Current techniques in postmortem imaging with specific attention to paediatric applications

In this review we discuss the decline of and current controversies regarding conventional autopsies and the use of postmortem radiology as an adjunct to and a possible alternative for the conventional autopsy. We will address the radiological techniques and applications for postmortem imaging in childre

Radiological strength assessment of the proximal femur

To Ambroise Pare (1510-1590), the famous French surgeon, credit is given for first recognizing a fracture of the femoral neck. A second step into understanding the pathology of the broken hip was taken by Sir Astley Paston Cooper (1768-1841), as he was the first to underline the importance of the vascularization of the femoral head, describing what is now known as avascular necrosis, Until the 1930's, methods of treatment for hip fractures were mainly conservative. This changed when Smith-Peterson of Boston developed a special nail that could be inserted surgically, thus keeping fracture fragments together '. Surgical results improved mainly by the brilliant work of Jolm Charnley (1911-1982) in England '. His work was followed by the development of numerous devices up to the point where the total joint, including the socket, could be replaced

Educational paper: Imaging child abuse: the bare bones

Fractures are reported to be the second most common findings in child abuse, after skin lesions such as bruises and contusions. This makes careful interpretation of childhood fractures in relation to the provided clinical history important. In this literature review, we address imaging techniques and the prevailing protocols as well as fractures, frequently seen in child abuse, and the differential diagnosis of these fractures. The use of a standardised protocol in radiological imaging is stressed, as adherence to the international guidelines has been consistently poor. As fractures are a relatively common finding in childhood and interpretation is sometimes difficult, involvement of a paediatric radiologist is important if not essential. Adherence to international guidelines necessitates review by experts and is therefore mandatory. As in all clinical differential diagnoses, liaison between paediatricians and paediatric radiologists in order to obtain additional clinical information or even better having joint review of radiological studies will improve diagnostic accuracy. It is fundamental to keep in mind that the diagnosis of child abuse can never be solely based on radiological imaging but always on a combination of clinical, investigative and social findings. The quality and interpretation, preferably by a paediatric radiologist, of radiographs is essential in reaching a correct diagnosis in cases of suspected child abuse

Thermosensory perception regulates speed of movement in response to temperature changes in <i>Drosophila melanogaster</i>

Temperature influences physiology and behavior of all organisms. For ectotherms, which lack central temperature regulation, temperature adaptation requires sheltering from or moving to a heat source. As temperature constrains the rate of metabolic reactions, it can directly affect ectotherm physiology and thus behavioral performance. This direct effect is particularly relevant for insects whose small body readily equilibrates with ambient temperature. In fact, models of enzyme kinetics applied to insect behavior predict performance at different temperatures, suggesting that thermal physiology governs behavior. However, insects also possess thermosensory neurons critical for locating preferred temperatures, showing cognitive control. This suggests that temperature-related behavior can emerge directly from a physiological effect, indirectly as consequence of thermosensory processing, or through both. To separate the roles of thermal physiology and cognitive control, we developed an arena that allows fast temperature changes in time and space, and in which animals' movements are automatically quantified. We exposed wild-type and thermosensory receptor mutants Drosophila melanogaster to a dynamic temperature environment and tracked their movements. The locomotor speed of wild-type flies closely matched models of enzyme kinetics, but the behavior of thermosensory mutants did not. Mutations in thermosensory receptor dTrpA1 (Transient receptor potential) expressed in the brain resulted in a complete lack of response to temperature changes, while mutation in peripheral thermosensory receptor Gr28b(D) resulted in diminished response. We conclude that flies react to temperature through cognitive control, informed by interactions between various thermosensory neurons, whose behavioral output resembles that of enzyme kinetics

European Society of Paediatric Radiology 2019 strategic research agenda: improving imaging for tomorrow’s children

The European Society of Paediatric Radiology (ESPR) research committee was established to initiate, drive forward and foster excellence in paediatric imaging, paediatric image-guided intervention and radiation protection research, by facilitating more evidence-based standards, protocols and multi-institutional collaborations. The ESPR Strategic Research Agenda outlines our current research approach, highlighting several areas of paediatric imaging where the society can help guide current and future research, and emphasizing those areas where early research (“seed”) funding may need to be allocated by this and other societies as precursors to larger grant applications. The key aims are to evaluate normal variation in order to be able to confidently diagnose disease states, develop robust image-based classification systems to aid diagnosis and treatment monitoring, and help develop evidence-based clinical guidelines using current literature and experience to identify knowledge gaps. For this reason, the development of evidence-based imaging pipelines, broken down step-by-step to include diagnosis, classification and clinical effectiveness, should be the end goal for each disease entity for each affected child. Here, we outline the 2019 ESPR Strategic Research Agenda along three points in the clinical imaging pipeline: clinical referral, disease diagnosis and evolution, and clinical therapeutic evaluation and effectiveness. Through multicentre trials, using existing high-level experience and expertise, and nurturing the next generation of researchers, we will be able to achieve these aims.publishedVersio

