The radiologic diagnosis of skeletal dysplasias : past, present and future

Skeletal dysplasias have been recognised since recorded history began. The advent of radiography at the beginning of the 20th century and the subsequent introduction of departments of radiology have had tremendous impact and allowed conditions to be identified by their specific radiographic phenotypes. This has been enhanced by the addition of cross-sectional modalities (ultrasound, computed tomography and magnetic resonance imaging), which have allowed for prenatal recognition and diagnosis of skeletal dysplasias, and by the recent explosion in identified genes. There are more than 400 recognised skeletal dysplasias, many of which (due to their rarity) the practising clinician (radiologist, paediatrician, geneticist) may never come across. This article provides a historical overview of aids to the radiologic diagnosis of skeletal dysplasias

Current and emerging artificial intelligence applications for pediatric musculoskeletal radiology

Artificial intelligence (AI) is playing an ever-increasing role in radiology (more so in the adult world than in pediatrics), to the extent that there are unfounded fears it will completely take over the role of the radiologist. In relation to musculoskeletal applications of AI in pediatric radiology, we are far from the time when AI will replace radiologists; even for the commonest application (bone age assessment), AI is more often employed in an AI-assist mode rather than an AI-replace or AI-extend mode. AI for bone age assessment has been in clinical use for more than a decade and is the area in which most research has been conducted. Most other potential indications in children (such as appendicular and vertebral fracture detection) remain largely in the research domain. This article reviews the areas in which AI is most prominent in relation to the pediatric musculoskeletal system, briefly summarizing the current literature and highlighting areas for future research. Pediatric radiologists are encouraged to participate as members of the research teams conducting pediatric radiology artificial intelligence research

Elevated platelet counts in a cohort of children with moderate-severe osteogenesis imperfecta suggest that inflammation is present

BACKGROUND: Elevated platelet counts are observed in cancer, autoimmunity and inflammation with concurrent illness. Proinflammatory cytokines are elevated in murine osteogenesis imperfecta (OI) models. We hypothesised that platelet counts might be elevated in children with moderate-severe OI. METHODS: We reviewed the hospital records of 71 children with moderate-severe OI, treated in the Sheffield Children's Hospital's Severe, Complex and Atypical Osteogenesis Imperfecta Highly Specialised Service. Data relating platelet count (below/above average, above upper limit) to prior and concurrent events were summarised as event proportions per child. Additionally, we created platelet SD scores to assess age and time-related trends, and relationship with OI type. RESULTS: 1206 platelet counts were recorded. Platelet SD scores were right-shifted by 0.89 SD overall. 49 of 71 (69%) patients had at least one platelet count above the normal range and 246 (20.4%) of all counts were above the upper limit of normal. Of these, 101 (41%) were high despite no confounding factors being present. For the 47 children with data at age less than 2 years, 89 (30.0%) platelet counts were above the upper limit of normal and 39 (44%) had no associated confounding factor. Elevated platelet counts were recorded most often for children with new or existing vertebral fractures. CONCLUSIONS: Raised platelet counts were observed in association with new and healing vertebral fractures, but also (41%-44%) in the absence of identified proinflammatory factors or events. We speculate that these findings are evidence for a proinflammatory component to OI that could be a target for therapeutic intervention

Imaging and reporting considerations for suspected physical abuse (non-accidental injury) in infants and young children. Part 2: axial skeleton and differential diagnoses

Recognising the skeletal manifestations of inflicted injury (II) in infants and young children is of crucial importance. There are specific fracture patterns which are highly suspicious of II in addition to common differential diagnoses with which radiologists should be familiar. Our objective is to provide a non-exhaustive review of the important factors relevant to the imaging and reporting of II as a platform for further learning. Part 2 encompasses fracture patterns of the axial skeleton and important differential diagnoses

Feasibility of quantitative ultrasonography for the detection of metabolic bone disease in preterm infants - systematic review.

