Flatfoot in children and adolescents. Analysis of imaging findings and therapeutic implications

SummaryIntroductionPes planovalgus (PPV) is a complex three-dimensional deformity of which routine radiographs provide only a two-dimensional analysis.HypothesisAngles and other radiographic parameters of the foot in children and adolescents, when studied on both the dorsoplantar and the lateral view, can be used to establish a radiographic classification system for PPV that provides useful therapeutic guidance in clinical practice.Materials and methodsA retrospective single-centre study was conducted on 65 feet in 35 patients aged 7 to 18 years and having adequate ossification. All patients had a clinical diagnosis of idiopathic or neurologic PPV and available weight-bearing dorsoplantar and strict lateral radiographs. We excluded pes planus due to tarsal coalition, congenital bone deformities, or overcorrection of talipes equinovarus (n=25). All possible axes were drawn and angles measured after an evaluation of interindividual agreement.ResultsWe identified four patterns of PPV: subtalar pes planus (n=16) with marked subtalar valgus and longitudinal sag predominating at the talonavicular joint, midtarsal pes planus (n=12) without subtalar valgus but with marked midtarsal abduction and sag predominating at the cuneonavicular joint, mixed pes planus (n=28) with subtalar valgus, midtarsal abduction, and sag at both the talonavicular and cuneonavicular joints, and pes planocavus (n=9) with sag of the medial arch and cavus deformity of the lateral arch.ConclusionThis original classification system provides therapeutic guidance by helping to match the surgical procedure to the nature and location of the deformities.Level of evidenceLevel IV

Neonatal brain MRI: how reliable is the radiologist’s eye?

International audienceAbstractIntroductionWhite matter (WM) analysis in neonatal brain magnetic resonance imaging (MRI) is challenging, as demonstrated by the issue of diffuse excessive high signal intensity (DEHSI). We evaluated the reliability of the radiologist'eye in this context.MethodsThree experienced observers graded the WM signal intensity on axial T2-weighted 1.5T images from 60 different premature newborns on 2 occasions 4 weeks apart with a semi-quantitative classification under identical viewing conditions.ResultsThe intra- and inter-observer correlation coefficients were fair to moderate (Fleiss’kappa between 0.21 and 0.60). ConclusionThis is a serious limitation of which we need to be aware, as it can lead to contradictory conclusions in the challenging context of term-equivalent age brain MRI in premature infants. These results highlight the need for a semiautomatic tool to help in objectively analyzing MRI signal intensity in the neonatal brain

Progrès récents de l'Imagerie par Résonance Magnétique (IRM) chez le nouveau-né. Recent advances in newborn MRI

International audienceAbstractThe accurate morphological exploration of the brain is a major challenge in neonatology that advances in magnetic resonance imaging (MRI) can now provide. MRI is the gold standard if an hypoxic ischemic pathology is suspected in a full term neonate. In prematures, the specific role of MRI remains to be defined, secondary to US in any case. We present a state of the art of hardware and software technical developments in MRI. The increase in magnetic field strength (3 tesla) and the emergence of new MRI sequences provide access to new information. They both have positive and negative consequences on the daily clinical data acquisition use. The semiology of brain imaging in full term newborns and prematures is more extensive and complex and thereby more difficult to interpret. The segmentation of different brain structures in the newborn, even very premature, is now available. It is now possible to dissociate the cortex and basal ganglia from the cerebral white matter, to calculate the volume of anatomical structures, which improves the morphometric quantification and the understanding of the normal and abnormal brain development. MRI is a powerful tool to analyze the neonatal brain. The relevance of the diagnostic contribution requires an adaptation of the parameters of the sequences to acquire and of the image processing methods.RésuméL’exploration morphologique fine du cerveau est un enjeu majeur en néonatalogie que les avancées de l’imagerie par résonance magnétique (IRM) permettent actuellement. L’IRM est l’examen de choix devant une suspicion de pathologie anoxo-ischémique à terme. Chez le prématuré, la place précise de l’IRM reste à définir, toujours en seconde intention après l’échographie transfontanellaire (ETF). Nous dressons un panorama des évolutions techniques récentes matérielles et logicielles, en IRM. L’augmentation de l’intensité des champs magnétiques (3 teslas) et l’apparition de nouvelles séquences donnent accès à de nouvelles informations. Elles ont des conséquences positives et négatives sur l’acquisition des données en utilisation clinique quotidienne. La sémiologie de l’imagerie cérébrale du nouveau-né et du prématuré est désormais plus riche, plus complexe et donc d’interprétation plus difficile. La segmentation des différentes structures cérébrales devient accessible chez le nouveau-né, même grand prématuré. Il est aujourd’hui possible de dissocier le cortex et les noyaux gris de la substance blanche cérébrale, de calculer des volumes de structures anatomiques, ce qui améliore la quantification morphométrique et la compréhension du développement cérébral normal et pathologique. L’IRM est un outil inégalable et puissant pour l’analyse du cerveau du nouveau-né, dont la pertinence de l’apport diagnostique requiert une adaptation des paramètres des séquences à acquérir et des méthodes de traitement d’images

E.U. paediatric MOG consortium consensus: Part 2 - Neuroimaging features of paediatric myelin oligodendrocyte glycoprotein antibody-associated disorders.

