben SGF, Lequin MH. [Congenital adrenal hyperplasia: clinical aspects and neonatal screening]. Ned Tijdschr Geneeskd 2002; 146:783-4; author reply 784. [PMID: 11998362] [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: 02/24/2023]
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Abstract
We report a case of spinal epidural abscess presenting as abdominal pain. An 7-year-old boy presented with abdominal pain. He was operated on under suspicion of appendicitis. During operation, no abnormalities were found. Postoperatively, the abdominal pain did not subside. Subsequently, the boy developed neurological abnormalities. MRI showed a spinal epidural abscess. A laminectomy was performed and the boy was treated with antibiotics; he recovered well. This case showed that it is important to consider a spinal epidural abscess as a cause of abdominal pain with fever in children.
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Affiliation(s)
- E R Flikweert
- Department of Pediatric Surgery, Sophia Children's Hospital, University Hospital Rotterdam, The Netherlands
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Lequin MH, van der Shuis IM, Van Rijn RR, Hop WCJ, van ven Huevel-Eibrink MM, MuinckKeizer-Schrama SMPF, van Kuijk C. Bone mineral assessment with tibial ultrasonometry and dual-energy X-ray absorptiometry in long-term survivors of acute lymphoblastic leukemia in childhood. J Clin Densitom 2002; 5:167-73. [PMID: 12110760 DOI: 10.1385/jcd:5:2:167] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2001] [Revised: 07/13/2002] [Accepted: 07/31/2001] [Indexed: 11/11/2022]
Abstract
Acute lymphoblastic leukemia (ALL) in childhood is a serious disease that can affect growth and the attainment of maximal peak bone mass. The latter has recently been recognized as a risk factor for the development of osteoporosis later in life. To determine long-term effects of the disease itself and its treatment, we assessed the bone status of a group of long-term survivors of childhood ALL, all treated with high doses of steroids (dexamethasone) and methotrexate and without cranial irradiation. All 21 subjects enrolled in this cross-sectional study were diagnosed to have non-high-risk precursors acute lymphoblastic leukemia (12 boys and 9 girls, mean age 16.5 yr, range 12.2-25.4 yr). Standard deviation (SD) scores were calculated using a tibial ultrasound device and spinal dual-energy X-ray absorptiometry (DXA) device as bone assessment techniques. SD scores of those two different bone assessment techniques were compared. The mean SOS (speed of sound) SD scores (SDS) of the tibia (mean 0.26, standard deviation [sd] 1.00) were not significantly different from our reference value of 0. There was no significant difference between the SOS SDS in boys and girls. With DXA, no significant difference was seen between the mean BMD SDS and the reference data and no significant difference in BMD between boys and girls was found. The individual mean SDS for bone mineral density (BMD) of lumbar spine are 0.24 (sd 1.02), total body 0.17 (sd 1.00), and apparent BMD (BMAD) 0.07 (sd 1.09). Spearman's correlation between mean SOS SDS and mean BMD of lumbar spine was 0.47, mean SOS SDS and mean BMAD SDS was 0.43, and mean SOS SDS and mean BMD of total body was 0.49. These correlations were significant at the 0.05 level (two tailed). Despite high-dose dexamethasone and methotrexate used for treatment of these children with ALL, no long-term side effects on the bone mineral status of the subjects, measured with DXA or tibial ultrasonometry, could be determined.
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Affiliation(s)
- M H Lequin
- Department of Pediatric Radiology, Sophia Children's Hospital, Rotterdam, The Netherlands.
