The value of MRI anterior cartilaginous acetabulum-head-index to evaluate hip function after treatment of developmental dysplasia of the hip / 中华放射学杂志

Objective:To evaluate the feasibility of high resolution MRI for the measurement of anterior cartilaginous acetabulum-head-index (A-CAHI) and the value of A-CAHI for predicting hip clinical function after treatment in developmental dysplasia of the hip (DDH).Methods:The imaging data of 92 hips from 61 children with treated DDH were retrospectively reviewed in Shandong Medical Imaging Research Institute from January 2019 to January 2020. All children underwent conservative treatments or surgical interventions 3 years ago. Hip function after treatment was evaluated clinically based on the modified MacKay criteria. The hips were divided into satisfactory clinical function group (McKay rating excellent or good, n=46) and unsatisfactory group (McKay rating fair or poor, n=46). All patients were imaged with conventional MRI, high resolution fat suppressed proton density weighted image (FS-PDWI) of the unilateral hip joint in oblique sagittal view, and anteroposterior hip radiographs. A-CAHI and lateral cartilaginous acetabulum-head-index (L-CAHI) were measured respectively on high-resolution oblique sagittal PDWI and conventional coronal T 1WI. Acetabulum head index (AHI) was also measured on anteroposterior hip radiograph. Mann-Whitney U test or independent-samples t test was used to compare the difference of A-CAHI, L-CAHI and AHI between satisfactory and unsatisfactory clinical function groups. The diagnostic value using A-CAHI, L-CAHI, AHI, or A-CAHI combined with L-CAHI for unsatisfactory clinical function were investigated by the ROC curve. The area under the curve (AUC) and the Z statistic were used to compare diagnostic performance. Results:The values of A-CAHI, L-CAHI and AHI were significantly higher in satisfactory clinical function group compared with the unsatisfactory group ( Z=-7.746, -7.735, t=-7.199, all P<0.001).A-CAHI combined with L-CAHI had the significant highest diagnostic accuracy compared with A-CAHI, L-CAHI and AHI (AUC were 0.994, 0.969, 0.968, 0.861, respectively), with significant differences ( Z=1.975, 2.006, 3.553, P=0.048, 0.051,<0.001). The sensitivity and specificity of A-CAHI combined with L-CAHI for the diagnosis of prognosis were 95.7% and 97.8%, respectively. Conclusions:A-CAHI measured by high resolution MRI was found to have the highest diagnostic accuracy for prediction of hip clinical function in the treated DDH, and combined with L-CAHI can improve the diagnostic accuracy significantly.

Cephalometry to determine the head index of children younger than 6 years in kindergartens at the Ministry of higher education in Kabul, Afghanistan

Background: A part of the anthropometry that measures and studies the dimensions of the head and the faces is called cephalometric, the results of which are used in various medical branches. The standard of this measurement is different in each country because different racial factors and geographic impact on it, so the values obtained by researchers in other countries cannot be a criterion for determining the normal growth of head in other countries. The aim of this study was to determine the head standard index and the prevalence of head anatomic types in children younger than 6 years old in Kabul ministry of higher education Kindergartens in order to determine the head standard index in 2018.Methods: This descriptive study was conducted for all male and female children less than 6 years old at the ministry of higher education in Kabul, which had no specific physical and mental problems in 2018. The measurements of the length and width of the head were measured by the Martin Calliper Cephalometry, and according to the protocol, the head index and the prevalence of different phenotypes was determined.Results: Based on the present study, it was found that most of the male and female head are in the form of brachicephalic with a total percentage of 56.82%, as well as 31.81% of the heads hyper brachicephalic and 9.09% of the mesosafalic head and the lowest number of heads the were dolgossific species with a total percentage of 2.28%. Also, the study of the head index based on age showed that in less than one-year olds, the heads were most the type of hyper brachicephalic and in other age groups, the head index was lower and the brachicephalic.Conclusions: The results of this study indicate that the dominant phenotypes in children under the age of six years in kindergartens at the ministry of higher education in Kabul are of brachicephalic in both males and females.

Hernia diafragmática congénita: marcadores sonográficos prenatales y pronóstico perinatal

