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Panwar J, Tolend M, Kirkhus E, Meyers AB, Redd B, Sudol-Szopinska I, Varma N, Inarejos Clemente EJ, Colbert RA, Akikusa J, Appenzeller S, Carrino JA, Herregods N, Highmore K, Jans L, Jaremko JL, von Kalle T, van Rossum MA, Rumsey DG, Srinivasalu H, Stimec J, Tse SM, Twilt M, Tzaribachev N, Doria AS. Reliability assessment of the OMERACT whole-body magnetic resonance imaging scoring system for juvenile idiopathic arthritis. Semin Arthritis Rheum 2024; 66:152437. [PMID: 38564998 DOI: 10.1016/j.semarthrit.2024.152437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 04/04/2024]
Abstract
Inter-reader reliability of a new scoring system for evaluating joint inflammation and enthesitis in whole body MRI (WBMRI) in juvenile idiopathic arthritis was tested. The scoring system grades 732 item-region combinations of bone marrow and soft tissue changes for commonly involved joints and entheseal sites. Five radiologists rated 17 WBMRI scans through an online rating platform. Item-wise reliability was calculated for 117 items with non-zero scores in >10 % of readings. Interquartile ranges of the five-reader Kappa reliability coefficients were 0.58-0.73 (range: 0.36-0.88) for the joints, 0.65-0.81 (range: 0.39-0.95) for the entheses, and 0.62-0.75 (range: 0.60-0.76) for chronic nonbacterial osteomyelitis-like lesions.
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Affiliation(s)
- Jyoti Panwar
- Department of Medical Imaging, The Tweed Hospital, Tweed Heads, NSW, Australia. Lumus Imaging, Brisbane, Queensland, Australia
| | - Mirkamal Tolend
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Eva Kirkhus
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Arthur B Meyers
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, United States
| | - Bernadette Redd
- Department of Radiology, Clinical Center, NIH, Bethesda, Maryland, United States
| | - Iwona Sudol-Szopinska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Nisha Varma
- Department of Medical Imaging, The Royal Children's Hospital, Murdoch Children's Research Institute and Department of Medical Imaging, Western Health, Melbourne, Australia
| | | | - Robert A Colbert
- Pediatric Translational Research Branch, National Institute of Arthritis, Musculoskeletal and Skin Diseases, NIH, Bethesda, MD, United States
| | - Jonathan Akikusa
- Rheumatology Service, Department of General Medicine, Royal Children's Hospital Melbourne, Australia
| | - Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology, School of Medical Science, University of Campinas, Campinas, Brazil
| | - John A Carrino
- Department of Radiology, Hospital for Special Surgery, New York, United States
| | - Nele Herregods
- Department of Radiology, Ghent University, Ghent, Belgium
| | - Kerri Highmore
- Department of Radiology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Lennart Jans
- Department of Radiology, Ghent University, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology & Diagnostic Imaging, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Thekla von Kalle
- RadiologischesInstitut, Olga Hospital Klinikum, Stuttgart, Germany
| | - Marion A van Rossum
- Amsterdam Rheumatology and Immunology Center, Reade, and Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Dax G Rumsey
- Division of Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Hemalatha Srinivasalu
- Pediatric Translational Research Branch, National Institute of Arthritis, Musculoskeletal and Skin Diseases, NIH, Bethesda, MD, United States; Division of Rheumatology, Children's National Hospital and George Washington University School of Medicine, Washington, DC, United States
| | - Jennifer Stimec
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Shirley M Tse
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Marinka Twilt
- Department of Pediatrics, Section of Rheumatology, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Andrea S Doria