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van Rijn RR, Lequin MH, Robben SG, Hop WC, van Kuijk C. Is the Greulich and Pyle atlas still valid for Dutch Caucasian children today? Pediatr Radiol 2001; 31:748-52. [PMID: 11685448 DOI: 10.1007/s002470100531] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2000] [Accepted: 03/06/2001] [Indexed: 10/27/2022]
Abstract
BACKGROUND In our Paediatric Radiology Department, the Greulich and Pyle technique is used to assess skeletal age. Several authors have raised questions with regard to the applicability of this technique in a contemporary paediatric and adolescent population. OBJECTIVE To compare skeletal age and calendar age in a healthy Dutch Caucasian population in order to test the applicability in this specific population. MATERIALS AND METHODS For this study we enrolled 278 Dutch Caucasian boys (age range 5.0-19.5 years, mean 12.6 years) and 294 Dutch Caucasian girls (age range 5.2-19.9 years, mean 12.2 years). Radiographs of the left hand were scored according to the Greulich and Pyle atlas by two investigators. RESULTS Intra-observer coefficient of variation of duplicate assessment of skeletal age for investigator 1 (resident) was 2.4 % and for investigator 2 (radiologist) was 1.5 %. We found no significant systematic differences between the two observers regarding variability and levels of measurement, and the agreement was good. There was a strongly significant correlation between skeletal and calendar age rgirls = 0.974 and rboys = 0.979 (P < 0.001). On average, calendar age preceded skeletal age by a small amount (1.7 months in girls and 3.3 months in boys, both P < 0.001). CONCLUSIONS The reliability of the Greulich and Pyle atlas in our study corresponds well with previously reported studies. Based on our data, we conclude that the Greulich and Pyle atlas is still applicable in Dutch Caucasian children and adolescents.
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Affiliation(s)
- R R van Rijn
- Department of Radiology, Suite D 206, University Hospital Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
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Lequin MH, van Rijn RR, Robben SG, van Leeuwen WJ, Hop WC, van Kuijk C. Quantitative tibial ultrasonometry versus radiographic phalangeal absorptiometry in a Caucasian pediatric population. Calcif Tissue Int 2001; 68:323-9. [PMID: 11685418 DOI: 10.1007/s002230020002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2000] [Accepted: 01/08/2001] [Indexed: 10/26/2022]
Abstract
There is a need for a reliable bone assessment technique in children. In this study, we compare an existing technique used in children, radiographic absorptiometry (RA), with a relatively novel technique, quantitative tibial ultrasonometry (QUS). In a prospective cohort study, we enrolled 290 girls (mean age 12.7 years) and 273 boys (mean age 12.4 years). Radiographs of the left hand and the left index finger were taken with an aluminium reference wedge within the field of exposure. Radiographic absorptiometry on the second middle phalanx at the mid-level (BMD50%) and proximal quarter (BMD25%) was performed with interactive software. Tibial QUS was performed using the SoundScan Compact. Multiple regression analysis showed that SOS correlated significantly with BMD25% for both boys (r = 0.65, P < 0.001) and girls (r = 0.59, P < 0.001), taking into account age and gender. The same applied for the correlation between speed of sound (SOS) and BMD50% in boys (r = 0.62, P < 0.001) and girls (r = 0.67, P < 0.001). Cubic regression between calendar age and BMD25% showed the best fit for both boys (r2 = 0.60) and girls (r2 = 0.60). For BMD50% a difference in regression was found between boys and girls. Quadratic regression gave a satisfactory fit for boys (r2 = 0.61 ) whereas for girls, a cubic relation was best (r2 = 0.59). Overall, there was a significant correlation between BMD25% and BMD50% for boys r = 0.89 and for girls r = 0.91 (both P < 0.001). Our data show a significant correlation between two different bone assessment techniques. In addition, these data suggest that both tibial ultrasonometry and RA are useful techniques in children.