Antecedentes: La hernia diafragmática congénita es una malformación congénita que afecta a 1 de cada 2 200 recién nacidos. Está asociada a elevada morbimortalidad, principalmente por hipoplasia pulmonar e hipertensión. En la última década la medicina perinatal ha concentrado su interés en la investigación de marcadores prenatales para evaluar la gravedad de la hipoplasia pulmonar, principalmente la relación pulmón cabeza (RPC; LHR, por sus siglas en inglés). Objetivos: Evaluar la RPC y la presencia de hígado en saco herniario en el tórax como predictores de resultados perinatales adversos en fetos con hernia diafragmática aislada. Diseño: Estudio retrospectivo, observacional, analítico, correlacional. Institución: Unidad de Vigilancia Fetal, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Perú. Participantes: Gestantes y sus fetos. Intervenciones: Se evaluó todos los casos de pacientes con diagnóstico de hernia diafragmática congénita de sus fetos, entre enero 2005 y diciembre 2011, y que contaran con medición ecográfica del índice pulmón-cabeza (RPC). En caso la paciente tuviera más de una medición del RPC, se consideró la medida tomada con menor edad gestacional. Se precisó la posición del hígado respecto al tórax fetal y si existía o no herniación del hígado en el tórax. En todos los casos, y con consentimiento, se realizó un estudio anatómico detallado y cariotipo fetal. Se consideró la variable supervivencia neonatal a los tres meses de edad y la relación entre la RPC y la presencia del hígado en el tórax fetal con respecto a la supervivencia neonatal. Basado en estudios previos, las pacientes fueron estratificados en dos grupos, en función del valor de la RPC: menor de 1,2 y más de 1,2. Se evaluó las diferencias entre los dos grupos mediante las pruebas chi-cuadrado y t de Student. Principales medidas de resultados: Supervivencia a los tres meses con relación a los marcadores ecográficos. Resultados: Durante el periodo de estudio se encontró 23 casos de hernia diafragmática congénita. Se excluyó 8 casos por presentar otras anormalidades. Solo 15 casos cumplieron los criterios de inclusión. La edad media materna fue 30,2 años. El promedio de edad gestacional en el último estudio ecográfico previo al término de embarazo fue 35 1,2 semanas. Todos los casos tuvieron más de 32 semanas al nacer. La media de edad gestacional al término de embarazo fue 35,7 semanas. Todos los casos terminaron vía cesárea, de acuerdo al protocolo institucional; nueve casos fueron cesárea de urgencia por causas fetales. En cinco casos (33,3%) se detectó herniación intratorácica del hígado y fueron informados como ‘hígado arriba, de acuerdo al protocolo de la unidad. De ellos, ningún caso sobrevivió al nacer. Ocho casos presentaron RPC >1,2: de ellos sobrevivieron siete (87,5%). Siete otros casos presentaron RPC 1,2 fue mejor indicador de supervivencia neonatal que el ‘hígado abajo. Conclusiones: La hernia diafragmática congénita con RPC <1,2 en la evaluación ecográfica prenatal asociada a la presencia del hígado en saco herniario en el tórax es predictora de alta mortalidad posnatal.

Background: Congenital diaphragmatic hernia is a congenital malformation that affects 1 in 2 200 newborns. It is associated to high morbidity and mortality mainly due to lung hypoplasia and hypertension. In the last decade perinatal medicine has emphasized research on prenatal markers to determine severity of lung hypoplasia, especially lung-head relation (LHR). Objectives: To determine LHR and presence of the liver in the thoracic hernia sac as predictors of adverse perinatal results in fetuses with isolated diaphragmatic hernia. Design: Retrospective, observational, analytical correlational study. setting: Fetal Surveillance Unit, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Peru. Participants: Pregnant women and their fetuses. Interventions: All patients with fetal congenital diaphragmatic hernia diagnosis were studied between January 2005 and December 2011, and ultrasound measurement of lung-head index was performed. In case the patient would have more than one LHR measurement, the one obtained with the least gestational age was considered. Liver position in relation to fetal thorax and possibility of herniation within the thorax were specified. Following informed consent detailed anatomical study and fetal karyotype were done. Neonatal survival at age three months and relation of LHR and presence of the liver within the fetal thorax with neonatal survival were considered. Based on previous studies patients were classified in two groups in relation to LHR: less than 1.2 and more than 1.2. Differences between the two groups by chi-square and Student-t were determined. Main outcome measures: Three months survival in relation to ultrasound markers. Results: During the study period 23 cases of congenital diaphragmatic hernia were found in the Registry of the Fetal Surveillance Unit. Eight cases were excluded because other anomalies. Only 15 cases fulfilled inclusion criteria. Mean maternal age was 30.2 years. Average gestational age at the last ultrasound study before ending the pregnancy was 35 1.2 weeks. All had over 32 weeks at birth. Mean gestational age at birth was 35.7 weeks. All were born by cesarean section following institutional protocol; nine cases were emergency cesarean sections by fetal reasons. Intrathoracic liver herniation was found in five cases (33.3%) reported as ‘liver up according to protocol; none survived. Eight cases presented LHR >1.2, and seven survived (87.5%). Seven other cases presented LHR 1.2 was better predictor of neonatal survival than ‘liver down. Conclusions: Congenital diaphragmatic hernia with LHR <1.2 in prenatal ultrasound evaluation associated to liver in the thoracic hernia sac was predictor of high post natal mortality.