Imaging plays a crucial role in differentiating the spectrum of paediatric acquired demyelinating syndromes (ADS), which apart from myelin oligodendrocyte glycoprotein antibody associated disorders (MOGAD) includes paediatric multiple sclerosis (MS), aquaporin-4 antibody neuromyelitis optica spectrum disorders (NMOSD) and unclassified patients with both monophasic and relapsing ADS. In contrast to the imaging characteristics of children with MS, children with MOGAD present with diverse imaging patterns which correlate with the main demyelinating phenotypes as well as age at presentation. In this review we describe the common neuroradiological features of children with MOGAD such as acute disseminated encephalomyelitis, optic neuritis, transverse myelitis, AQP4 negative NMOSD. In addition, we report newly recognized presentations also associated with MOG-ab such as the 'leukodystophy-like' phenotype and autoimmune encephalitis with predominant involvement of cortical and deep grey matter structures. We further delineate the features, which may help to distinguish MOGAD from other ADS and discuss the future role of MR-imaging in regards to treatment decisions and prognosis in children with MOGAD. Finally, we propose an MRI protocol for routine examination and discuss new imaging techniques, which may help to better understand the neurobiology of MOGAD

Congenital anterolateral tibial bowing and polydactyly: a case report

Congenital anterolateral bowing of the tibia is a rare deformity that may lead to pseudarthrosis and risk of fracture. This is commonly associated with neurofibromatosis type 1. In this report, we describe a 15-month old male with congenital anterolateral bowing of the right tibia and associated hallux duplication. This is a distinct entity with a generally favourable prognosis that should not be confused with other conditions such as neurofibromatosis type 1. Previously published cases are reviewed

E.U. paediatric MOG consortium consensus: Part 1 - Classification of clinical phenotypes of paediatric myelin oligodendrocyte glycoprotein antibody-associated disorders

Over the past few years, increasing interest in the role of autoantibodies against myelin oligodendrocyte glycoprotein (MOG-abs) as a new candidate biomarker in demyelinating central nervous system diseases has arisen. MOG-abs have now consistently been identified in a variety of demyelinating syndromes, with a predominance in paediatric patients. The clinical spectrum of these MOG-ab-associated disorders (MOGAD) is still expanding and differs between paediatric and adult patients. This first part of the Paediatric European Collaborative Consensus emphasises the diversity in clinical phenotypes associated with MOG-abs in paediatric patients and discusses these associated clinical phenotypes in detail. Typical MOGAD presentations consist of demyelinating syndromes, including acute disseminated encephalomyelitis (ADEM) in younger, and optic neuritis (ON) and/or transverse myelitis (TM) in older children. A proportion of patients experience a relapsing disease course, presenting as ADEM followed by one or multiple episode(s) of ON (ADEM-ON), multiphasic disseminated encephalomyelitis (MDEM), relapsing ON (RON) or relapsing neuromyelitis optica spectrum disorders (NMOSD)-like syndromes. More recently, the disease spectrum has been expanded with clinical and radiological phenotypes including encephalitis-like, leukodystrophy-like, and other non-classifiable presentations. This review concludes with recommendations following expert consensus on serologic testing for MOG-abs in paediatric patients, the presence of which has consequences for long-term monitoring, relapse risk, treatments, and for counselling of patient and families. Furthermore, we propose a clinical classification of paediatric MOGAD with clinical definitions and key features. These are operational and need to be tested, however essential for future paediatric MOGAD studies

E.U. paediatric MOG consortium consensus: Part 4 - Outcome of paediatric myelin oligodendrocyte glycoprotein antibody-associated disorders

There is increasing knowledge on the role of antibodies against myelin oligodendrocyte glycoprotein (MOG-abs) in acquired demyelinating syndromes and autoimmune encephalitis in children. Better understanding and prediction of outcome is essential to guide treatment protocol decisions. Therefore, this part of the Paediatric European Collaborative Consensus provides an oversight of existing knowledge of clinical outcome assessment in paediatric MOG-ab-associated disorders (MOGAD). The large heterogeneity in disease phenotype, disease course, treatment and follow-up protocols is a major obstacle for reliable prediction of outcome. However, the clinical phenotype of MOGAD appears to be the main determinant of outcome. Patients with a transverse myelitis phenotype in particular are at high risk of accruing neurological disability (motor and autonomic), which is frequently severe. In contrast, having a single episode of optic neuritis any time during disease course is broadly associated with a lower risk of persistent disability. Furthermore, MOG-ab-associated optic neuritis often results in good functional visual recovery, although retinal axonal loss may be severe. The field of cognitive and behavioural outcome and epilepsy following demyelinating episodes has not been extensively explored, but in recent studies acute disseminated encephalomyelitis (-like) phenotype in the young children was associated with cognitive problems and epilepsy in long-term follow-up. In conclusion, main domains of importance in determining clinical outcome in paediatric MOGAD are visual, motor, autonomic and cognitive function. A standardised evaluation of these outcome domains in all children is of importance to allow adequate rehabilitation and follow-up