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Affiliation(s)
- M H Lequin
- Department of Pediatric Radiology, Sophia Children's Hospital, Erasmus University, Rotterdam, The Netherlands
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Lequin MH, Hop WC, van Rijn RR, Bukkems MC, Verhaak LL, Robben SG, Van Kuijk C. Comparison between quantitative calcaneal and tibial ultrasound in a Dutch Caucasian pediatric and adolescent population. J Clin Densitom 2001; 4:137-46. [PMID: 11477307 DOI: 10.1385/jcd:4:2:137] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2000] [Revised: 10/15/2000] [Accepted: 11/03/2000] [Indexed: 11/11/2022]
Abstract
In the field of bone densitometry, attention has recently been focused on the pediatric population. Quantitative ultrasound (QUS) as bone assessment technique has many advantages for children in comparison with bone assessment techniques that use ionizing radiation. In this pilot study, we investigated the use of calcaneal and tibial QUS systems in a healthy Caucasian pediatric population. We studied 120 healthy Caucasian Dutch children between ages 7 and 19 yr: 53 boys (mean age of 12.5 yr, range 4.5-18) and 67 girls (mean age of 13.5 yr; range 7.1-19). We recruited children from a large population who previously had participated in a bone assessment study performed at our hospital. Two operators performed calcaneal QUS of the right calcaneus and tibial QUS of the right tibia. The correlation between calcaneal and tibial ultrasound was modest but significant (r = 0.29; p < 0.01). Using the calcaneal device, we found in girls a weak positive correlation between skeletal age and speed of sound (SOS) (r = 0.38), broadband ultrasound attenuation (r = 0.57), and quantitative ultrasound index (r = 0.46), all with a value of p < 0.01. For boys all parameters failed to reach significance. Using the tibial device, we found a good correlation between skeletal age and SOS in girls (r = 0.76) and modest correlation in boys (r = 0.50), both with a value of p < 0.01. This is one of the first studies to present a comparison between two ultrasound techniques in children. At present we feel that, in light of the poor correlation with skeletal age, calcaneal ultrasound has yet to prove its efficacy in children. Tibial ultrasound seems to be a good bone assessment technique in children.
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Affiliation(s)
- M H Lequin
- Department of Radiology, University Children's Hospital Sophia Rotterdam, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands.
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Verwest AM, Poelman M, Dinjens WN, Batstra MR, Oostra BA, Lequin MH, Larsson LI, Aanstoot HJ, Bruining GJ, de Krijger RR. Absence of a PDX-1 mutation and normal gastroduodenal immunohistology in a child with pancreatic agenesis. Virchows Arch 2000; 437:680-4. [PMID: 11193482 DOI: 10.1007/s004280000305] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pancreatic agenesis is a rare condition, of which only a limited number of cases have been described. One recent paper reported a homozygous mutation in the pancreatic duodenal homeobox gene 1 (PDX-1) in a child with pancreatic agenesis. We report a 6-year-old boy with pancreatic agenesis, treated medically, without abnormalities in the PDX-1 gene coding sequence and with normal gastroduodenal endocrine cell distribution. Genes other than PDX-1 also appear to be involved in human pancreatic agenesis.
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Affiliation(s)
- A M Verwest
- Department of Pediatrics, Erasmus University and University Hospital/Sophia Childrens' Hospital Rotterdam, The Netherlands
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van Rijn RR, van der Sluis IM, Lequin MH, Robben SG, de Muinck Keizer-Schrama SM, Hop WC, van Kuijk C. Tibial quantitative ultrasound versus whole-body and lumbar spine DXA in a Dutch pediatric and adolescent population. Invest Radiol 2000; 35:548-52. [PMID: 10981999 DOI: 10.1097/00004424-200009000-00005] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES To understand normal bone development, studies in healthy children and adolescents are important. To assess the applicability of tibial quantitative ultrasound measurements (QUS) in children, we performed a study that compared dual-energy x-ray absorptiometry (DXA) of the lumbar spine and whole body with tibial QUS. METHODS For this study we recruited 146 Dutch children and adolescents, 58 boys (median age, 14.1 years; range, 7.6-23.4 years) and 88 girls (median age, 18.0 years; range, 7.6-23.5 years). Tanner stage, weight, and height were assessed for all participants. Bone mineral density (BMD; g x cm(-2)) of the whole body and lumbar spine (L2-L4) and bone mineral apparent density (BMAD) of the lumbar spine (g x cm(-3)) were assessed by using the Lunar DPXL. For tibial QUS, the Soundscan compact system was used. RESULTS Both lumbar as well as whole-body BMD showed a strong, significant correlation with tibial QUS in boys and girls: rtotal body boys = 0.81, rtotal body girls = 0.77, rlumbar spine boys = 0.79, and rlumbar spine girls = 0.72. Lumbar spine BMAD also showed significant correlations with tibial QUS: rboys= 0.63 and rgirls = 0.63 (for all correlations, P < 0.001). CONCLUSIONS Our study showing strong, significant correlations between DXA and tibial QUS measurements suggests that tibial QUS is a technique that may be applicable in children and adolescents.
