Mohamed Abdolell

Selecting and Assessing Quantitative Early Ultrasound Texture Measures for Their Association With Cerebral Palsy

Cerebral palsy (CP) develops as a consequence of white matter damage (WMD) in approximately one out of every 10 very preterm infants. Ultrasound (US) is widely used to screen for a variety of brain injuries in this patient population, but early US often fails to detect WMD. We hypothesized that quantitative texture measures on US images obtained within one week of birth are associated with the subsequent development of CP. In this retrospective study, using images from a variety of US machines, we extracted unique texture measures by means of adaptive processing and high resolution feature enhancement. We did not standardize the images, but used patients as their own controls. We did not remove speckle, as it may contain information. To test our hypothesis, we used the ldquorandom forestrdquo algorithm to create a model. The random forest classifier achieved a 72% match to the health outcome of the patients (CP versus no CP), whereas designating all patients as having CP would have resulted in 53% error. This suggests that quantitative early texture measures contain diagnostic information relevant to the development of CP.

Abnormal antenatal sonogram: an indicator of disease severity in children with posterior urethral valves.

Purpose To review the association of an abnormal prenatal sonogram with most recent serum creatinine in patients with proven posterior urethral valves (PUV). Methods Since 1992, all live-born patients between 1992–2004 with clinically proven PUV, with postnatally proven PUV, from 2 pediatric tertiary care centers, were reviewed for age at diagnosis, most recent serum creatinine, presence of chronic renal failure (CRF) (serum creatinine >2 standard deviations above normal for age), or end stage renal disease (dialysis or transplant). Available antenatal reports from the 2 centres and surrounding community hospitals were reviewed for gestational age (GA) at the time of ultrasound, volume of amniotic fluid, and urinary-tract abnormality. Results Thirty-four patients with proven PUV and prenatal sonograms were identified (1992–2004). Eighteen patients had abnormalities on their prenatal sonogram, with poor outcome in 5 (mean follow-up, 8 years [1–13 y]). No specific features were identified on prenatal sonogram. Sixteen patients had normal prenatal sonograms, with poor outcomes in 2 (mean follow-up, 8 years [3–13y]). There is an increased risk of an abnormal serum creatinine among those patients with an abnormal prenatal study, odds ratio (OR) 2.6 (95% confidence interval, 0.35–32). Conclusions PUV represents a spectrum of disease severity. A normal prenatal ultrasound does not preclude PUV. The majority of patients with a normal prenatal examination have good outcomes. The OR suggests that there may be increased risk for poor outcome in those with an abnormal prenatal examination. A multicenter study is necessary to obtain a larger sample size and more precise ORs.

Secular pattern of aneurismal rupture with the lunar cycle and season.

Background The lunar cycle and seasons may be associated with rates of rupture of intracranial aneurysms, but the literature is mixed. Studies of the association between the lunar cycle and rates of aneurysm rupture used the eight qualitative moon phases. The purpose of this study was to assess any association of aneurysm rupture with the lunar cycle and with the season. Materials and methods We retrospectively reviewed all cases of subarachnoid haemorrhage secondary to ruptured intracranial aneurysm treated with endovascular coiling in our institution over a 10-year period. We included only cases with a known rupture date. We used the degree of illumination of the moon to quantitatively code the lunar cycle. Results A total of 212 cases were included in our analyses. The odds of aneurysm rupture were significantly greater (p < 0.001) when the moon was least (new moon) and most (full moon) illuminated, as compared to the middle of the lunar cycle. The odds of rupture tended to be higher (p = 0.059) in the summer, compared to autumn. Conclusions The odds of aneurysm rupture were greater when the moon was least illuminated (new moon) and most illuminated (full moon), compared to the middle of the lunar cycle.