Bouloussa, H; Pietton, R; Vergari, C; Haen, T X; Skalli, W; Vialle, R
In: Eur Spine J, vol. 28, no. 9, pp. 1962–1969, 2019, ISSN: 1432-0932.
@article{pmid30895379,
title = {Biplanar stereoradiography predicts pulmonary function tests in adolescent idiopathic scoliosis: a cross-sectional study},
author = {H Bouloussa and R Pietton and C Vergari and T X Haen and W Skalli and R Vialle},
doi = {10.1007/s00586-019-05940-3},
issn = {1432-0932},
year = {2019},
date = {2019-09-01},
journal = {Eur Spine J},
volume = {28},
number = {9},
pages = {1962--1969},
abstract = {PURPOSE: Various spinal and rib cage parameters measured from complex examinations were found to be correlated with preoperative pulmonary function tests (PFT). The aim was to investigate the relationship between preoperative rib cage parameters and PFT using biplanar stereoradiography in patients with severe adolescent idiopathic scoliosis.nnMETHODS: Fifty-four patients, 45 girls and nine boys, aged 13.8 ± 1.2 years, with Lenke 1 or 2 thoracic scoliosis (> 50°) requiring surgical correction were prospectively included. All patients underwent preoperative PFT and low-dose biplanar X-rays. The following data were collected: forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, residual volume, slow vital capacity (SVC), total lung capacity (TLC), rib cage volume (RCV), maximum rib hump, maximum width, mean thoracic index, spinal penetration index, apical vertebral rotation, main curve Cobb angle (MCCA), T4-T12 kyphosis. The primary outcome was the relationship between rib cage parameters and PFT. The secondary outcome was the relationship between rib cage parameters and spine parameters. Data were analyzed using Spearman's rank test. A multivariable regression analysis was performed to compare PFTs and structural parameters. Significance was set at α = 0.05.nnRESULTS: The mean MCCA was 68.7° ± 16.7°. RCV was highly correlated with all pulmonary capacities: TLC (r = 0.76, p < 0.0001), SVC (r = 0.78, p < 0.0001) and FVC (r = 0.77, p < 0.0001). RCV had a low correlation with FEV1/FVC (r = - 0.34, p = 0.014). SPI was not correlated with any pulmonary parameters.nnCONCLUSION: Rib cage volume measured by biplanar stereoradiography may represent a prediction tool for PFTs.nnLEVEL OF EVIDENCE: Non-randomized cross-sectional study among consecutive patients, Level 2. These slides can be retrieved under Electronic Supplementary Material.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: Various spinal and rib cage parameters measured from complex examinations were found to be correlated with preoperative pulmonary function tests (PFT). The aim was to investigate the relationship between preoperative rib cage parameters and PFT using biplanar stereoradiography in patients with severe adolescent idiopathic scoliosis.nnMETHODS: Fifty-four patients, 45 girls and nine boys, aged 13.8 ± 1.2 years, with Lenke 1 or 2 thoracic scoliosis (> 50°) requiring surgical correction were prospectively included. All patients underwent preoperative PFT and low-dose biplanar X-rays. The following data were collected: forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, residual volume, slow vital capacity (SVC), total lung capacity (TLC), rib cage volume (RCV), maximum rib hump, maximum width, mean thoracic index, spinal penetration index, apical vertebral rotation, main curve Cobb angle (MCCA), T4-T12 kyphosis. The primary outcome was the relationship between rib cage parameters and PFT. The secondary outcome was the relationship between rib cage parameters and spine parameters. Data were analyzed using Spearman’s rank test. A multivariable regression analysis was performed to compare PFTs and structural parameters. Significance was set at α = 0.05.nnRESULTS: The mean MCCA was 68.7° ± 16.7°. RCV was highly correlated with all pulmonary capacities: TLC (r = 0.76, p < 0.0001), SVC (r = 0.78, p < 0.0001) and FVC (r = 0.77, p < 0.0001). RCV had a low correlation with FEV1/FVC (r = - 0.34, p = 0.014). SPI was not correlated with any pulmonary parameters.nnCONCLUSION: Rib cage volume measured by biplanar stereoradiography may represent a prediction tool for PFTs.nnLEVEL OF EVIDENCE: Non-randomized cross-sectional study among consecutive patients, Level 2. These slides can be retrieved under Electronic Supplementary Material.
Pedersen, Peter H; Vergari, Claudio; Tran, Alexia; Xavier, Fred; Jaeger, Antoine; Laboudie, Pierre; Housset, Victor; Eiskjær, Søren P; Vialle, Raphäel
In: Clin Spine Surg, vol. 32, no. 7, pp. E340–E345, 2019, ISSN: 2380-0194.
