Conor Bogue

A method to establish the relationship between chronological age and stage of union from radiographic assessment of epiphyseal fusion at the knee: an Irish population study

Characteristic changes during epiphyseal union provide a skeletal age, which when compared with age‐based standards provides an estimation of chronological age. Currently there are no data on epiphyseal union for the purposes of age estimation specific to an Irish population. This cross‐sectional study aims to investigate the relationship between stage of epiphyseal union at the knee joint and chronological age in a modern Irish population. A novel radiographic method that sub‐divides the continuum of development into five specific stages of union is presented. Anteroposterior and lateral knee radiographs of 148 males and 86 females, aged 9–19 years, were examined. Fusion was scored as Stage 0, non‐union; Stage 1, beginning union; Stage 2, active union; Stage 3, recent union; or Stage 4, complete union. Stage of epiphyseal union is correlated with chronological age in both males and females. Mean age gradually increases with each stage of union and also varies between male and female subjects. A statistically significant difference in mean age was recorded between stages when compared to the previous stage, for the three epiphyses. Irish children are comparable to those from previously published studies with epiphyseal union in females occurring earlier than males. A significant difference was noted between the mean age of union for males and females for each of Stages 1 and 2 for the femur and Stages 0, 1, 2 and 3 for the tibia and the fibula. The results also suggest that the stages of union occur at earlier ages in this Irish population. Implementation of standardized methodology is necessary to investigate if this is due to a secular or population variation in maturation or to a methodology which clearly identifies five stages of union.

Early postnatal EEG features of perinatal arterial ischaemic stroke with seizures.

Background Stroke is the second most common cause of seizures in term neonates and is associated with abnormal long-term neurodevelopmental outcome in some cases. Objective To aid diagnosis earlier in the postnatal period, our aim was to describe the characteristic EEG patterns in term neonates with perinatal arterial ischaemic stroke (PAIS) seizures. Design Retrospective observational study. Patients Neonates >37 weeks born between 2003 and 2011 in two hospitals. Method Continuous multichannel video-EEG was used to analyze the background patterns and characteristics of seizures. Each EEG was assessed for continuity, symmetry, characteristic features and sleep cycling; morphology of electrographic seizures was also examined. Each seizure was categorized as electrographic-only or electroclinical; the percentage of seizure events for each seizure type was also summarized. Results Nine neonates with PAIS seizures and EEG monitoring were identified. While EEG continuity was present in all cases, the background pattern showed suppression over the infarcted side; this was quite marked (>50% amplitude reduction) when the lesion was large. Characteristic unilateral bursts of theta activity with sharp or spike waves intermixed were seen in all cases. Sleep cycling was generally present but was more disturbed over the infarcted side. Seizures demonstrated a characteristic pattern; focal sharp waves/spike-polyspikes were seen at frequency of 1–2 Hz and phase reversal over the central region was common. Electrographic-only seizure events were more frequent compared to electroclinical seizure events (78 vs 22%). Conclusions Focal electrographic and electroclinical seizures with ipsilateral suppression of the background activity and focal sharp waves are strong indicators of PAIS. Approximately 80% of seizure events were the result of clinically unsuspected seizures in neonates with PAIS. Prolonged and continuous multichannel video-EEG monitoring is advocated for adequate seizure surveillance.

Early continuous video electroencephalography in neonatal stroke.

Perinatal stroke is the second most common cause of neonatal seizures, and can result in long‐term neurological impairment. Diagnosis is often delayed until after seizure onset, owing to the subtle nature of associated signs. We report the early electroencephalographic (EEG) findings in a female infant with a perinatal infarction, born at 41u2003weeks 2u2003days and weighing 3.42kg. Before the onset of seizures, the EEG from 3u2003hours after delivery demonstrated occasional focal sharp waves over the affected region. After electroclinical seizures, focal sharp waves became more frequent, complex, and of higher amplitude, particularly in ‘quiet sleep’. In ‘active sleep’, sharp waves often disappeared. Diffusion‐weighted imaging confirmed the infarct, demonstrating left frontal and parietal diffusion restriction. At 9u2003months, the infant has had no further seizures, and neurological examination is normal. To our knowledge, this report is the first to describe the EEG findings in perinatal stroke before seizures, and highlights the evolution of characteristic background EEG features.

