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Zhuang J, Liu S, Wang J, Chen Y, Zhang H, Jiang Y, Wang G, Chen C. Prenatal whole exome sequencing identified two rare compound heterozygous variants in EVC2 causing Ellis-van Creveld syndrome. Mol Genet Genomic Med 2023; 11:e2242. [PMID: 37485807 PMCID: PMC10568384 DOI: 10.1002/mgg3.2242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Pathogenic mutations in EVC or EVC2 gene can lead to Ellis-van Creveld (EvC) syndrome, which is a rare autosomal recessive skeletal dysplasia disorder. This study aimed to determine pathogenic gene variations associated with EvC syndrome in fetuses showing ultrasound anomalies. METHODS A 32-year-old pregnant woman from Quanzhou, China was investigated. In her pregnancy examination, the fetus exhibited multiple fetal malformations, including a narrow thorax, short limbs, postaxial polydactyly, cardiac malformations, and separation of double renal pelvis. Karyotype, chromosomal microarray analysis and whole exome sequencing were performed for prenatal genetic etiology analysis. RESULTS Chromosome abnormalities and copy number variants were not observed in the fetus using karyotype and chromosomal microarray analysis. Using whole exome sequencing, two compound heterozygous variants NM_147127.5:c.[2484G>A(p.Trp828Ter)];[871-2_894del] in EVC2 gene were identified in the fetus as pathogenic variants inherited from parents. CONCLUSIONS The study is the first to identify two rare compound variants in EVC2 gene in a Chinese family using whole exome sequencing. The application of whole-exome sequencing would be helpful in fetal etiological diagnosis with ultrasound anomalies.
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Affiliation(s)
- Jianlong Zhuang
- Prenatal Diagnosis CenterQuanzhou Women's and Children's HospitalQuanzhouChina
| | - Shufen Liu
- Department of NeurologyThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouChina
| | - Junyu Wang
- Prenatal Diagnosis CenterQuanzhou Women's and Children's HospitalQuanzhouChina
| | - Yu'e Chen
- Department of UltrasoundQuanzhou Women's and Children's HospitalQuanzhouChina
| | - Hegan Zhang
- Department of GynecologyQuanzhou Women's and Children's HospitalQuanzhouChina
| | - Yuying Jiang
- Prenatal Diagnosis CenterQuanzhou Women's and Children's HospitalQuanzhouChina
| | - Gaoxiong Wang
- Quanzhou Women's and Children's HospitalQuanzhouChina
| | - Chunnuan Chen
- Department of NeurologyThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouChina
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Lin Q, Zhou Y, Shi S, Zhang Y, Yin S, Liu X, Peng Q, Huang S, Jiang Y, Cui C, She R, Xu J, Dong F. How much can AI see in early pregnancy: A multi-center study of fetus head characterization in week 10-14 in ultrasound using deep learning. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 226:107170. [PMID: 36272307 DOI: 10.1016/j.cmpb.2022.107170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/22/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To investigate if artificial intelligence can identify fetus intracranial structures in pregnancy week 11-14; to provide an automated method of standard and non-standard sagittal view classification in obstetric ultrasound examination METHOD AND MATERIALS: We proposed a newly designed scheme based on deep learning (DL) - Fetus Framework to identify nine fetus intracranial structures: thalami, midbrain, palate, 4th ventricle, cisterna magna, nuchal translucency (NT), nasal tip, nasal skin, and nasal bone. Fetus Framework was trained and tested on a dataset of 1528 2D sagittal-view ultrasound images from 1519 females collected from Shenzhen People's Hospital. Results from Fetus Framework were further used for standard/non-standard (S-NS) plane classification, a key step for NT measurement and Down Syndrome assessment. S-NS classification was also tested with 156 images from the Longhua branch of Shenzhen People's Hospital. Sensitivity, specificity, and area under the curve (AUC) were evaluated for comparison among Fetus Framework, three classic DL models, and human experts with 1-, 3- and 5-year ultrasound training. Furthermore, 4 physicians with more than 5 years of experience conducted a reader study of diagnosing fetal malformation on a dataset of 316 standard images confirmed by the Fetus framework and another dataset of 316 standard images selected by physicians. Accuracy, sensitivity, specificity, precision, and F1-Score of physicians' diagnosis on both sets are compared. RESULTS Nine intracranial structures identified by Fetus Framework in validation are all consistent with that of senior radiologists. For S-NS sagittal view identification, Fetus Framework achieved an AUC of 0.996 (95%CI: 0.987, 1.000) in internal test, at par with classic DL models. In external test, FF reaches an AUC of 0.974 (95%CI: 0.952, 0.995), while ResNet-50 arrives at AUC∼0.883, 95% CI 0.828-0.939, Xception AUC∼0.890, 95% CI 0.834-0.946, and DenseNet-121 AUC∼0.894, 95% CI 0.839-0.949. For the internal test set, the sensitivity and specificity of the proposed framework are (0.905, 1), while the first-, third-, and fifth-year clinicians are (0.619, 0.986), (0.690, 0.958), and (0.798, 0.986), respectively. For the external test set, the sensitivity and specificity of FF is (0.989, 0.797), and first-, third-, and fifth-year clinicians are (0.533, 0.875), (0.609, 0.844), and (0.663, 0.781), respectively.On the fetal malformation classification task, all physicians achieved higher accuracy and F1-Score on Fetus selected standard images with statistical significance (p < 0.01). CONCLUSION We proposed a new deep learning-based Fetus Framework for identifying key fetus intracranial structures. The framework was tested on data from two different medical centers. The results show consistency and improvement from classic models and human experts in standard and non-standard sagittal view classification during pregnancy week 11-13+6. CLINICAL RELEVANCE/APPLICATION With further refinement in larger population, the proposed model can improve the efficiency and accuracy of early pregnancy test using ultrasound examination.