@article{pmid31162186,
title = {A Nano-Dose Protocol For Cobb Angle Assessment in Children With Scoliosis: Results of a Phantom-based and Clinically Validated Study},
author = {Peter H Pedersen and Claudio Vergari and Alexia Tran and Fred Xavier and Antoine Jaeger and Pierre Laboudie and Victor Housset and Søren P Eiskjær and Raphäel Vialle},
doi = {10.1097/BSD.0000000000000834},
issn = {2380-0194},
year = {2019},
date = {2019-08-01},
journal = {Clin Spine Surg},
volume = {32},
number = {7},
pages = {E340--E345},
abstract = {STUDY DESIGN: This was a prospective validation study with technical notes.nnOBJECTIVE: This study aimed to validate a new ultra-low-dose full-spine protocol for reproducible Cobb angle measurements-the "nano-dose" protocol.nnSUMMARY OF BACKGROUND DATA: Scoliosis is a 3-dimensional (3D) deformity of the spine characterized by 3D clinical parameters. Nevertheless, 2D Cobb angle remains an essential and widely used radiologic measure in clinical practice. Repeated imaging is required for the assessment and follow-up of scoliosis patients. The resultant high dose of absorbed radiation increases the potential risk of developing radiation-induced cancer in such patients. Micro-dose radiographic imaging is already available in clinical practice, but the radiation dose delivered to the patient could be further reduced.nnMETHODS: An anthropomorphic child phantom was used to establish an ultra-low-dose protocol in the EOS Imaging System still allowing Cobb angle measurements, defined as nano-dose. A group of 23 consecutive children presenting for scoliosis assessment, 12 years of age or younger, were assessed with standard-dose or micro-dose and additional nano-dose full-spine imaging modalities. Intraobserver and interobserver reliability of determining the reliability of 2D Cobb angle measurements was performed. The dosimetry was performed in the anthropomorphic phantom to confirm theoretical radiation dose reduction.nnRESULTS: A nano-dose protocol was established for reliable Cobb angle measurements. Dose area product with this new nano-dose protocol was reduced to 5 mGy×cm, corresponding to one sixth of the micro-dose protocol (30 mGy×cm) and <1/40th of the standard-dose protocol (222 mGy×cm). Theoretical dose reduction, for posteroanterolateral positioning was confirmed using phantom dosimetry. Our study showed good reliability and repeatability between the 2 groups. Cobb variability was <5 degrees from the mean using 95% confidence intervals.nnCONCLUSIONS: We propose a new clinically validated nano-dose protocol for routine follow-up of scoliosis patients before surgery, keeping the radiation dose at a bare minimum, while allowing for reproducible Cobb angle measurements.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
STUDY DESIGN: This was a prospective validation study with technical notes.nnOBJECTIVE: This study aimed to validate a new ultra-low-dose full-spine protocol for reproducible Cobb angle measurements-the “nano-dose” protocol.nnSUMMARY OF BACKGROUND DATA: Scoliosis is a 3-dimensional (3D) deformity of the spine characterized by 3D clinical parameters. Nevertheless, 2D Cobb angle remains an essential and widely used radiologic measure in clinical practice. Repeated imaging is required for the assessment and follow-up of scoliosis patients. The resultant high dose of absorbed radiation increases the potential risk of developing radiation-induced cancer in such patients. Micro-dose radiographic imaging is already available in clinical practice, but the radiation dose delivered to the patient could be further reduced.nnMETHODS: An anthropomorphic child phantom was used to establish an ultra-low-dose protocol in the EOS Imaging System still allowing Cobb angle measurements, defined as nano-dose. A group of 23 consecutive children presenting for scoliosis assessment, 12 years of age or younger, were assessed with standard-dose or micro-dose and additional nano-dose full-spine imaging modalities. Intraobserver and interobserver reliability of determining the reliability of 2D Cobb angle measurements was performed. The dosimetry was performed in the anthropomorphic phantom to confirm theoretical radiation dose reduction.nnRESULTS: A nano-dose protocol was established for reliable Cobb angle measurements. Dose area product with this new nano-dose protocol was reduced to 5 mGy×cm, corresponding to one sixth of the micro-dose protocol (30 mGy×cm) and <1/40th of the standard-dose protocol (222 mGy×cm). Theoretical dose reduction, for posteroanterolateral positioning was confirmed using phantom dosimetry. Our study showed good reliability and repeatability between the 2 groups. Cobb variability was <5 degrees from the mean using 95% confidence intervals.nnCONCLUSIONS: We propose a new clinically validated nano-dose protocol for routine follow-up of scoliosis patients before surgery, keeping the radiation dose at a bare minimum, while allowing for reproducible Cobb angle measurements.