Age prediction formulae from radiographic assessment of skeletal maturation at the knee in an Irish population

Age estimation in living subjects is primarily achieved through assessment of a hand-wrist radiograph and comparison with a standard reference atlas. Recently, maturation of other regions of the skeleton has also been assessed in an attempt to refine the age estimates. The current study presents a method to predict bone age directly from the knee in a modern Irish sample. Ten maturity indicators (A-J) at the knee were examined from radiographs of 221 subjects (137 males; 84 females). Each indicator was assigned a maturity score. Scores for indicators A-G, H-J and A-J, respectively, were totalled to provide a cumulative maturity score for change in morphology of the epiphyses (AG), epiphyseal union (HJ) and the combination of both (AJ). Linear regression equations to predict age from the maturity scores (AG, HJ, AJ) were constructed for males and females. For males, equation-AJ demonstrated the greatest predictive capability (R(2)=0.775) while for females equation-HJ had the strongest capacity for prediction (R(2)=0.815). When equation-AJ for males and equation-HJ for females were applied to the current sample, the predicted age of 90% of subjects was within ±1.5 years of actual age for male subjects and within +2.0 to -1.9 years of actual age for female subjects. The regression formulae and associated charts represent the most contemporary method of age prediction currently available for an Irish population, and provide a further technique which can contribute to a multifactorial approach to age estimation in non-adults.

Comparison of single CT scan assessment of bone mineral density, vascular calcification and fat mass with standard clinical measurements in renal transplant subjects: the ABC HeART study

BackgroundDespite limitations of routine methods, Clinical Practice Guidelines support the assessment of bone mineral density (BMD) and vascular calcification in renal transplant recipients. Changes in fat mass also occur post-transplantation, although they are traditionally difficult to measure accurately. We report the feasibility, convenience and accuracy of measuring the above 3 parameters using a novel CT protocol.MethodsWe conducted a cross-sectional study of 64 first renal allograft recipients (eGFRu2009>u200930xa0ml/min/1.73xa0m2). Quantitative CT (QCT) BMD analysis was conducted using CT lumbar spine (GE Medical Systems Lightspeed VCT & Mindways QCT Pro Bone Mineral Densitometry System Version 4.2.3) to calculate spinal volumetric BMD and compared with standard DXA calculated areal BMD at the spine, hip and distal forearm. Abdominal aortic calcification was assessed by semi-quantitative Aortic Calcification Index (ACI) method and compared with lateral lumbar x-ray Kappuila score and pulse wave velocity (PWV). Visceral and subcutaneous adipose tissue volume (Osirix 16 Ver 3.7.1) was compared with BMI.ResultsParticipants were 61xa0% male, had a mean age of 47xa0years, median ESKD duration of 5.4xa0years and a mean eGFR of 54xa0ml/min. iDXA median T-score at proximal femur was −1.2 and at lumbar spine was −0.2. Median QCT Trabecular T-score at lumbar spine was −1.2. The percent of subjects with a T-score of <2.5 by site and method was DXA Proximal Femur: 7xa0%, DXA distal radius: 17xa0%, DXA spine: 9xa0%, QCT (American College of Radiology cutoffs): 9xa0%. CT derived ACI correlated with PWV (ru2009=u20090.29, pu2009=u20090.02), pulse wave pressure (ru2009=u20090.51, pu2009<u20090.001), QCT Trabecular (−0.31, pu2009=u20090.01) and cortical volumetric BMD and history of cardiovascular events (Mann–Whitney U, pu2009=u20090.02). Both visceral and subcutaneous adipose tissue correlated with BMI (ru2009=u20090.63 & 0.64, pu2009<u20090.001).ConclusionsSingle CT scan triple assessment of BMD, vascular calcification and body composition is an efficient, accurate and convenient method of risk factor monitoring post renal transplantation.

Bilateral inferior vena cava filter insertion in a patient with duplication of the infrarenal vena cava

BackgroundInferior vena cava (IVC) filter insertion is a commonly performed procedure for indications such as recurrent pulmonary emboli or contraindication to anticoagulation. Symptomatic duplication of the IVC is exceedingly rare with only a handful of cases being described in the literature.AimWe report an unusual case of a patient with symptomatic duplication of the IVC.ResultA 53-year-old woman presented at our hospital for resection of a cerebral metastasis from a non-small cell lung cancer following a recent diagnosis of bilateral lower limb deep venous thrombosis. This required perioperative reversal of anticoagulation and IVC filter insertion. Conventional venography performed during filter insertion documented the existence of a duplicated IVC.ConclusionWe present a case of a symptomatic duplication of the IVC requiring filter insertion. We review the developmental anatomy of the IVC along with the diagnostic findings and management strategies available.