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
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Gladkikh M, Benchimol EI, Mack DR, Mojaverian N, Highmore K, Miller E, Davila J. MR Enterography Scores Correlate with Degree of Mucosal Healing in Pediatric Crohn's Disease: A Pilot Study. J Can Assoc Gastroenterol 2023; 6:125-130. [PMID: 37273972 PMCID: PMC10235592 DOI: 10.1093/jcag/gwad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Objectives MR enterography (MRE) Index of Activity (MaRIA) and Clermont are validated scores that correlate with Crohn's disease (CD) activity; however, the Clermont score has not been validated to correlate with the degree of change in mucosal inflammation post induction treatment in children. This pilot study evaluated if MaRIA and Clermont scores can serve as surrogates to ileocolonoscopy for assessing interval change in mucosal inflammation in pediatric CD post-induction treatment. Methods Children with known or newly diagnosed ileocolonic CD starting or changing therapy underwent ileocolonoscopy, scored with simple endoscopic score for Crohn's disease (SES-CD), and MRE on the same day at two time points (Week 0 and 12). Accuracy of global MaRIA and Clermont indices relative to ileocolonoscopy in detecting degree of post-treatment interval change in mucosal inflammation was assessed through correlational coefficients (r). Inter-reader agreement was calculated for imaging scores through intraclass correlation (ICC). Results Sixteen children (mean age 11.5 ± 2.8) were evaluated. Global MaRIA/Clermont correlated with SES-CD in detecting the degree of change in mucosal inflammation (r = 0.676 and r = 0.677, P < 0.005, respectively). Correlation for pooled timepoint assessments between SES-CD and global MaRIA/Clermont was moderate (r = 0.546, P < 0.001 and r = 0.582, P < 0.001, respectively). Inter-rater reliability for global MaRIA and Clermont was good (ICC = 0.809 and ICC = 0.768, respectively, P < 0.001). Conclusions MRE-based global scores correlate with endoscopic indices and may be used to monitor disease changes in children with CD undergoing induction treatment, which can advise the physician if treatment changes should be made.
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Affiliation(s)
- Maria Gladkikh
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medical Imaging, McMaster University, Hamilton, Ontario, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - David R Mack
- Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Nassim Mojaverian
- Institute for Clinical Evaluative Sciences, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kerri Highmore
- Department of Medical Imaging, CHEO, Ottawa, Ontario, Canada
- Faculty of Medicine, Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Elka Miller
- Department of Medical Imaging, CHEO, Ottawa, Ontario, Canada
- Faculty of Medicine, Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Jorge Davila
- Correspondence: Jorge Davila, MD, FRCPC, Department of Medical Imaging, CHEO, 401 Smyth Road, Ottawa, Ontario K1H 8L1, Canada, e-mail:
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Abouassaly M, Blumetti FC, Gauthier L, Willis RB, Kontio K, Highmore K, Abdeen N, Plint AC, Tse S, Barrowman N, Moroz PJ. Are 2 Radiographic Views As Good as 3 Views to Diagnose Ankle Fractures in Children and Adolescents? Pediatr Emerg Care 2022; 38:e1508-e1511. [PMID: 35947061 DOI: 10.1097/pec.0000000000002810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Ankle radiographs are among the most commonly obtained trauma images in the pediatric population, with the standard 3 views (AP/mortise [M]/lateral [L]) routinely ordered in the emergency department. The purpose of this study was to compare the diagnostic accuracy, sensitivity, and specificity of sets of 2 views (AP/L or M/L) with the standard 3 views. METHODS One hundred twenty sets of ankle radiographs of skeletally immature patients obtained in the emergency