Dhombres, Ferdinand; Maurice, Paul; Guilbaud, Lucie; Franchinard, Loriane; Dias, Barbara; Charlet, Jean; Blondiaux, Eléonore; Khoshnood, Babak; Jurkovic, Davor; Jauniaux, Eric; Jouannic, Jean-Marie
In: J Med Internet Res, vol. 21, no. 7, pp. e14286, 2019, ISSN: 1438-8871.
@article{pmid31271152,
title = {A Novel Intelligent Scan Assistant System for Early Pregnancy Diagnosis by Ultrasound: Clinical Decision Support System Evaluation Study},
author = {Ferdinand Dhombres and Paul Maurice and Lucie Guilbaud and Loriane Franchinard and Barbara Dias and Jean Charlet and Eléonore Blondiaux and Babak Khoshnood and Davor Jurkovic and Eric Jauniaux and Jean-Marie Jouannic},
doi = {10.2196/14286},
issn = {1438-8871},
year = {2019},
date = {2019-07-01},
journal = {J Med Internet Res},
volume = {21},
number = {7},
pages = {e14286},
abstract = {BACKGROUND: Early pregnancy ultrasound scans are usually performed by nonexpert examiners in obstetrics/gynecology (OB/GYN) emergency departments. Establishing the precise diagnosis of pregnancy location is key for appropriate management of early pregnancies, and experts are usually able to locate a pregnancy in the first scan. A decision-support system based on a semantic, expert-validated knowledge base may improve the diagnostic performance of nonexpert examiners for early pregnancy transvaginal ultrasound.nnOBJECTIVE: This study aims to evaluate a novel Intelligent Scan Assistant System for early pregnancy ultrasound to diagnose the pregnancy location and determine the image quality.nnMETHODS: Two trainees performed virtual transvaginal ultrasound examinations of early pregnancy cases with and without the system. The ultrasound images and reports were blindly reviewed by two experts using scoring methods. A diagnosis of pregnancy location and ultrasound image quality were compared between scans performed with and without the system.nnRESULTS: Each trainee performed a virtual vaginal examination for all 32 cases with and without use of the system. The analysis of the 128 resulting scans showed higher quality of the images (quality score: +23%; P<.001), less images per scan (4.6 vs 6.3 [without the CDSS]; P<.001), and higher confidence in reporting conclusions (trust score: +20%; P<.001) with use of the system. Further, use of the system cost an additional 8 minutes per scan. We observed a correct diagnosis of pregnancy location in 39 (61%) and 52 (81%) of 64 scans in the nonassisted mode and assisted mode, respectively. Additionally, an exact diagnosis (with precise ectopic location) was made in 30 (47%) and 49 (73%) of the 64 scans without and with use of the system, respectively. These differences in diagnostic performance (+20% for correct location diagnosis and +30% for exact diagnosis) were both statistically significant (P=.002 and P<.001, respectively).nnCONCLUSIONS: The Intelligent Scan Assistant System is based on an expert-validated knowledge base and demonstrates significant improvement in early pregnancy scanning, both in diagnostic performance (pregnancy location and precise diagnosis) and scan quality (selection of images, confidence, and image quality).},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Early pregnancy ultrasound scans are usually performed by nonexpert examiners in obstetrics/gynecology (OB/GYN) emergency departments. Establishing the precise diagnosis of pregnancy location is key for appropriate management of early pregnancies, and experts are usually able to locate a pregnancy in the first scan. A decision-support system based on a semantic, expert-validated knowledge base may improve the diagnostic performance of nonexpert examiners for early pregnancy transvaginal ultrasound.nnOBJECTIVE: This study aims to evaluate a novel Intelligent Scan Assistant System for early pregnancy ultrasound to diagnose the pregnancy location and determine the image quality.nnMETHODS: Two trainees performed virtual transvaginal ultrasound examinations of early pregnancy cases with and without the system. The ultrasound images and reports were blindly reviewed by two experts using scoring methods. A diagnosis of pregnancy location and ultrasound image quality were compared between scans performed with and without the system.nnRESULTS: Each trainee performed a virtual vaginal examination for all 32 cases with and without use of the system. The analysis of the 128 resulting scans showed higher quality of the images (quality score: +23%; P<.001), less images per scan (4.6 vs 6.3 [without the CDSS]; P<.001), and higher confidence in reporting conclusions (trust score: +20%; P<.001) with use of the system. Further, use of the system cost an additional 8 minutes per scan. We observed a correct diagnosis of pregnancy location in 39 (61%) and 52 (81%) of 64 scans in the nonassisted mode and assisted mode, respectively. Additionally, an exact diagnosis (with precise ectopic location) was made in 30 (47%) and 49 (73%) of the 64 scans without and with use of the system, respectively. These differences in diagnostic performance (+20% for correct location diagnosis and +30% for exact diagnosis) were both statistically significant (P=.002 and P<.001, respectively).nnCONCLUSIONS: The Intelligent Scan Assistant System is based on an expert-validated knowledge base and demonstrates significant improvement in early pregnancy scanning, both in diagnostic performance (pregnancy location and precise diagnosis) and scan quality (selection of images, confidence, and image quality).