C-reactive protein and radiographic findings of lower respiratory tract infection in infants

AIM To evaluate the association between C-reactive protein (CRP) and radiological evidence of lower respiratory tract infection (LRTI) in infants. METHODS All patients aged less than 4 years who presented with suspected lower respiratory tract infection, who received a peri-presentation chest radiograph and CRP blood measurement over an 18-mo period were included in the study. Age, gender, source of referral, CRP, white cell count, neutrophil count along with the patients’ symptoms and radiologist’s report were recorded. RESULTS Three hundred and eleven patients met the inclusion criteria. Abnormal chest radiographs were more common in patients with elevated CRP levels (P < 0.01). Radiologic signs of LRTI were identified in 73.7% of chest radiographs when a patient had a CRP level between 50-99 mg/L. CRP levels were a better predictor of positive chest radiograph findings for those aged greater than I year compared to those 1 year or less. CONCLUSION CRP may be used in patients with suspected LRTI diagnosis to select those who are likely to have positive findings on chest radiograph, thus reducing unnecessary chest radiographs.

G375(P) Automated neonatal brain volumetric analysis in down syndrome

Aims Adults and children with Down syndrome (DS) have reduced total and regional brain volumes. No published studies describe brain volumes of neonates with DS. This study aims to analyse brain volumes in neonates with DS using a fully automatic brain tissue segmentation algorithm. Methodology Neonates with DS and healthy term controls underwent MRI. Coronal T2 scans were acquired in a 1.5T scanner. Total brain tissue (TBT) was divided into cortical grey matter, white matter, deep nuclear grey matter, brainstem and cerebellum. TBT, in addition to ventricles and extra-axial cerebrospinal fluid, formed total intra-cranial volume (TICV). Two observers annotated all seven tissues types in three slices per scan. An automatic algorithm, using supervised learning was developed to segment all tissues in every slice. Thus, tissue types on each T2 scan were identified and volumes calculated. Results Thirty neonates (20 DS, 10 controls) were recruited. Median birth gestation (weeks), birthweight (g) and head circumference (cm) in DS were 38+3, 3006 and 34.0, vs. Control infants 39+1 3340 and 34.9. The automated segmentations were compared with the observers’ annotations using Dice-coefficient (DC). The mean (SD) DC across tissues was 0.86 (0.06). Between the two observers this was 0.81 (0.06). Individual tissue volumes were calculated as a percentage of TICV (to adjust for head circumference). In DS infants, ventricular volumes as a percentage of TICV were significantly larger p = . 00001 and cerebellar volumes were significantly smaller p value. 03. TBT as a percentage of TICV was also significantly smaller in the DS group (p = 0.02). Results for all tissues are represented in Figure 1. Conclusion This study has demonstrated that there are structural differences in the brain of Down syndrome infants, which are present at birth. In particular the ventricles are larger, the cerebellum is smaller and the total brain volume is smaller. This suggests that early brain development in DS is altered, and the differences observed in adulthood develop in utero as opposed to being the result of degeneration later in adult life.Abstract G375(P) Figure 1 Tissue volumes (expressed as % of TICV) for DS and control groups

Global suppression of electrocortical activity in unilateral perinatal thalamic stroke

We present an unusual case of persistent generalized electroencephalography (EEG) suppression and right‐sided clonic seizures in a male infant born at 40+2 weeks gestation, birthweight 3240g, with an isolated unilateral thalamic stroke. The EEG at 13 hours after birth showed a generalized very low amplitude background pattern, which progressed to frequent electrographic seizures over the left hemisphere. The interictal background EEG pattern remained grossly abnormal over the next 48 hours, showing very low background amplitudes (<10μV). Magnetic resonance imaging revealed an isolated acute left‐sided thalamic infarction. This is the first description of severe global EEG suppression caused by an isolated unilateral thalamic stroke and supports the role of the thalamus as the control centre for cortical electrical activity.