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Affiliation(s)
- R R van Rijn
- Department of Radiology, University Hospital Rotterdam, The Netherlands.
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Nosir YF, Vletter WB, Kasprzak JD, Boersma E, Lequin MH, Elhendy AA, Yao J, Stoker J, Ten Cate FJ, Roelandt JR. Optimal rotational interval for 3-dimensional echocardiography data acquisition for rapid and accurate measurement of left ventricular function. J Am Soc Echocardiogr 2000; 13:715-22. [PMID: 10936814 DOI: 10.1067/mje.2000.104899] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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: 11/22/2022]
Abstract
BACKGROUND Prolonged 3-dimensional echocardiography (3DE) acquisition time currently limits its routine use for calculating left ventricular volume (LVV) and ejection fraction (EF). Our goal was to reduce the acquisition time by defining the largest rotational acquisition interval that still allows 3DE reconstruction for accurate and reproducible LVV and EF calculation. METHODS Twenty-one subjects underwent magnetic resonance imaging and precordial 3DE with 2 degrees acquisition intervals. Images were processed to result in data sets containing images at 2 degrees, 4 degrees, 8 degrees, 16 degrees, 32 degrees, and 64 degrees intervals by excluding images in between. With use of the paraplane feature, 8 equidistant short-axis slices were generated from each data set. The suitability of these short-axis slices for manual endocardial tracing was scored visually by 4 independent experienced observers. The LVV and EF were calculated by using Simpson's rule from 3DE data sets with 2 degrees, 8 degrees, and 16 degrees intervals, and the results were compared with values obtained from magnetic resonance imaging. The probability of 3DE to detect LVV and EF differences was calculated. RESULTS All patients were in sinus rhythm with a mean heart rate of 72 bpm (SD + or - 12). The LV short-axis images obtained with 16 degrees rotational scanning intervals allowed LV endocardial tracing in all subjects. Good correlation, close limits of agreement, and nonsignificant differences were found between values of LVV and EF calculated with 3DE at 2 degrees, 8 degrees, and 16 degrees rotational intervals and those obtained with magnetic resonance imaging. At steps of 16 degrees, 3DE had excellent correlation (r = 98, 99, and 99), close limits of agreement (+ or - 38, + or - 28.6, and + or - 4.8), and nonsignificant differences (P =.5,.8, and.2) with values obtained from magnetic resonance imaging for calculating end-diastolic LVV, end-systolic LVV, and EF, respectively. Three-dimensional echocardiography with use of 16 degrees rotational intervals could detect 15-mL differences in end-diastolic volume with a probability of 95%, 11-mL differences in end-systolic volume with a probability of 92%, and 0.02 differences in EF with a probability of 95%. CONCLUSIONS The 3DE data sets reconstructed with images selected at 16 degrees intervals from data sets obtained at 2 degrees precordial rotational acquisition intervals allowed the generation of LV short-axis images with adequate quality for endocardial border tracing. Therefore precordial acquisition at 16 degrees intervals would be sufficient for the reconstruction of 3DE data sets for LV function measurement. This would reduce the acquisition time while maintaining enough accuracy for clinical decision making and would thus make 3DE more practical as a routine method.
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Affiliation(s)
- Y F Nosir
- Thoraxcenter, Rotterdam, The Netherlands
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