Ferrier, Clément; Dhombres, Ferdinand; Khoshnood, Babak; Randrianaivo, Hanitra; Perthus, Isabelle; Guilbaut, Lucie; Durand-Zaleski, Isabelle; Jouannic, Jean-Marie
In: BMJ Open, vol. 9, no. 2, pp. e025482, 2019, ISSN: 2044-6055.
@article{pmid30772861,
title = {Trends in resource use and effectiveness of ultrasound detection of fetal structural anomalies in France: a multiple registry-based study},
author = {Clément Ferrier and Ferdinand Dhombres and Babak Khoshnood and Hanitra Randrianaivo and Isabelle Perthus and Lucie Guilbaut and Isabelle Durand-Zaleski and Jean-Marie Jouannic},
doi = {10.1136/bmjopen-2018-025482},
issn = {2044-6055},
year = {2019},
date = {2019-02-01},
journal = {BMJ Open},
volume = {9},
number = {2},
pages = {e025482},
abstract = {OBJECTIVE: To analyse trends in the number of ultrasound examinations in relation to the effectiveness of prenatal detection of birth defects using population-based data in France.nnDESIGN: A multiple registry-based study of time trends in resource use (number of ultrasounds) and effectiveness (proportion of cases prenatally diagnosed).nnSETTING: Three registries of congenital anomalies and claims data on ultrasounds for all pregnant women in France.nnPARTICIPANTS: There were two samples of pregnant women. Effectiveness was assessed using data from three French birth defect registries. Resource use for ultrasound screening was based on the French national healthcare database.nnMAIN OUTCOME MEASURES: The main outcome measures were prenatal diagnosis (effectiveness) and the average number of ultrasounds (resource use). Statistical analyses included linear and logistic regression models to assess trends in resource use and effectiveness of prenatal testing, respectively.nnRESULTS: The average number of ultrasound examinations per pregnancy significantly increased over the study period, from 2.47 in 2006 to 2.98 in 2014 (p=0.005). However, there was no significant increase in the odds of prenatal diagnosis. The probability of prenatal diagnosis was substantially higher for cases associated with a chromosomal anomaly (91.2%) than those without (51.8%). However, there was no evidence of an increase in prenatal detection of either over time.nnCONCLUSIONS: The average number of ultrasound examinations per pregnancy increased over time, whereas the probability of prenatal diagnosis of congenital anomalies did not. Hence, there is a need to implement policies such as high-quality training programmes which can improve the efficiency of ultrasound examinations for prenatal detection of congenital anomalies.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: To analyse trends in the number of ultrasound examinations in relation to the effectiveness of prenatal detection of birth defects using population-based data in France.nnDESIGN: A multiple registry-based study of time trends in resource use (number of ultrasounds) and effectiveness (proportion of cases prenatally diagnosed).nnSETTING: Three registries of congenital anomalies and claims data on ultrasounds for all pregnant women in France.nnPARTICIPANTS: There were two samples of pregnant women. Effectiveness was assessed using data from three French birth defect registries. Resource use for ultrasound screening was based on the French national healthcare database.nnMAIN OUTCOME MEASURES: The main outcome measures were prenatal diagnosis (effectiveness) and the average number of ultrasounds (resource use). Statistical analyses included linear and logistic regression models to assess trends in resource use and effectiveness of prenatal testing, respectively.nnRESULTS: The average number of ultrasound examinations per pregnancy significantly increased over the study period, from 2.47 in 2006 to 2.98 in 2014 (p=0.005). However, there was no significant increase in the odds of prenatal diagnosis. The probability of prenatal diagnosis was substantially higher for cases associated with a chromosomal anomaly (91.2%) than those without (51.8%). However, there was no evidence of an increase in prenatal detection of either over time.nnCONCLUSIONS: The average number of ultrasound examinations per pregnancy increased over time, whereas the probability of prenatal diagnosis of congenital anomalies did not. Hence, there is a need to implement policies such as high-quality training programmes which can improve the efficiency of ultrasound examinations for prenatal detection of congenital anomalies.