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Affiliation(s)
- Qi Lin
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Yuli Zhou
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Siyuan Shi
- Illuminate, LLC, Shenzhen, Guangdong, China; Microport Prophecy, Shanghai, China
| | - Yujuan Zhang
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Shaoli Yin
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Xuye Liu
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Qihui Peng
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Shaoting Huang
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Yitao Jiang
- Illuminate, LLC, Shenzhen, Guangdong, China; Microport Prophecy, Shanghai, China
| | - Chen Cui
- Illuminate, LLC, Shenzhen, Guangdong, China; Microport Prophecy, Shanghai, China.
| | - Ruilian She
- Department of Obstetric, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China.
| | - Jinfeng Xu
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China.
| | - Fajin Dong
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China.
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Chen CP, Chen CY, Chern SR, Su JW, Wang W. First-trimester prenatal diagnosis of Ellis-van Creveld syndrome. Taiwan J Obstet Gynecol 2013; 51:643-8. [PMID: 23276573 DOI: 10.1016/j.tjog.2012.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2012] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To present the perinatal findings and first-trimester molecular and transabdominal ultrasound diagnosis of a fetus with Ellis-van Creveld (EvC) syndrome. CASE REPORT A 35-year-old woman was referred for genetic counseling at 13 weeks of gestation because of a family history of skeletal dysplasia. She had experienced one spontaneous abortion, and delivered one male fetus and one female fetus with EvC syndrome. During this pregnancy, a prenatal transabdominal ultrasound at 13(+4) weeks of gestation revealed a nuchal translucency (NT) thickness of 2.0 mm, an endocardial cushion defect, postaxial polydactyly of bilateral hands, and mesomelic dysplasia of the long bones. Amniocentesis was performed at 13(+5) weeks of gestation. Results of a cytogenetic analysis revealed a karyotype of 46,XX and that of a molecular analysis revealed compound heterozygous mutations of c.1195C>T and c.871-2_894del26 in the EVC2 gene. Prenatal ultrasound at 16 weeks of gestation showed a fetus with short limbs, an endocardial cushion defect, and postaxial polydactyly of bilateral hands. The parents decided to terminate the pregnancy, and a 116-g female fetus was delivered with a narrow thorax, shortening limbs, and postaxial polydactyly of the hands. CONCLUSION Prenatal diagnosis of an endocardial cushion defect with postaxial polydactyly should include a differential diagnosis of EvC syndrome in addition to short rib-polydactyly syndrome, Bardet-Biedl syndrome, orofaciodigital syndrome, Smith-Lemli-Opitz syndrome, and hydrolethalus syndrome.
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Affiliation(s)
- Chih-Ping Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.