Metabolic bone disease of prematurity is characterised by disordered bone mineralisation and is therefore an increased fracture risk. Preterm infants are especially at risk due to incomplete in utero bone accretion during the last trimester. Currently, diagnosing metabolic bone disease mainly relies on biochemistry and radiographs. Dual-energy x-ray absorptiometry and quantitative ultrasound (US) are used less frequently. However, biochemical measurements correlate poorly with bone mineralisation and although scoring systems exist for metabolic bone disease, radiographs are subjective and do not detect early features of osteopenia. Dual energy x-ray absorptiometry is the reference standard for determining bone density in older children and adults. However, challenges with this method include movement artefact, difficulty scanning small and sick infants and a lack of normative data for young children. Quantitative US has a relatively low cost, is radiation-free and portable, and may hence be suitable for assessing bone status in preterm infants. This review aims to provide an overview of the use of quantitative US in detecting metabolic bone disease in preterm infants

Investigating the mechanical response of paediatric bone under bending and torsion using finite element analysis

Fractures of bone account 25% of all paediatric injuries (Cooper et al. in J Bone Miner Res 19:1976-1981, 2004. https://doi.org/10.1359/JBMR.040902 ). These can be broadly categorised into accidental or inflicted injuries. The current clinical approach to distinguish between these two is based on the clinician's judgment, which can be subjective. Furthermore, there is a lack of studies on paediatric bone to provide evidence-based information on bone strength, mainly due to the difficulties of obtaining paediatric bone samples. There is a need to investigate the behaviour of children's bones under external loading. Such data will critically enhance our understanding of injury tolerance of paediatric bones under various loading conditions, related to injuries, such as bending and torsional loads. The aim of this study is therefore to investigate the response of paediatric femora under two types of loading conditions, bending and torsion, using a CT-based finite element approach, and to determine a relationship between bone strength and age/body mass of the child. Thirty post-mortem CT scans of children aged between 0 and 3 years old were used in this study. Two different boundary conditions were defined to represent four-point bending and pure torsional loads. The principal strain criterion was used to estimate the failure moment for both loading conditions. The results showed that failure moment of the bone increases with the age and mass of the child. The predicted failure moment for bending, external and internal torsions were 0.8-27.9, 1.0-31.4 and 1.0-30.7 Nm, respectively. To the authors' knowledge, this is the first report on infant bone strength in relation to age/mass using models developed from modern medical images. This technology may in future help advance the design of child, car restrain system, and more accurate computer models of children

Applicability of two commonly used bone age assessment methods to twenty-first century UK children

Objectives To assess the effect of secular change on skeletal maturation and thus on the applicability of the Greulich and Pyle (G&P) and Tanner and Whitehouse (TW3) methods. Methods BoneXpert was used to assess bone age from 392 hand trauma radiographs (206 males, 257 left). The paired sample t test was performed to assess the difference between mean bone age (BA) and mean chronological age (CA). ANOVA was used to assess the differences between groups based on socioeconomic status (taken from the Index of Multiple Deprivation). Results CA ranged from 2 to 15 years for females and 2.5 to 15 years for males. Numbers of children living in low, average and high socioeconomic areas were 216 (55%), 74 (19%) and 102 (26%) respectively. We found no statistically significant difference between BA and CA when using G&P. However, using TW3, CA was underestimated in females beyond the age of 3 years, with significant differences between BA and CA (− 0.43 years, SD 1.05, p = < 0.001) but not in males (0.01 years, SD 0.97, p = 0.76). Of the difference in females, 17.8% was accounted for by socioeconomic status. Conclusion No significant difference exists between BoneXpert-derived BA and CA when using the G&P atlas in our study population. There was a statistically significant underestimation of BoneXpert-derived BA compared with CA in females when using TW3, particularly in those from low and average socioeconomic backgrounds. Secular change has not led to significant advancement in skeletal maturation within our study population

The diagnostic accuracy of cross-sectional imaging for detecting acute scaphoid fractures in children: a systematic review

