Publications by authors named "Elspeth Whitby"

44 Publications

T2*-weighted MRI produces viable fetal "Black-Bone" contrast with significant benefits when compared to current sequences.

Br J Radiol 2021 Jul 21;94(1123):20200940. Epub 2021 May 21.

Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK.

Objectives: Fetal "black bone" MRI could be useful in the diagnosis of various skeletal conditions during pregnancy without exposure to ionizing radiation. Previously suggested susceptibility-weighted imaging (SWI) is not available in the suggested form on all scanners leading to long imaging times that are susceptible to motion artefacts. We aimed to assess if an optimized T2*-weighted GRE sequence can provide viable "black bone" contrast and compared it to other sequences in the literature.

Methods: A retrospective study was conducted on 17 patients who underwent fetal MRI. Patients were imaged with an optimized T2*-weighted GRE sequence, as well as at least one other "black-bone" sequence. Image quality was scored by four blinded observers on a five-point scale.

Results: The T2*-weighted GRE sequence offered adequate to excellent image quality in 63% of cases and scored consistently higher than the three other comparison sequences when comparing images from the same patient. Image quality was found to be dependent on gestational age with good image quality achieved on almost all patients after 26 weeks.

Conclusions: T2*-weighted GRE imaging can provide adequate fetal "black bone" contrast and performs at least as well as other sequences in the literature due to good bone to soft tissue contrast and minimal motion artefacts.

Advances In Knowledge: T2*-weighted fetal "black-bone" imaging can provide excellent bone to soft tissue contrast without using ionizing radiation. It is as good as other "black bone" sequences and may be simpler and more widely implemented, with less motion artefacts.
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http://dx.doi.org/10.1259/bjr.20200940DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8248208PMC
July 2021

"Why didn't we do it"? Reproductive loss and the problem of post-mortem consent.

Soc Sci Med 2021 05 12;276:113835. Epub 2021 Mar 12.

Clinical Senior Lecturer/Honorary Consultant, University of Sheffield, Department of Oncology and Metabolism, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK. Electronic address:

Informed consent has been a much debated topic within the social sciences. It often forms a central feature of discussions on research in medical settings and in social research methods more broadly. While sympathetic to its' underlying principles of autonomy and choice, social scientists have tended to argue that these are seldom enacted in research or clinical practice. Rather, such principles are often circumscribed by wider social structures and by a culture of medical dominance. Drawing on data from a qualitative study on perinatal post-mortem, this paper explores informed consent in the emotionally charged clinical arena of perinatal pathology. Our in-depth analysis will provide fresh insight into post-mortem decision-making in the sensitive arena of baby loss. Our findings show how parents often found it difficult to give consent for post-mortem, and also for professionals to take consent from parents. It was also not uncommon for parents to experience regret over non-consent later on. One of our key findings, however, related to the sense of emotional and diagnostic closure often afforded by post-mortem when consent had been given. We conclude by arguing that, although we cannot resolve the tension between the principles of consent and their enactment in practice, we can develop a reflexive approach with which to navigate the process. In doing so, the paper contributes to wider sociological discussions on the meaning and use of informed consent in various settings beyond medical contexts.
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http://dx.doi.org/10.1016/j.socscimed.2021.113835DOI Listing
May 2021

Current state of perinatal postmortem magnetic resonance imaging: European Society of Paediatric Radiology questionnaire-based survey and recommendations.

Pediatr Radiol 2021 May 23;51(5):792-799. Epub 2020 Dec 23.

Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK.

Background: Postmortem magnetic resonance imaging (MRI) in perinatal and childhood deaths is increasingly used as a noninvasive adjunct or alternative to autopsy. Imaging protocols vary between centres and consensus guidelines do not exist.

Objective: Our aim was to develop practical, standardised recommendations for perinatal postmortem MRI.

Materials And Methods: Recommendations were based on the results of two surveys regarding local postmortem MRI practices sent electronically to all 14 members of the European Society of Paediatric Radiology (ESPR) Postmortem Imaging Task Force and 17 members of the International Society of Forensic Radiology and Imaging Task Force (25 different centres).

Results: Overall, 11/14 (78.6%) respondents from different institutions perform postmortem MRI. All of these centres perform postmortem MRI for perinatal and neonatal deaths, but only 6/11 (54.5%) perform imaging in older children.