department of a level 1 pediatric trauma center were used. These included sets with and without fractures. Sets of 3 and 2 views were reviewed by pairs of pediatric-trained orthopedic surgeons, radiologists, and emergency physicians. Each completed 3 randomized viewing sessions where all possible combinations for each set of radiographs were reviewed. Diagnoses for the 3 sets of views were compared for accuracy, sensitivity, and specificity. RESULTS Overall accuracy, sensitivity, and specificity for all reviewers were as follows: AP/M/L 74%, 94%, and 90%, AP/L 71%, 90%, and 94%, as well as M/L 69%, 90%, and 91%. P values for accuracy, sensitivity, and specificity of AP/L and M/L compared with 3 views were 0.34, 0.04, and 0.52, as well as 0.04, 0.004, and 1.00, respectively. CONCLUSIONS In skeletally immature patients, statistically significant differences in accuracy were obtained when comparing the standard 3 AP/M/L views with more limited M/L views, suggesting that this set of 2 views is not as accurate. Differences in sensitivity of limited views were also statistically significant. Conversely, differences in accuracy between the standard 3 views and AP/Lateral views were not statistically significant. While more limited AP/L views may be comparable in accuracy and specificity and lead to dramatically decreased radiation and costs, this can be at the expense of less diagnostic sensitivity and increased risk of misdiagnosing or missing certain fractures. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | | | | | - Ken Kontio
- Dr Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Kerri Highmore
- Dr Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Nishard Abdeen
- Dr Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Sandy Tse
- Dr Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Nick Barrowman
- Dr Children's Hospital of Eastern Ontario, Ottawa, Canada
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Wolter NE, Vilchez-Madrigal LD, Gorodensky Jh JH, Greer MLC, Peer S, Highmore K, Padfield N, Holowka S, Propst EJ. Predicting Maximal Costal Cartilage Graft Size for Laryngotracheal Reconstruction. Laryngoscope 2021; 132:1682-1686. [PMID: 34687469 DOI: 10.1002/lary.29914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/28/2021] [Accepted: 10/06/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Current methods of assessing rib cartilage dimensions for laryngotracheal reconstruction (LTR) are inexact, making surgical planning difficult. The purpose of this study was to determine the most appropriate rib for costal cartilage graft LTR to minimize the number of ribs harvested and improve surgical outcomes. STUDY DESIGN Retrospective review. METHODS Computed tomography imaging of chest scans in 25 children aged 1 to 18 years was evaluated. The lengths and widths of medial and lateral cartilaginous segments of ribs 4 to 7 were measured bilaterally. Right and left cartilaginous rib dimensions were compared using a two-sample t-test. Linear mixed-effect regression was performed to develop models quantifying the relationship between rib size and patient height, rib side, and rib number. RESULTS Regression analysis established strong models for medial rib length (R2 = 0.89) and for medial and lateral rib width (R2 = 0.71, 0.77, respectively). There was no difference in rib dimensions across chest sides. Rib length and width increased with child height. Total cartilaginous rib length increased from superiorly to inferiorly, primarily due to an increase in the dimensions of the medial portion of each rib. CONCLUSION Cartilaginous rib lengths and widths were associated with patient height, with taller children having longer ribs. Inferior ribs were longer than superior ribs, suggesting that inferior ribs may be preferred for LTR. There was no difference in cartilaginous rib length across chest side. Results may help surgeons with preoperative planning. LEVEL OF EVIDENCE Not applicable Laryngoscope, 2021.