OBJECTIVE: To determine the diagnostic accuracy of cross-sectional imaging for the diagnosis of acute scaphoid fractures in children. METHODS: A systematic review of Medline, Embase and Cochrane databases between 1980 and July 2017 was independently performed by two observers. Criteria for study inclusion in a meta-analysis and assessment of the quality of such studies using the QADAS tool, were predetermined. RESULTS: No studies were eligible for inclusion in a meta-analysis. Three studies (of low quality when assessed against the STARD guidelines for reporting of studies of diagnostic accuracy) assessed MRI (performed between Days 2 and 10 after acute injury) for the diagnosis of scaphoid fractures in a total of 119 children (age range 6 to 16 years). Study 1 (45 children) reported inter-observer reliability of radiographs and MRI of 0.53 and 0.95 respectively. Study 3 (18 children) reported a negative predictive value of MRI (even as early as Day 2), of 100%. No measure of diagnostic accuracy or observer reliability was reported in Study 2 (56 children). In all 3 studies, MRI identified more scaphoid fractures (and other carpal injuries) than radiographs. Study 3 showed that follow-up MRI between Days 38 and 45 added no new information compared to initial MRI. CONCLUSION: Based on a systematic review of the literature, there is currently no evidence on which to suggest an imaging protocol for suspected scaphoid fracture in children. Until such evidence is available, existing guidelines (which are based on expert opinion from adult studies) should be followed. Advances in Knowledge 1. There is low quality evidence regarding the diagnostic accuracy of cross-sectional imaging for suspected scaphoid fractures in children and no evidence on which to propose an optimal imaging strategy. 2. Until such evidence is available, current guidelines (based predominantly on findings in adults and expert opinion) should be followed

Comparison of prevalence and characteristics of fractures in term and preterm infants in the first 3 years of life

Background Preterm infants may be more vulnerable to fractures due to various factors, including metabolic bone disease, but an increased risk of fractures up to the age of 2 is unproven. Objective To compare fracture patterns in premature and full-term children in the first 3 years of life. Materials and methods A retrospective study was conducted. We excluded any child who returned with the same injury, with known metabolic bone disease, with any disease or condition known to reduce bone density, who received any medication known to affect Vitamin D metabolism within 3 months of enrollment or who had fractures post-surgery/resuscitation. Variables such as the number of fractures sustained each year, age of presentation to the Emergency Department and mechanism of injury were compared between the preterm and term groups using statistical analysis (χ2 and Fisher exact test for categorical variables and Student’s t-test for continuous variables). Simple linear regression was performed on the total number of fractures sustained by age 3. Results Forty-four children with fractures were included. Of these, none were born extremely preterm, 24 (55%) were preterm, and 20 (45%) were born at term. Mean gestational ages of the preterm and term groups were 32 weeks 3 days and 39 weeks 6 days, respectively. There were no extremely low birth weight or very low birth weight children. There was no significant difference in the number of fractures sustained yearly, the age of presentation to the Emergency Department or the site of fracture between preterm and term groups. Linear regression showed that the total number of fractures sustained by age 3 years was unrelated to prematurity status, gender or birth weight category. Conclusion No significant difference in fracture number or pattern was identified

Prevalence and histopathological pattern of breast cancer among patients at Abia State University teaching Hospital, Aba, South Eastern Nigeria

There has been no previous study to classify breast cancers in detail based on histopathologically confirmed diagnosis in Abia State University Teaching Hospital, Aba, Nigeria. This study aims at determining the prevalence and histological pattern of breast cancers in our centre. This retrospective study was based on histopathological diagnosed breast cancer lesions from January 2012 to December 2016. Out of 305 archival results and slides retrieved, 29.8% were cancerous in nature. The ratio of benign to malignant lesion was 2.35:1. The age range of the patients was 21-71years. The peak incidence age range was the fifth decade (50, 54.94%). Mean age of breast cancer patients was 46.5+5.4years while majority of patients (78.0%) were in s age group of 21-50years. The left breast (61.5%) was more affected than the right. Invasive ductal carcinoma was the predominant histologic presentation (72.52%), followed by invasive lobular carcinoma (10.98%) and metastatic carcinoma (4.40%). Nineteen (21%) of the patients presented with stages 1 and 11 of the disease while majority 72 (79.1%) presented with advanced stage of disease commonly with stage 111. There was no significant relationship between clinical stage of breast cancer and the age of patients seen (p value &gt;0.05).Key words: Breast cancer, Histopathological patterns, Aba, Nigeria