Conclusion: We propose a clinical standard for postmortem MRI sequences plus optional sequences for neuroimaging and cardiac anatomy depending on available scanning time and referral indications.
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http://dx.doi.org/10.1007/s00247-020-04905-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055569PMC
May 2021

Computed tomography chest imaging offers no advantage over chest X-ray in the initial assessment of gestational trophoblastic neoplasia.

Br J Cancer 2021 Mar 16;124(6):1066-1071. Epub 2020 Dec 16.

Department of Automatic Control and Systems Engineering, The University of Sheffield, Mappin Street, Sheffield, S1 3JD, UK.

Background: The International Federation of Gynaecology and Obstetrics (FIGO) score identifies gestational trophoblastic neoplasia (GTN) patients as low- or high-risk of single-agent chemotherapy resistance (SACR). Computed tomography (CT) has greater sensitivity than chest X-ray (CXR) in detecting pulmonary metastases, but effects upon outcomes remain unclear.

Methods: Five hundred and eighty-nine patients underwent both CXR and CT during GTN assessment. Treatment decisions were CXR based. The number of metastases, risk scores, and risk category using CXR versus CT were compared. CT-derived chest assessment was evaluated as impact upon treatment decision compared to patient outcome, incidence of SACR, time-to-normal human chorionic gonadotrophin hormone (TNhCG), and primary chemotherapy resistance (PCR).

Results: Metastasis detection (p < 0.0001) and FIGO score (p = 0.001) were higher using CT versus CXR. CT would have increased FIGO score in 188 (31.9%), with 43 re-classified from low- to high-risk, of whom 23 (53.5%) received curative single-agent chemotherapy. SACR was higher when score (p = 0.044) or risk group (p < 0.0001) changed. Metastases on CXR (p = 0.019) but not CT (p = 0.088) lengthened TNhCG. Logistic regression analysis found no difference between CXR (area under the curve (AUC) = 0.63) versus CT (AUC = 0.64) in predicting PCR.

Conclusions: CT chest would improve the prediction of SACR, but does not influence overall treatment outcome, TNhCG, or prediction of PCR. Lower radiation doses and cost mean ongoing CXR-based assessment is recommended.
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http://dx.doi.org/10.1038/s41416-020-01206-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7961138PMC
March 2021

Visualisation of fetal meconium on post-mortem magnetic resonance imaging scans: a retrospective observational study.

Acta Radiol Open 2020 Nov 19;9(11):2058460120970541. Epub 2020 Nov 19.

Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield, Sheffield, UK.

Background: Less invasive techniques for fetal post-mortems are increasingly used to correlate with parental wishes. With the use of post-mortem magnetic resonance imaging (MRI), normal appearance of the organs must be established.

Purpose: To investigate the after death appearance of the fetal meconium throughout gestation using the hyperintense appearance of meconium on T1 weighted MRI.

Material And Methods: This was a retrospective study that took place in a tertiary referral centre radiology department. Sixty-two fetal body post-mortem MRI scans (January 2014 to May 2018) between 12 and 41 weeks gestation were reviewed. Signal intensity of meconium at the rectum, sigmoid colon, splenic flexure and hepatic flexure was evaluated and correlated with gestational age. Interrater reliability was calculated.

Results: Meconium did not consistently have high signal intensity on T1 scans and was not always obvious. Rectal meconium had the highest intensity, and the more proximal the bowel the lower the intensity. The meconium had higher intensity at earlier gestations. Interrater reliability for rectal meconium gradings was excellent.

Conclusion: This study provides the first published primary research on the appearance of fetal meconium on post-mortem MRI. Overall, results were variable and suggest an alteration of bowel contents after death, but further investigation is needed to effectively inform practice.
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http://dx.doi.org/10.1177/2058460120970541DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7683848PMC
November 2020

Biometric analysis of the foetal meconium pattern using T1 weighted 2D gradient echo MRI.

BJR Open 2020 5;2(1):20200032. Epub 2020 Aug 5.

Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, United Kingdom.

Objectives: Foetal MRI is used to assess abnormalities after ultrasonography. Bowel anomalies are a significant cause of neonatal morbidity, however there are little data concerning its normal appearance on antenatal MRI. This study aims to investigate the pattern of meconium accumulation throughout gestation using its hyperintense appearance on weighted scans and add to the current published data.