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Affiliation(s)
- Nikolaus E Wolter
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Luis D Vilchez-Madrigal
- Department of Otolaryngology-Head and Neck Surgery, National Children's Hospital, San José, Costa Rica
| | - Jonah H Gorodensky Jh
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Shazia Peer
- Red Cross War Memorial Children's Hospital, Cape Town, South Africa.,Division of Otorhinolaryngology, Head and Neck Surgery, University of Cape Town, Cape Town, South Africa
| | - Kerri Highmore
- Department of Radiology, Division of pediatric radiology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Nancy Padfield
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Holowka
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Evan J Propst
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Panwar J, Patel H, Tolend M, Akikusa J, Herregods N, Highmore K, Inarejos Clemente EJ, Jans L, Jaremko JL, von Kalle T, Kirkhus E, Meyers AB, van Rossum MA, Rumsey DG, Stimec J, Tse SM, Twilt M, Tzaribachev N, Doria AS. Toward Developing a Semiquantitative Whole Body-MRI Scoring for Juvenile Idiopathic Arthritis: Critical Appraisal of the State of the Art, Challenges, and Opportunities. Acad Radiol 2021; 28:271-286. [PMID: 32139304 DOI: 10.1016/j.acra.2020.01.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 01/05/2020] [Accepted: 01/15/2020] [Indexed: 12/18/2022]
Abstract
With powerful new therapies available for management of juvenile idiopathic arthritis (JIA), early diagnosis leading to appropriate treatment may prevent long-term structural joint damage. Although magnetic resonance imaging (MRI) is typically used to assess individual body parts, indications for whole body (WB) MRI are increasing. Its utility as a diagnostic and monitoring tool has already been widely investigated in adult rheumatology patients, but less so in pediatric rheumatologic patients. This paper is a comprehensive review of scoring systems and a proposal for the conceptual development of a WB-MRI scoring system for the evaluation of JIA. In this review we identify, summarize, and critically appraise the available literature on the use of WB-MRI in inflammatory arthritis, addressing relevant considerations on components of a classification system that can lead to the development of a future pediatric WB-MRI scoring system for use in children with JIA. We also discuss advantages and challenges of developing such a WB-MRI scoring system for assessment of JIA and outline next steps toward the conceptual development of this scoring system.
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Affiliation(s)
- Jyoti Panwar
- Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Hiten Patel
- Department of Radiology, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Mirkamal Tolend
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Jonathan Akikusa
- Department of Radiology, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Nele Herregods
- Department of Radiology, Ghent University, Ghent, Belgium
| | - Kerri Highmore
- Department of Radiology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Lennart Jans
- Department of Radiology, Ghent University, Ghent, Belgium
| | | | - Thekla von Kalle
- RadiologischesInstitut, Olga hospital Klinikum, Stuttgart, Germany
| | - Eva Kirkhus
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Arthur B Meyers
- Department of Radiology, Nemours Children's Hospital, Orlando, Florida, United States
| | - Marion A van Rossum
- Amsterdam Rheumatology and immunology Center, Reade, and Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Dax G Rumsey
- Division of Rheumatology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Stimec
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Shirley M Tse
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marinka Twilt
- Department of Pediatrics, Division of rheumatology, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Andrea S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
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Cassim R, Van Walraven C, Lavallée LT, McAlpine K, Highmore K, Leonard MP, Guerra L, Grandpierre V, Vethamuthu J, Keays MA. Systematic radiologic detection of kidney stones in Canadian children: a new era of asymptomatic stones? J Pediatr Urol 2019; 15:467.e1-467.e7. [PMID: 31235439 DOI: 10.1016/j.jpurol.2019.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 05/12/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Asymptomatic, or incidental, pediatric kidney stones detected on abdominal imaging pose a clinical challenge as their significance and expected outcome are not well described. OBJECTIVE Our primary objective was to estimate the incidence of nephrolithiasis in pediatric patients undergoing abdominal ultrasound (US) or computerized tomography (CT), for all indications, in a pediatric tertiary care hospital. Our secondary objective was to determine the clinical outcome of these radiographically detected stones. METHODS All abdominal US or CT radiology reports for patients younger than 18 years between January 1, 2011, and December 31, 2016, were retrieved. Reports were automatically flagged using textual analysis if they contained one of the 32 keywords potentially indicating nephrolithiasis. Flagged reports, as well as 10% of unflagged reports, were reviewed to confirm the radiologist impression of presence or absence of stones. Patient and stone-related clinical data were extracted. RESULTS Two thousand four hundred forty-nine (5%) of 53 235 imaging reports cited at least one of the keywords. Manual review of flagged reports identified 498 studies having a radiologist impression of stones (244 unique patients). Stone incidence in children undergoing abdominal imaging more than doubled between 2011 and 2016. Medical record review found that 140 patients (57%) were symptomatic, while the other 104 patients (43%) were asymptomatic. Spontaneous resolution was greater (57% vs 34%) in asymptomatic patients compared to symptomatic patients. Asymptomatic patients were younger with a median age of 0.6 compared to 12.3 years. Asymptomatic and symptomatic stones were followed up for similar lengths of time (2.3 vs 2.0 years, p > 0.05) and had a similar number of follow-up USs (3.9 vs 4.6 studies, p > 0.05). CONCLUSIONS The incidence of radiologically identified stones in children undergoing abdominal imaging at our center increased over time. Asymptomatic stones follow a benign course with minimal need for intervention; however, they were detected almost as frequently as symptomatic stones. Asymptomatic stones may represent increased healthcare resource utilization due to similar follow-up compared to symptomatic stones. Further research regarding the optimal imaging intervals and long-term follow-up for asymptomatic stones is warranted.