Two-Port Fetoscopic Repair of Myelomeningocele in Fetal Lambs
Guilbaud, Lucie; Roux, Nathalie; Friszer, Stéphanie; Dhombres, Ferdinand; Vialle, Raphaël; Shah, Zoobia; Garabedian, Charles; Bessières, Bettina; Rocco, Federico Di; Zerah, Michel; Jouannic, Jean-Marie
In: Fetal Diagn Ther, vol. 45, no. 1, pp. 36–41, 2019, ISSN: 1421-9964.
@article{pmid29466789,
title = {Two-Port Fetoscopic Repair of Myelomeningocele in Fetal Lambs},
author = {Lucie Guilbaud and Nathalie Roux and Stéphanie Friszer and Ferdinand Dhombres and Raphaël Vialle and Zoobia Shah and Charles Garabedian and Bettina Bessières and Federico Di Rocco and Michel Zerah and Jean-Marie Jouannic},
doi = {10.1159/000485655},
issn = {1421-9964},
year = {2019},
date = {2019-01-01},
journal = {Fetal Diagn Ther},
volume = {45},
number = {1},
pages = {36--41},
abstract = {OBJECTIVE: The aim of this study was to assess the feasibility and the effectiveness of a fetoscopic myelomeningocele (MMC) repair with a running single suture using a 2-port access in the sheep model.nnMETHODS: Eighteen fetuses underwent surgical creation of a MMC defect at day 75. Fetuses were then randomized into 3 groups. Four fetuses remained untreated (control group). In the other 14 fetuses, a prenatal repair was performed at day 90: 7 fetuses had an open repair (oMMC), and 7 fetuses had a fetoscopic repair (fMMC) using a single-layer running suture through a 2-port access. Lambs were sacrificed at term, and histological examinations were performed.nnRESULTS: Hindbrain herniation was observed in all live lambs in the control group. A complete closure of the defect was achieved in all the lambs of the fMMC group. A complete healing of the defect and no hindbrain herniation were observed in all live lambs of the oMMC and fMMC groups. The durations of surgeries were not statistically different between the oMMC and the fMMC groups (60 vs. 53 min, p = 0.40), as was the risk of fetal loss (fMMC: 1/7, oMMC: 3/7, p = 0.56).nnDISCUSSION: Fetoscopic repair of MMC can be performed using a single-layer running suture through a 2-port access and may be promising to reduce the risk of premature rupture of membranes.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: The aim of this study was to assess the feasibility and the effectiveness of a fetoscopic myelomeningocele (MMC) repair with a running single suture using a 2-port access in the sheep model.nnMETHODS: Eighteen fetuses underwent surgical creation of a MMC defect at day 75. Fetuses were then randomized into 3 groups. Four fetuses remained untreated (control group). In the other 14 fetuses, a prenatal repair was performed at day 90: 7 fetuses had an open repair (oMMC), and 7 fetuses had a fetoscopic repair (fMMC) using a single-layer running suture through a 2-port access. Lambs were sacrificed at term, and histological examinations were performed.nnRESULTS: Hindbrain herniation was observed in all live lambs in the control group. A complete closure of the defect was achieved in all the lambs of the fMMC group. A complete healing of the defect and no hindbrain herniation were observed in all live lambs of the oMMC and fMMC groups. The durations of surgeries were not statistically different between the oMMC and the fMMC groups (60 vs. 53 min, p = 0.40), as was the risk of fetal loss (fMMC: 1/7, oMMC: 3/7, p = 0.56).nnDISCUSSION: Fetoscopic repair of MMC can be performed using a single-layer running suture through a 2-port access and may be promising to reduce the risk of premature rupture of membranes.
Jouannic, Jean-Marie; Zerah, Michel; Rigouzzo, Agnès; Guilbaud, Lucie
2019, ISSN: 1471-0528.