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Chen CP, Su YN, Hsu CY, Chern SR, Tsai FJ, Wu PC, Chen PT, Wang W. Ellis-van Creveld syndrome: prenatal diagnosis, molecular analysis and genetic counseling. Taiwan J Obstet Gynecol 2011; 49:481-6. [PMID: 21199751 DOI: 10.1016/s1028-4559(10)60101-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2010] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To present the perinatal findings and molecular genetic analysis of two siblings with Ellis-van Creveld (EvC) syndrome. MATERIALS, METHODS AND RESULTS A 33-year-old woman, gravida 3, para 1, was referred for genetic counseling at 18 gestational weeks because of recurrent fetal skeletal dysplasia. Two years previously, she had delivered a 1,316-g dead male baby at 28 gestational weeks with a karyotype of 46,XY, postaxial polydactyly of the hands, thoracic narrowness, endocardial cushion defects, transposition of the great arteries, shortening of the long bones, malposition of the toes, and hypoplastic nails. During this pregnancy, prenatal ultrasound at 18 gestational weeks revealed shortening of the long bones (equivalent to 15 weeks), postaxial polydactyly of both hands, thoracic narrowness, and endocardial cushion defects. The pregnancy was subsequently terminated, and a 236-g female fetus was delivered with a karyotype of 46,XX, postaxial polydactyly of the hands, thoracic dysplasia, endocardial cushion defects, shortening of the long bones, and malposition of the toes and hypoplastic nails. The phenotype of each of the two siblings was consistent with EVC syndrome. Molecular analysis of the EVC and EVC2 genes revealed heterozygous mutations in the EVC2 gene. A heterozygous deletion mutation of a 26-bp deletion of c.871-2_894del26 encompassing the junction between intron 7 and exon 8 of the EVC2 gene was found in the mother and two siblings, and a heterozygous nonsense mutation of c.1195C >T, p.R399X in exon 10 of the EVC2 gene was found in the father and two siblings. CONCLUSION Prenatal sonographic identification of endocardial cushion defects in association with shortening of the long bones should alert clinicians to the possibility of EvC syndrome and prompt a careful search of hexadactyly of the hands. Molecular analysis of the EVC and EVC2 genes is helpful in genetic counseling in cases with prenatally detected postaxial polydactyly, thoracic narrowness, short limbs and endocardial cushion defects.
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Affiliation(s)
- Chih-Ping Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taichung, Taiwan.
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Bilardo CM, Timmerman E, Pajkrt E, van Maarle M. Increased nuchal translucency in euploid fetuses--what should we be telling the parents? Prenat Diagn 2010; 30:93-102. [PMID: 20077440 DOI: 10.1002/pd.2396] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Nuchal translucency (NT) measurement between 11 and 14 weeks' gestation is an undisputed marker for aneuploidies. When conventional karyotyping is normal, enlarged NT is a strong marker for adverse pregnancy outcome, associated with miscarriage, intrauterine death, congenital heart defects, and numerous other structural defects and genetic syndromes. The risk of adverse outcome is proportional to the degree of NT enlargement. Although the majority of structural anomalies are amenable to ultrasound detection, unspecified genetic syndromes involving developmental delay may only emerge after birth. Concern over these prenatally undetectable conditions is a heavy burden for parents. However, following detection of enlarged NT the majority of babies with normal detailed ultrasound examination and echocardiography will have an uneventful outcome with no increased risk for developmental delay when compared to the general population. Counseling should emphasize this to help parents restore hope in normal pregnancy outcome and infant development.
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Affiliation(s)
- C M Bilardo
- Department of Obstetrics and Gynaecology, Fetal Medicine Unit Academic Medical Centre, Amsterdam, The Netherlands.
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Abstract
Ellis-van Creveld syndrome (EVC) is a chondral and ectodermal dysplasia characterized by short ribs, polydactyly, growth retardation, and ectodermal and heart defects. It is a rare disease with approximately 150 cases reported worldwide. The exact prevalence is unknown, but the syndrome seems more common among the Amish community. Prenatal abnormalities (that may be detected by ultrasound examination) include narrow thorax, shortening of long bones, hexadactyly and cardiac defects. After birth, cardinal features are short stature, short ribs, polydactyly, and dysplastic fingernails and teeth. Heart defects, especially abnormalities of atrial septation, occur in about 60% of cases. Cognitive and motor development is normal. This rare condition is inherited as an autosomal recessive trait with variable expression. Mutations of the EVC1 and EVC2 genes, located in a head to head configuration on chromosome 4p16, have been identified as causative. EVC belongs to the short rib-polydactyly group (SRP) and these SRPs, especially type III (Verma-Naumoff syndrome), are discussed in the prenatal differential diagnosis. Postnatally, the essential differential diagnoses include Jeune dystrophy, McKusick-Kaufman syndrome and Weyers syndrome. The management of EVC is multidisciplinary. Management during the neonatal period is mostly symptomatic, involving treatment of the respiratory distress due to narrow chest and heart failure. Orthopedic follow-up is required to manage the bones deformities. Professional dental care should be considered for management of the oral manifestations. Prognosis is linked to the respiratory difficulties in the first months of life due to thoracic narrowness and possible heart defects. Prognosis of the final body height is difficult to predict.
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Affiliation(s)
- Geneviève Baujat
- Centre de Référence des Maladies Osseuses Constitutionnelles, Hôpital Necker-Enfants Malades, 149 rue de Sèvres 75743, Paris Cedex 15, France
| | - Martine Le Merrer
- Centre de Référence des Maladies Osseuses Constitutionnelles, Hôpital Necker-Enfants Malades, 149 rue de Sèvres 75743, Paris Cedex 15, France
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