Methods: This was a retrospective cohort study in a tertiary referral clinical MRI centre. Foetal body MRI scans of varying gestational ages were obtained dating between October 2011 and March 2018. The bowel was visualised on weighted images. The length of the meconium and the width of the meconium at the rectum, sigmoid colon, splenic flexure and hepatic flexure was measured. Presence or absence of meconium in the small bowel was noted. Inter- and intrarater reliability was assessed.

Results: 181 foetal body scans were reviewed. 52 were excluded and 129 analysed. Visualisation of the meconium in the large bowel became increasingly proximal with later gestations, and small bowel visualisation was greater at earlier gestations. There was statistically significant strong ( = 0.6-0.8) or very strong ( = 0.8-1.0) positive correlation of length and width with increasing gestation. Interrater reliability was moderate to excellent ( = 0.4-1.0).

Conclusion: This study provides new information regarding the pattern of meconium accumulation throughout gestation. With care, the results can be used in clinical practice to aid diagnosis of bowel pathology.

Advances In Knowledge: The findings of this study provide further information concerning the normal accumulation of foetal meconium on MR imaging, an area where current research is limited.
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http://dx.doi.org/10.1259/bjro.20200032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594886PMC
August 2020

Benefits and Limitations of the Minimally Invasive Postmortem: A Review of an Innovative Service Development.

Pediatr Dev Pathol 2020 Nov-Dec;23(6):431-437. Epub 2020 Sep 21.

Histopathology Department, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, UK.

Introduction: Pediatric postmortem (PM) rates have significantly declined, creating a need for effective minimally invasive alternatives to correlate with parental wishes. We review the use of a minimally invasive fetal and neonatal PM service further to preliminary findings published in 2015.

Materials And Methods: Cases taken from the mortuary electronic database from 2012 to 2017 are analyzed. The minimally invasive service consisted primarily of external examination, magnetic resonance imaging (MRI), and placental examination. Any significant conditions found noted. All pathology reports include a levant ndition at ath (ReCoDe) obstetric classification. Reports analyzed to determine which aspects of the service provided positive information.

Results: Of 1498 perinatal postmortems, 105 (7%) were PM MRI, of which 75.24% were intrauterine fetal deaths. Relevant conditions were identified in 94 cases (89.52%), and ReCoDe categories in 80 cases (76.19%). Moreover, 90% of cases had a ReCoDe condition, with 10% unclassified. Seven cases had more than 1 ReCoDe. Main conditions related to placenta (32.5%) and umbilical cord (27.5%). The most informative elements were placental examination and MRI.

Conclusion: Minimally invasive PMs are a viable alternative to traditional autopsy when this option is refused. However, further case analysis is needed to determine potential bias toward certain classification codes.
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http://dx.doi.org/10.1177/1093526620956797DOI Listing
September 2020

Joint European Society of Paediatric Radiology (ESPR) and International Society for Forensic Radiology and Imaging (ISFRI) guidelines: paediatric postmortem computed tomography imaging protocol.

Pediatr Radiol 2019 05 28;49(5):694-701. Epub 2019 Feb 28.

Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK.

Postmortem CT for investigating childhood deaths is increasingly utilised as a noninvasive adjunct or alternative to standard autopsy; however there are no standardised published imaging protocols. This article describes a standardised imaging protocol that has been developed based on current practices of international postmortem imaging practitioners and experts. This recommendation is expected to be useful for postmortem imaging centres wishing to update their existing practices and for those starting paediatric postmortem CT as a new service.
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http://dx.doi.org/10.1007/s00247-018-04340-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459792PMC
May 2019

How to obtain diagnostic planes of the fetal central nervous system using three-dimensional ultrasound and a context-preserving rendering technology.

Am J Obstet Gynecol 2019 03 14;220(3):215-229. Epub 2018 Nov 14.

Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, UK; Department of Development and Regeneration, KU Leuven, Belgium. Electronic address:

The antenatal evaluation of the fetal central nervous system (CNS) is among the most difficult tasks of prenatal ultrasound (US), requiring technical skills in relation to ultrasound and image acquisition as well as knowledge of CNS anatomy and how this changes with gestation. According to the International Guidelines for fetal neurosonology, the basic assessment of fetal CNS is most frequently performed on the axial planes, whereas the coronal and sagittal planes are required for the multiplanar evaluation of the CNS within the context of fetal neurosonology. It can be even more technically challenging to obtain "nonaxial" views with 2-dimensional (2D) US. The modality of 3-dimensional (3D) US has been suggested as a panacea to overcome the technical difficulties of achieving nonaxial views. The lack of familiarity of most sonologists with the use of 3D US and its related processing techniques may preclude its use even where it could play an important role in complementing antenatal 2D US assessment. Furthermore, once a 3D volume has been acquired, proprietary software allows it to be processed in different ways, leading to multiple ways of displaying and analyzing the same anatomical imaging or plane. These are difficult to learn and time consuming in the absence of specific training. In this article, we describe the key steps for volume acquisition of a 3D US volume, manipulation, and processing with reference to images of the fetal CNS, using a newly developed context-preserving rendering technique.
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http://dx.doi.org/10.1016/j.ajog.2018.11.1088DOI Listing
March 2019

Visualising uncertainty: Examining women's views on the role of Magnetic Resonance Imaging (MRI) in late pregnancy.

Soc Sci Med 2016 09 14;164:19-26. Epub 2016 Jul 14.

University of Sheffield, Academic Unit of Reproductive and Developmental Medicine, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK. Electronic address:

Prenatal screening occupies a prominent role within sociological debates on medical uncertainty. A particular issue concerns the limitations of routine screening which tends to be based on risk prediction. Computer assisted visual technologies such as Magnetic Resonance Imaging (MRI) are now starting to be applied to the prenatal realm to assist in the diagnosis of a range of fetal and maternal disorders (from problems with the fetal brain to the placenta). MRI is often perceived in popular and medical discourse as a technology of certainty and truth. However, little is known about the use of MRI as a tool to confirm or refute the diagnosis of a range of disorders in pregnancy. Drawing on qualitative research with pregnant women attending a fetal medicine clinic in the North of England this paper examines the potential role that MRI can play in mediating pregnancy uncertainty. The paper will argue that MRI can create and manage women's feelings of uncertainty during pregnancy. However, while MRI may not always provide women with unequivocal answers, the detailed information provided by MR images combined with the interpretation and communication skills of the radiologist in many ways enables women to navigate the issue. Our analysis of empirical data therefore highlights the value of this novel technological application for women and their partners. It also seeks to stress the merit of taking a productive approach to the study of diagnostic uncertainty, an approach which recognises the concepts dual nature.
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http://dx.doi.org/10.1016/j.socscimed.2016.07.012DOI Listing
September 2016

ESPR postmortem imaging task force: where we begin.

Pediatr Radiol 2016 Aug 13;46(9):1363-9. Epub 2016 Jul 13.

Radiology Department, National Women's Health and Starship Children's Hospital, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand.

A new task force on postmortem imaging was established at the annual meeting of the European Society of Paediatric Radiology (ESPR) in Graz, Austria, in 2015. The postmortem task force is separate from the child abuse task force as it covers all aspects of fetal, neonatal and non-forensic postmortem imaging. The main focus of the task force is the guidance and standardization of non-radiographic postmortem imaging, particularly postmortem CT and postmortem MRI. This manuscript outlines the starting point of the task force, with a mission statement, outline of current experience, and short- and long-term goals.
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http://dx.doi.org/10.1007/s00247-016-3639-2DOI Listing
August 2016

The MRI features of placental adhesion disorder-a pictorial review.

Br J Radiol 2016 Sep 29;89(1065):20160284. Epub 2016 Jun 29.

2 University of Sheffield and Sheffield Teaching Hospitals Foundation Trust, Jessop Wing, Sheffield, UK.

Placental adhesion disorder (PAD) comprises placenta accreta, increta and percreta lesions; these are classified according to the depth of uterine invasion. Although PAD is considered a rare condition, its incidence has increased 10-fold in the last 50 years. Ultrasound is the primary imaging modality for the assessment of the placenta and in the majority of cases, it is sufficient for diagnosis; however, when ultrasound findings are suspicious or inconclusive, MRI is recommended as an adjunct imaging technique. Numerous MRI features of PAD have been described, including dark intraplacental bands, disorganized intraplacental vascularity and abnormal uterine bulging. This pictorial review describes and illustrates these characteristics and discusses their implications in planning delivery. In addition, we present a series of "pitfall" cases to aid the interpreting radiologist and discuss management of PAD. PAD is a clinical and diagnostic challenge that is encountered with increasing frequency, requiring a cohesive multidisciplinary approach to its management.
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http://dx.doi.org/10.1259/bjr.20160284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5124928PMC
September 2016

Estimation of trabecular bone parameters in children from multisequence MRI using texture-based regression.