Occurrence of subdural hematomas in Dutch glutaric aciduria type 1 patients

Patients with glutaric aciduria type 1 (GA1), a rare inherited metabolic disorder, have an increased risk for subdural hematomas (SDHs). GA1 is therefore generally included in the differential diagnosis of children presenting with SDHs. This retrospective cohort study reviews all 25 registered, in the Dutch Diagnosis Registration for Metabolic Disorders, GA1 patients in the Netherlands. This was done between May 2014 and November 2014 to determine the lifetime incidence of SDHs in this population. Seventeen patients were diagnosed either due to clinical symptoms or because of family members with GA1. One out of these 17 had a SDH. This patient showed widened Sylvian fissures on MRI, characteristic for GA1. Eight patients were diagnosed by newborn screening. Three of them had neuroimaging results, and none of them had SDHs. This study shows an overall lower incidence (4.0 %) of SDHs in patients with GA1 than reported in the literature (20–30 %). Conclusion: This finding, in combination with the fact that SDHs in GA1 appear to occur only in the presence of characteristic brain abnormalities on imaging, we recommend that GA1 should not routinely be a part of the differential diagnosis of children with unexplained SDHs in the absence of imaging characteristics suggestive of GA1. What is known:• Glutaric aciduria type 1 is a rare metabolic disorder predisposing children to subdural hematoma development due to brain abnormalities.• Because of these subdural hematomas, glutaric aciduria type 1 testing is part of abusive head trauma work-up.What is new:• The overall subdural hematoma incidence in glutaric aciduria type 1 patients is much lower than previously reported and only occurs in case of predisposing brain abnormalities

Automatic determination of Greulich and Pyle bone age in healthy Dutch children

Background: Bone age (BA) assessment is a routine procedure in paediatric radiology, for which the Greulich and Pyle (GP) atlas is mostly used. There is rater variability, but the advent of automatic BA determination eliminates this. Objective: To validate the BoneXpert method for automatic determination of skeletal maturity of healthy children against manual GP BA ratings. Materials and methods: Two observers determined GP BA with knowledge of the chronological age (CA). A total of 226 boys with a BA of 3-17 years and 179 girls with a BA of 3-15 years were included in the study. BoneXpert's estimate of GP BA was calibrated to agree on average with the manual ratings based on several studies, including the present study. Results: Seven subjects showed a deviation between manual and automatic BA in excess of 1.9 years. They were re-rated blindly by two raters. After correcting these seven ratings, the root mean square error between manual and automatic rating in the 405 subjects was 0.71 years (range 0.66-0.76 years, 95% CI). BoneXpert's GP BA is on average 0.28 and 0.20 years behind the CA for boys and girls, respectively. Conclusion: BoneXpert is a robust method for automatic determination of BA

The influence of motion artefacts on magnetic resonance imaging of the clavicles for age estimation

Purpose To determine how motion affects stage allocation to the clavicle's sternal end on MRI. Materials and methods Eighteen volunteers (9 females, 9 males) between 14 and 30 years old were prospectively scanned with 3-T MRI. One resting-state scan was followed by five intentional motion scans. Additionally, a control group of 72 resting-state scans were selected from previous research. Firstly, six observers allocated developmental stages to the clavicles independently. Secondly, they re-assessed the images, allocating developmental statuses (immature, mature). Finally, the resting-state scans of the 18 volunteers were assessed in consensus to decide on the "correct" stage/status. Results were compared between groups (control, prospective resting state, prospective motion), and between staging techniques (stages/statuses). Results Inter-observer agreement was low (Krippendorff alpha 0.23-0.67). The proportion of correctly allocated stages (64%) was lower than correctly allocated statuses (83%). Overall, intentional motion resulted in fewer assessable images and less images of sufficient evidential value. The proportion of correctly allocated stages did not differ between resting-state (64%) and motion scans (65%), while correctly allocated statuses were more prevalent in resting-state scans (83% versus 77%). Remarkably, motion scans did not render a systematically higher or lower stage/status, compared to the consensus. Conclusion Intentional motion impedes clavicle MRI for age estimation. Still, in case of obvious disturbances, the forensic expert will consider the MRI unsuitable as evidence. Thus, the development of the clavicle as such and the staging technique seem to play a more important role in allocating a faulty stage for age estimation