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Affiliation(s)
- R Cassim
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Canada
| | - C Van Walraven
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Canada; Institute for Clinical Evaluative Sciences, Canada
| | - L T Lavallée
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Canada
| | - K McAlpine
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Canada
| | - K Highmore
- Department of Medical Imaging, Children's Hospital of Eastern Ontario, University of Ottawa, Canada
| | - M P Leonard
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Canada
| | - L Guerra
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Canada
| | - V Grandpierre
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Canada
| | - J Vethamuthu
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Canada
| | - M A Keays
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Canada.
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Shapira-Zaltsberg G, Miller E, Martinez-Rios C, Bass J, Goldbloom EB, Tang K, Hayawi L, Highmore K. Comparison of the diagnostic performance of the 2017 ACR TI-RADS guideline to the Kwak guideline in children with thyroid nodules. Pediatr Radiol 2019; 49:862-868. [PMID: 31154502 DOI: 10.1007/s00247-019-04385-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/06/2019] [Accepted: 03/08/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND The Kwak Thyroid Imaging Reporting and Data System (Kwak-TI-RADS) guideline (2011) and American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) guideline (2017) were developed as ultrasound (US) risk stratification tools for detecting thyroid malignancy in adults. OBJECTIVE The purpose of this study was to investigate the inter-rater reliability and diagnostic performance of the ACR TI-RADS guideline in the pediatric population and compare it to the Kwak guideline. MATERIALS AND METHODS This retrospective study comprised 75 children who underwent thyroid US at a tertiary-level pediatric hospital. Three pediatric radiologists and one pediatric radiology fellow graded the US findings using the Kwak-TI-RADS and ACR TI-RADS guidelines. We assessed reliability of radiologists' ratings using percentage inter-rater agreement, and intra-class correlation coefficients (ICC2,1). We assessed area-under-the-receiver-operating-characteristic curve (AUROCC) to compare the discriminative diagnostic ability of the Kwak-TI-RADS and ACR TI-RADS scoring systems against histopathology/cytology, or stability on US over a 2-year follow-up period for cases without tissue diagnosis. RESULTS The inter-rater agreement was significantly better for the ACR TI-RADS level compared to the Kwak-TI-RADS level (P<0.001) using the percentage pairwise agreement. The ROC curves for assessing the diagnostic performance of the two methods showed no significant difference between the methods. The AUROCCs for the Kwak-TI-RADS and ACR TI-RADS levels were 0.74 (95% confidence interval [CI] 0.67-0.82) and 0.72 (95% CI 0.61-0.82), respectively. CONCLUSION Both the Kwak-TI-RADS and ACR TI-RADS guidelines provide moderate malignancy risk stratification for thyroid nodules in the pediatric population, with better inter-rater agreement for the ACR TI-RADS guideline. Further work to adjust the recommendations for pediatric patients is necessary.