Med Phys 2016 Jun;43(6):3071-3079

The Academic Unit of Radiology, The University of Sheffield, Sheffield S10 2JF, United Kingdom.

Purpose: This paper presents a statistical approach for the prediction of trabecular bone parameters from low-resolution multisequence magnetic resonance imaging (MRI) in children, thus addressing the limitations of high-resolution modalities such as HR-pQCT, including the significant exposure of young patients to radiation and the limited applicability of such modalities to peripheral bones in vivo.

Methods: A statistical predictive model is constructed from a database of MRI and HR-pQCT datasets, to relate the low-resolution MRI appearance in the cancellous bone to the trabecular parameters extracted from the high-resolution images. The description of the MRI appearance is achieved between subjects by using a collection of feature descriptors, which describe the texture properties inside the cancellous bone, and which are invariant to the geometry and size of the trabecular areas. The predictive model is built by fitting to the training data a nonlinear partial least square regression between the input MRI features and the output trabecular parameters.

Results: Detailed validation based on a sample of 96 datasets shows correlations >0.7 between the trabecular parameters predicted from low-resolution multisequence MRI based on the proposed statistical model and the values extracted from high-resolution HRp-QCT.

Conclusions: The obtained results indicate the promise of the proposed predictive technique for the estimation of trabecular parameters in children from multisequence MRI, thus reducing the need for high-resolution radiation-based scans for a fragile population that is under development and growth.
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http://dx.doi.org/10.1118/1.4950713DOI Listing
June 2016

Non-central nervous system fetal magnetic resonance imaging.

Semin Fetal Neonatal Med 2015 Jun 23;20(3):130-7. Epub 2015 May 23.

Medical Imaging and Medical Physics, Radiology, Royal Hallamshire Hospital, Sheffield, UK.

Fetal magnetic resonance imaging (MRI) is currently offered in a limited number of centers but is predominantly used for suspected fetal central nervous system abnormalities. This article concentrates on the role of the different imaging sequences and their value to clinical practice. It also discusses the future of fetal MRI.
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http://dx.doi.org/10.1016/j.siny.2015.04.001DOI Listing
June 2015

Running a postmortem service--a business case and clinical experience.

Pediatr Radiol 2015 Apr 1;45(4):501-8. Epub 2015 Apr 1.

Academic Unit of Child Health, Sheffield Children's NHS Foundation Trust, University of Sheffield, Western Bank, Sheffield, S10 2TH, UK.

The purpose of the postmortem examination is to offer answers to explain the cause and manner of death. In the case of perinatal, infant and paediatric postmortem examinations, the goal is to identify unsuspected associated features, to describe pathogenic mechanisms and new conditions, and to evaluate the clinical management and diagnosis. Additionally, the postmortem examination is useful to counsel families regarding the probability of recurrence in future pregnancies and to inform family planning. Worldwide the rate of paediatric autopsy examinations has significantly declined during the last few decades. Religious objections to postmortem dissection and organ retention scandals in the United Kingdom provided some of the impetus for a search for non-invasive alternatives to the traditional autopsy; however, until recently, imaging studies remained an adjunct to, rather than a replacement for, the traditional autopsy. In 2012, Sheffield Children's Hospital National Health Service Foundation Trust set up the service provision of minimally invasive fetal, perinatal and neonatal autopsy, while a postmortem imaging service has been running in Melbourne, Australia, since 2008. Here we summarise the essentials of a business case and practical British and Australian experiences in terms of the pathological and radiologic aspects of setting up a minimally invasive clinical service in the United Kingdom and of developing a clinical postmortem imaging service as a complementary tool to the traditional autopsy in Australia.
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http://dx.doi.org/10.1007/s00247-014-3156-0DOI Listing
April 2015

Initial experiences of a minimally invasive autopsy service. A report of the techniques and observations in the first 11 cases.

Pediatr Dev Pathol 2015 Jan-Feb;18(1):24-9. Epub 2014 Nov 11.

1 Academic Unit of Reproductive & Developmental Medicine, Department of Human Metabolism, University of Sheffield, Jessop Wing, Tree Root Walk, Sheffield S10 1SF, United Kingdom.