@misc{pmid30320496,
title = {Re: Perinatal outcomes after open fetal surgery for myelomeningocele repair: a retrospective cohort study},
author = {Jean-Marie Jouannic and Michel Zerah and Agnès Rigouzzo and Lucie Guilbaud},
doi = {10.1111/1471-0528.15462},
issn = {1471-0528},
year = {2019},
date = {2019-01-01},
journal = {BJOG},
volume = {126},
number = {1},
pages = {130--131},
keywords = {},
pubstate = {published},
tppubtype = {misc}
}
Hernandez, Thibault; Thenard, Thomas; Vergari, Claudio; Robichon, Leopold; Skalli, Wafa; Vialle, Raphaël
In: Orthop Traumatol Surg Res, vol. 104, no. 5, pp. 617–622, 2018, ISSN: 1877-0568.
@article{pmid29908357,
title = {Coronal trunk imbalance in idiopathic scoliosis: Does gravity line localisation confirm the physical findings?},
author = {Thibault Hernandez and Thomas Thenard and Claudio Vergari and Leopold Robichon and Wafa Skalli and Raphaël Vialle},
doi = {10.1016/j.otsr.2018.04.018},
issn = {1877-0568},
year = {2018},
date = {2018-09-01},
journal = {Orthop Traumatol Surg Res},
volume = {104},
number = {5},
pages = {617--622},
abstract = {BACKGROUND: Adolescent idiopathic scoliosis (AIS) can require surgical procedures that have major consequences. Coronal imbalance as assessed clinically using a plumb line is a key criterion for selecting patients to surgery. Nevertheless, the reference standard for assessing postural balance of the trunk is gravity line localisation within a validated frame of reference. Recent studies have established that the gravity line can be localised after body contour reconstruction from biplanar radiographs. The objective of this study was to validate a gravity line localisation method based on biplanar radiographs in a population with AIS then to validate gravity line position versus plumb line position.nnHYPOTHESIS: Plumb line and gravity line assessments of coronal balance correlate with each other.nnMATERIAL AND METHODS: A gravity line localisation method based on biplanar radiography was validated in 14 patients with AIS versus force platform as the method of reference. Normal plumb line and gravity line positions were determined in 27 asymptomatic adolescents using biplanar radiography. The results of the two methods were then compared in 53 patients with AIS.nnRESULTS: The reliability of gravity line localisation in the coronal plane based on biplanar radiography was 2.4mm (95% confidence interval). The distance between the gravity line and the middle of the line connecting the centres of the two femoral heads (HA) showed a strongly significant association with plumb line position computed as the distance from the vertical line through the middle of T1 and the centre of the S1 endplate (T1V/S): r=0.71, p<0.0001. Of the 20 patients with plumb line results indicating coronal imbalance, 11 (55%) had a normal gravity line-to-HA distance. Of the 33 patients with normal plumb line results, 7 (21%) had an abnormal gravity line-to-HA distance.nnCONCLUSION: The results of this study validate gravity line determination from biplanar radiographs in a population with AIS. Plumb line position correlated significantly with gravity line position but was less accurate for guiding surgical decisions.nnLEVEL OF EVIDENCE: IV, retrospective study.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Adolescent idiopathic scoliosis (AIS) can require surgical procedures that have major consequences. Coronal imbalance as assessed clinically using a plumb line is a key criterion for selecting patients to surgery. Nevertheless, the reference standard for assessing postural balance of the trunk is gravity line localisation within a validated frame of reference. Recent studies have established that the gravity line can be localised after body contour reconstruction from biplanar radiographs. The objective of this study was to validate a gravity line localisation method based on biplanar radiographs in a population with AIS then to validate gravity line position versus plumb line position.nnHYPOTHESIS: Plumb line and gravity line assessments of coronal balance correlate with each other.nnMATERIAL AND METHODS: A gravity line localisation method based on biplanar radiography was validated in 14 patients with AIS versus force platform as the method of reference. Normal plumb line and gravity line positions were determined in 27 asymptomatic adolescents using biplanar radiography. The results of the two methods were then compared in 53 patients with AIS.nnRESULTS: The reliability of gravity line localisation in the coronal plane based on biplanar radiography was 2.4mm (95% confidence interval). The distance between the gravity line and the middle of the line connecting the centres of the two femoral heads (HA) showed a strongly significant association with plumb line position computed as the distance from the vertical line through the middle of T1 and the centre of the S1 endplate (T1V/S): r=0.71, p<0.0001. Of the 20 patients with plumb line results indicating coronal imbalance, 11 (55%) had a normal gravity line-to-HA distance. Of the 33 patients with normal plumb line results, 7 (21%) had an abnormal gravity line-to-HA distance.nnCONCLUSION: The results of this study validate gravity line determination from biplanar radiographs in a population with AIS. Plumb line position correlated significantly with gravity line position but was less accurate for guiding surgical decisions.nnLEVEL OF EVIDENCE: IV, retrospective study.