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Affiliation(s)
- Gali Shapira-Zaltsberg
- Department of Medical Imaging, CHEO, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada. .,University of Ottawa, Ottawa, ON, Canada.
| | - Elka Miller
- Department of Medical Imaging, CHEO, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.,University of Ottawa, Ottawa, ON, Canada
| | - Claudia Martinez-Rios
- Department of Medical Imaging, CHEO, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.,University of Ottawa, Ottawa, ON, Canada
| | - Juan Bass
- University of Ottawa, Ottawa, ON, Canada.,Department of General Surgery, CHEO, Ottawa, ON, Canada
| | - Ellen B Goldbloom
- University of Ottawa, Ottawa, ON, Canada.,Department of Endocrinology, CHEO, Ottawa, ON, Canada
| | - Ken Tang
- University of Ottawa, Ottawa, ON, Canada.,Research Institute, CHEO, Ottawa, ON, Canada
| | - Lamia Hayawi
- University of Ottawa, Ottawa, ON, Canada.,Research Institute, CHEO, Ottawa, ON, Canada
| | - Kerri Highmore
- Department of Medical Imaging, CHEO, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.,University of Ottawa, Ottawa, ON, Canada
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8
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Shapira-Zaltsberg G, Highmore K. Synovial osteochondromatosis in a 14-year-old boy with a history of Legg-Calve-Perthes disease. Radiol Case Rep 2017; 12:405-408. [PMID: 28491198 PMCID: PMC5417737 DOI: 10.1016/j.radcr.2017.01.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 01/05/2017] [Accepted: 01/13/2017] [Indexed: 11/23/2022] Open
Abstract
We describe a case of a 14-year-old boy with a history of Legg–Calve–Perthes disease diagnosed at the age of 6 years and development of synovial osteochondromatosis of the same hip joint 7 years later. Synovial osteochondromatosis is very rare in children, and to the best of our knowledge, only a single case of Legg–Calve–Perthes disease and secondary synovial osteochondromatosis was described in the literature in a 35-year-old male, making this the first reported case of Legg–Calve–Perthes disease with development of synovial osteochondromatosis in a pediatric patient.
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9
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White BG, Williams SJ, Highmore K, Macphee DJ. Small heat shock protein 27 (Hsp27) expression is highly induced in rat myometrium during late pregnancy and labour. Reproduction 2005; 129:115-26. [PMID: 15615903 DOI: 10.1530/rep.1.00426] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The underlying mechanisms that regulate uterine contractions during labour are still poorly understood. A candidate regulatory protein is heat shock protein 27 (Hsp27). It belongs to the small heat shock protein family and can regulate actin cytoskeleton dynamics, act as a chaperone, and may regulate contractile protein activation. As a result, we hypothesized that Hsp27 expression would be highly induced during late pregnancy and labour. Hsp27 mRNA expression was significantly elevated (P <0.05) on days 17 to 22 of gestation. In addition, immunoblot analysis demonstrated that detection of total Hsp27 increased (P <0.05) between day 21 and 1 day post-partum (PP) inclusive. Since phosphorylation of Hsp27 has been reported to be a prerequisite for smooth muscle contraction, we examined the temporal and spatial expression of Ser-15 phosphorylated Hsp27. Immunoblot analysis showed that the detection of Ser-15 phosphorylated Hsp27 significantly increased (P <0.05) between days 19 and 23 (active labour) inclusive, in parallel with detection of total Hsp27. Immunocytochemical analysis of Ser-15 phosphorylated Hsp27 expression in situ demonstrated that phosphorylated Hsp27 in circular muscle became detectable in peri-nuclear and membrane regions on days 19 to 22, but was primarily restricted to the cytoplasm on days 23 to PP. In contrast, phosphorylated Hsp27 in longitudinal muscle was primarily detected in myocyte membranes on days 15 to 22, and then also became detectable in the cytoplasm of myocytes on days 23 and PP. Our results demonstrate that Hsp27 expression is highly upregulated during late pregnancy and labour and suggest that Hsp27 is a potential candidate contraction-associated protein.
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Affiliation(s)
- B G White
- Division of Basic Medical Sciences, Health Sciences Centre, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada A1B 3V6
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