Our goal was to set up a clinical service for minimally invasive postmortem examination for the fetal and neonatal age group. The minimally invasive service consisted of imaging, external review, placental examination, and ancillary tests that form part of the formal autopsy process. Eleven patients had imaging and relevant conditions at death successfully determined with the minimally invasive service. We conclude that a minimally invasive autopsy service for fetal and neonatal cases is possible and acceptable to patients and professionals.
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http://dx.doi.org/10.2350/14-06-1503-OA.1DOI Listing
March 2015

Funding resources for junior paediatric radiology clinical scientists: where should they look?

Authors:
Elspeth H Whitby

Pediatr Radiol 2014 Nov 21;44(11):1342-4. Epub 2014 Oct 21.

University of Sheffield and Sheffield Teaching Hospitals Foundation Trust, 4th Floor, Jessop Wing, Tree Root Walk, Sheffield, S10 1SF, United Kingdom,

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http://dx.doi.org/10.1007/s00247-014-3046-5DOI Listing
November 2014

Fetal demise on MRI.

Authors:
Elspeth H Whitby

Pediatr Radiol 2011 Dec 27;41(12):1598; author reply 1599. Epub 2011 Oct 27.

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http://dx.doi.org/10.1007/s00247-011-2284-zDOI Listing
December 2011

Is there a causal relationship between open spinal dysraphism and Chiari II deformity? A study using in utero magnetic resonance imaging of the fetus.

Neurosurgery 2012 Apr;70(4):890-8; discussion 898-9

Academic Unit of Radiology, University of Sheffield, Sheffield, United Kingdom.

Background: Chiari II deformity is associated with open spinal dysraphism. A causal relationship has been proposed by McLone and Knepper. This article evaluates that hypothesis.

Objective: To establish the frequency of Chiari II deformity in fetuses with open spinal dysraphism, assess whether meningocele sac neck area and volume influence the severity of posterior fossa changes, and assess whether the severity of associated findings (ventriculomegaly, amount of extracerebral CSF) are associated with Chiari II deformity.

Methods: Sixty-five fetuses with open spinal dysraphism were compared with gestationally aged matched "normal" fetuses on ultrafast MR images. Cerebellar vermis and bony posterior fossa surface area were measured on midline sagittal images. Hindbrain herniation was noted if present. In the open spinal dysraphic group, sac neck area and volume were measured. Ventriculomegaly was assessed by linear measurement of the trigone of the lateral ventricle and extracerebral CSF depth was measured maximally over the lateral surface of the cerebral hemispheres.

Results: Fifteen of 65 fetuses with open spinal dysraphism did not have Chiari II deformity. Neck area and volume of the sac did not correlate with the presence of Chiari II deformity or reduction in bony posterior fossa size.

Conclusion: A relatively high proportion of fetuses with open spinal dysraphism do not have Chiari II deformity in utero. There is a lack of correlation between indicators of spinal dysraphism severity and the extent of the posterior fossa abnormality. This raises some interesting questions about the causality of the Chiari II deformity.
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http://dx.doi.org/10.1227/NEU.0b013e318237a6c1DOI Listing
April 2012

Recurrent pseudo-TORCH appearances of the brain presenting as "Dandy-Walker" malformation.

Pediatr Dev Pathol 2012 Jan-Feb;15(1):45-9. Epub 2011 Jul 15.

Department of Histopathology, Sheffield Children's NHS Foundation Trust, Sheffield, S10 2TH, UK.

Dandy-Walker malformation (DWM) is a developmental abnormality characterized by cystic dilatation of the fourth ventricle, complete or partial agenesis of the cerebellar vermis, and enlarged posterior fossa with upward displacement of the lateral sinuses, tentorium, and torcula. Calcification of brain tissue is a feature of congenital infection, particularly those involving the TORCH ( Toxoplasma gondii , rubella virus, Cytomegalovirus, and herpesvirus) group. An autosomal-recessive congenital infection-like syndrome with intracranial and extracranial calcifications has been categorized as pseudo-TORCH syndrome. We describe two male siblings diagnosed as DWM by ultrasound and by in utero and postmortem magnetic resonance imaging (MRI) but in whom the neuropathology revealed features of intracranial necrosis and calcification in the absence of extracranial calcific deposition. The fetal anomaly was identified by routine prenatal ultrasound scan at 16 weeks. In both cases the postmortem MRI showed bilateral ventriculomegaly with distortion of the overlying cortices, enlarged posterior fossa with a cyst related to small cerebellar hemispheres, and an incomplete cerebellar vermis. The diagnosis of DWM was offered. The histology revealed hypoplastic cerebral hemispheres with poorly cellular developing cortex. The white matter and periventricular matrix were disrupted by areas of necrosis and calcification not associated with any inflammatory infiltration, organisms, inclusions, or giant cells. To our knowledge, these two male siblings are the 1st cases that show pseudo-TORCH syndrome with distinctive intracranial calcification presenting as DWM. An autosomal-recessive or X-linked inheritance needs to be considered. Our study confirms the relevance of the multidisciplinary teamwork involved in the diagnosis of these complex cases.
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http://dx.doi.org/10.2350/10-01-0783-CR.1DOI Listing
May 2012