Shear-wave elastography can evaluate annulus fibrosus alteration in adolescent scoliosis
Langlais, Tristan; Vergari, Claudio; Pietton, Raphael; Dubousset, Jean; Skalli, Wafa; Vialle, Raphael
In: Eur Radiol, vol. 28, no. 7, pp. 2830–2837, 2018, ISSN: 1432-1084.
@article{pmid29404767,
title = {Shear-wave elastography can evaluate annulus fibrosus alteration in adolescent scoliosis},
author = {Tristan Langlais and Claudio Vergari and Raphael Pietton and Jean Dubousset and Wafa Skalli and Raphael Vialle},
doi = {10.1007/s00330-018-5309-2},
issn = {1432-1084},
year = {2018},
date = {2018-07-01},
journal = {Eur Radiol},
volume = {28},
number = {7},
pages = {2830--2837},
abstract = {OBJECTIVES: In vitro studies showed that annulus fibrosus lose its integrity in idiopathic scoliosis. Shear-wave ultrasound elastography can be used for non-invasive measurement of shear-wave speed (SWS) in vivo in the annulus fibrosus, a parameter related to its mechanical properties. The main aim was to assess SWS in lumbar annulus fibrosus of scoliotic adolescents and compare it to healthy subjects.nnMETHODS: SWS was measured in 180 lumbar IVDs (L3L4, L4L5, L5S1) of 30 healthy adolescents (13 ± 1.9 years old) and 30 adolescent idiopathic scoliosis patients (13 ± 2 years old, Cobb angle: 28.8° ± 10.4°). SWS was compared between the scoliosis and healthy control groups.nnRESULTS: In healthy subjects, average SWS (all disc levels pooled) was 3.0 ± 0.3 m/s, whereas in scoliotic patients it was significantly higher at 3.5 ± 0.3 m/s (p = 0.0004; Mann-Whitney test). Differences were also significant at all disc levels. No difference was observed between males and females. No correlation was found with age, weight and height.nnCONCLUSION: Non-invasive shear-wave ultrasound is a novel method of assessment to quantitative alteration of annulus fibrosus. These preliminary results are promising for considering shear-wave elastography as a biomechanical marker for assessment of idiopathic scoliosis.nnKEY POINTS: • Adolescent idiopathic scoliosis may have an altered lumbar annulus fibrosus. • Shear-wave elastography can quantify lumbar annulus fibrosus mechanical properties. • Shear-wave speed was higher in scoliotic annulus than in healthy subjects. • Elastography showed potential as a biomechanical marker for characterizing disc alteration.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVES: In vitro studies showed that annulus fibrosus lose its integrity in idiopathic scoliosis. Shear-wave ultrasound elastography can be used for non-invasive measurement of shear-wave speed (SWS) in vivo in the annulus fibrosus, a parameter related to its mechanical properties. The main aim was to assess SWS in lumbar annulus fibrosus of scoliotic adolescents and compare it to healthy subjects.nnMETHODS: SWS was measured in 180 lumbar IVDs (L3L4, L4L5, L5S1) of 30 healthy adolescents (13 ± 1.9 years old) and 30 adolescent idiopathic scoliosis patients (13 ± 2 years old, Cobb angle: 28.8° ± 10.4°). SWS was compared between the scoliosis and healthy control groups.nnRESULTS: In healthy subjects, average SWS (all disc levels pooled) was 3.0 ± 0.3 m/s, whereas in scoliotic patients it was significantly higher at 3.5 ± 0.3 m/s (p = 0.0004; Mann-Whitney test). Differences were also significant at all disc levels. No difference was observed between males and females. No correlation was found with age, weight and height.nnCONCLUSION: Non-invasive shear-wave ultrasound is a novel method of assessment to quantitative alteration of annulus fibrosus. These preliminary results are promising for considering shear-wave elastography as a biomechanical marker for assessment of idiopathic scoliosis.nnKEY POINTS: • Adolescent idiopathic scoliosis may have an altered lumbar annulus fibrosus. • Shear-wave elastography can quantify lumbar annulus fibrosus mechanical properties. • Shear-wave speed was higher in scoliotic annulus than in healthy subjects. • Elastography showed potential as a biomechanical marker for characterizing disc alteration.