Neuro-developmental outcome at 18 months in premature infants with diffuse excessive high signal intensity on MR imaging of the brain.

Pediatr Radiol 2011 Oct 17;41(10):1284-92. Epub 2011 Jun 17.

Department of Neonatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.

Background: Diffuse excessive high signal intensity (DEHSI) may represent damage to the white matter in preterm infants, but may be best studied alongside quantitative markers. Limited published data exists on its neuro-developmental implications.

Objective: The purpose of this study was to assess whether preterm children with DEHSI at term-corrected age have abnormal neuro-developmental outcome.

Materials And Methods: This was a prospective observational study of 67 preterm infants with MRI of the brain around term-equivalent age, including diffusion-weighted imaging (DWI). Images were reported as being normal, overtly abnormal or to show DEHSI. A single observer placed six regions of interest in the periventricular white matter and calculated the apparent diffusion coefficients (ADC). DEHSI was defined as (1) high signal on T2-weighted images alone, (2) high signal with raised ADC values or (3) raised ADC values independent of visual appearances. The neuro-development was assessed around 18 months' corrected age using the Bayley Scales of Infant and Toddler Development (3rd Edition). Standard t tests compared outcome scores between imaging groups.

Results: No statistically significant difference in neuro-developmental outcome scores was seen between participants with normal MRI and DEHSI, regardless of which definition was used.

Conclusion: Preterm children with DEHSI have similar neuro-developmental outcome to those with normal brain MRI, even if the definition includes objective markers alongside visual appearances.
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http://dx.doi.org/10.1007/s00247-011-2155-7DOI Listing
October 2011

Magnetic resonance imaging of the fetus.

Dev Med Child Neurol 2011 Jan 18;53(1):18-28. Epub 2010 Nov 18.

Department of Obstetrics and Gynaecology, Jessop Wing, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.

Fetal magnetic resonance imaging (MRI) has become established as part of clinical practice in many centres worldwide especially when visualization of the central nervous system pathology is required. In this review we summarize the recent literature and provide an overview of fetal development and the commonly encountered fetal pathologies visualized with MRI and illustrated with numerous MR images. We aim to convey the role of fetal MRI in clinical practice and its value as an additional investigation alongside ultrasound yet emphasize the need for caution when interpreting fetal MR images especially where experience is limited.
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http://dx.doi.org/10.1111/j.1469-8749.2010.03813.xDOI Listing
January 2011

Neonatal cochlear function: measurement after exposure to acoustic noise during in utero MR imaging.

Radiology 2010 Dec 27;257(3):802-9. Epub 2010 Sep 27.

Academic Unit of Radiology, University of Sheffield, Royal Hallamshire Hospital, Glossop Rd, C Floor, Sheffield S10 2JF, England.

Purpose: To establish whether fetal exposure to the operating noise of 1.5-T magnetic resonance (MR) imaging is associated with cochlear injury and subsequent hearing loss in neonates.

Materials And Methods: The study was performed with local research ethics committee approval and written informed parental consent. Neonatal hearing test results, including otoacoustic emission (OAE) data, were sought for all neonates delivered in Sheffield who had previously undergone in utero MR imaging between August 1999 and September 2007. The prevalence of hearing impairment in these neonates was determined, with corresponding 95% confidence intervals calculated by using the binomial exact method, and mean OAE measurements were compared with anonymized local audiometric reference data by using the t test.