[Micturition disorders in children]
Charlanes, Audrey; Lallemant-Dudek, Pauline; Forin, Véronique
In: Rev Prat, vol. 68, no. 6, pp. e249–e254, 2018, ISSN: 0035-2640.
@article{pmid30869274,
title = {[Micturition disorders in children]},
author = {Audrey Charlanes and Pauline Lallemant-Dudek and Véronique Forin},
issn = {0035-2640},
year = {2018},
date = {2018-06-01},
journal = {Rev Prat},
volume = {68},
number = {6},
pages = {e249--e254},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Morel, Baptiste; Moueddeb, Sonia; Blondiaux, Eleonore; Richard, Stephen; Bachy, Manon; Vialle, Raphael; Pointe, Hubert Ducou Le
In: Eur Spine J, vol. 27, no. 5, pp. 1082–1088, 2018, ISSN: 1432-0932.
@article{pmid29340779,
title = {Dose, image quality and spine modeling assessment of biplanar EOS micro-dose radiographs for the follow-up of in-brace adolescent idiopathic scoliosis patients},
author = {Baptiste Morel and Sonia Moueddeb and Eleonore Blondiaux and Stephen Richard and Manon Bachy and Raphael Vialle and Hubert Ducou Le Pointe},
doi = {10.1007/s00586-018-5464-9},
issn = {1432-0932},
year = {2018},
date = {2018-05-01},
journal = {Eur Spine J},
volume = {27},
number = {5},
pages = {1082--1088},
abstract = {PURPOSE: The aim of this study was to compare the radiation dose, image quality and 3D spine parameter measurements of EOS low-dose and micro-dose protocols for in-brace adolescent idiopathic scoliosis (AIS) patients.nnMETHODS: We prospectively included 25 consecutive patients (20 females, 5 males) followed for AIS and undergoing brace treatment. The mean age was 12 years (SD 2 years, range 8-15 years). For each patient, in-brace biplanar EOS radiographs were acquired in a standing position using both the conventional low-dose and micro-dose protocols. Dose area product (DAP) was systematically recorded. Diagnostic image quality was qualitatively assessed by two radiologists for visibility of anatomical structures. The reliability of 3D spine modeling between two operators was quantitatively evaluated for the most clinically relevant 3D radiological parameters using intraclass correlation coefficient (ICC).nnRESULTS: The mean DAP for the posteroanterior and lateral acquisitions was 300 ± 134 and 433 ± 181 mGy cm for the low-dose radiographs, and 41 ± 19 and 81 ± 39 mGy cm for micro-dose radiographs. Image quality was lower with the micro-dose protocol. The agreement was "good" to "very good" for all measured clinical parameters when comparing the low-dose and micro-dose protocols (ICC > 0.73).nnCONCLUSION: The micro-dose protocol substantially reduced the delivered dose (by a factor of 5-7 compared to the low-dose protocol) in braced children with AIS. Although image quality was reduced, the micro-dose protocol proved to be adapted to radiological follow-up, with adequate image quality and reliable clinical measurements. These slides can be retrieved under Electronic Supplementary Material.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: The aim of this study was to compare the radiation dose, image quality and 3D spine parameter measurements of EOS low-dose and micro-dose protocols for in-brace adolescent idiopathic scoliosis (AIS) patients.nnMETHODS: We prospectively included 25 consecutive patients (20 females, 5 males) followed for AIS and undergoing brace treatment. The mean age was 12 years (SD 2 years, range 8-15 years). For each patient, in-brace biplanar EOS radiographs were acquired in a standing position using both the conventional low-dose and micro-dose protocols. Dose area product (DAP) was systematically recorded. Diagnostic image quality was qualitatively assessed by two radiologists for visibility of anatomical structures. The reliability of 3D spine modeling between two operators was quantitatively evaluated for the most clinically relevant 3D radiological parameters using intraclass correlation coefficient (ICC).nnRESULTS: The mean DAP for the posteroanterior and lateral acquisitions was 300 ± 134 and 433 ± 181 mGy cm for the low-dose radiographs, and 41 ± 19 and 81 ± 39 mGy cm for micro-dose radiographs. Image quality was lower with the micro-dose protocol. The agreement was “good” to “very good” for all measured clinical parameters when comparing the low-dose and micro-dose protocols (ICC > 0.73).nnCONCLUSION: The micro-dose protocol substantially reduced the delivered dose (by a factor of 5-7 compared to the low-dose protocol) in braced children with AIS. Although image quality was reduced, the micro-dose protocol proved to be adapted to radiological follow-up, with adequate image quality and reliable clinical measurements. These slides can be retrieved under Electronic Supplementary Material.