Results: One hundred three neonates who had undergone in utero MR imaging were identified; 96 of them had completed hearing screening assessment. Thirty-four of these babies were admitted to the neonatal intensive care unit (NICU), and one of them had bilateral hearing impairment. The prevalence of hearing impairment was 1% (one of 96; 95% confidence interval: 0.03%, 5.67%), which is in accordance with the prevalence expected, given the high proportion of babies in this study who had been in the NICU (ie, NICU graduates). In addition, for the well babies, there was no significant difference in mean OAE cochlear response compared with that for a reference data set of more than 16,000 OAE results. When NICU graduates were included in the comparison, a significant difference (P = .002) was found in one of four frequency bands used to analyze the cochlear response; however, this difference was small compared with the normal variation in OAE measurements.

Conclusion: The findings in this study provide some evidence that exposure of the fetus to 1.5-T MR imaging during the second and third trimesters of pregnancy is not associated with an increased risk of substantial neonatal hearing impairment.
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http://dx.doi.org/10.1148/radiol.10092366DOI Listing
December 2010

Subdural hemorrhage, intradural hemorrhage and hypoxia in the pediatric and perinatal post mortem: are they related? An observational study combining the use of post mortem pathology and magnetic resonance imaging.

Forensic Sci Int 2010 Jul 26;200(1-3):100-7. Epub 2010 May 26.

Histopathology Department, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, Yorkshire S10 2TH, UK.

Background And Purpose: Controversies exist over the causes of intradural hemorrhages (IDH), subdural hemorrhages (SDH) and hypoxia. SDH is a recognised finding at perinatal and pediatric autopsy. We describe the occurrence of IDH, SDH, and hypoxia in these deaths using a combined approach of post mortem magnetic resonance imaging (PM MRI), autopsy examination and histology.

Material And Methods: Forty-two cases (1 day to 4 years, mean 6.9 months) underwent PM MRI and autopsy. Two further children (8 and 32 month of age) underwent autopsy only. MRI was conducted with a 1.5 T Magnet with fast spin-echo T2 weighted images, the images were assessed for the presence of SDH, hypoxia and structural abnormalities. Hypoxia was defined by a low signal in the ventrolateral thalami and peri-rolandic regions on MRI. Edema was interpreted as early acute hypoxia. On histology, hypoxia was defined by the presence of hypoxic neurons.

Results: IDH was seen histologically in 35/39 cases: diffuse in 17 and focal in 18. On the PM MRI focal IDH was not distinguished, and DIDH was only retrospectively suggested as a low signal around the venous sinuses or prominent venous sinuses, predominantly in the posterior falx and tentorium. Confident identification on the MRI was not possible. 12/17 cases with DIDH were less than a week old. SDH was seen in 11 cases on PM MRI. SDH was seen at autopsy in the same 11 cases and in the 2 cases where no PM MRI was performed. DIDH was seen in all these cases on histological examination (except in 1 case where the dura had not been sampled). Acute hypoxia was present in 14/42 cases both on histology and MRI. In 1 case changes of hypoxia were seen on MRI only. In 7 cases the hypoxia was seen on histology only. 12/13 cases with SDH had features of hypoxia. Of the cases with DIDH on histology 14/17 had hypoxia (on MRI, histology, or both).

Conclusion: IDH and SDH are frequent findings in the perinatal and pediatric autopsy. SDH was associated with a DIDH and was also frequently associated with hypoxia. Focal IDH was not identified at the PM MRI; it was associated with hypoxia (on MRI and/or on histology) in less than a quarter of cases. Our results exhibit an association between IDH, SDH and hypoxia in children dying of natural causes. The highest incidence is seen in the perinatal period.
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http://dx.doi.org/10.1016/j.forsciint.2010.03.036DOI Listing
July 2010

Appearances of diffuse excessive high signal intensity (DEHSI) on MR imaging following preterm birth.

Pediatr Radiol 2010 Aug 24;40(8):1390-6. Epub 2010 Mar 24.

Department of Neonatology, Jessop Wing, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK.

Background: Diffuse damage to the periventricular white matter has recently been suggested to be a cause of the cognitive deficits seen following preterm birth. It is unclear whether this form of injury can be visualised on MR imaging, but one group has described diffuse excessive high signal intensity (DEHSI) as a possible form of diffuse white matter injury. This finding is dependent on window imaging and the subjective assessment of the reviewer, but little data have been published on the degree of subjectivity on its appearance among raters.

Objective: To assess the subjectivity of DEHSI on conventional and ultrafast T2-weighted MR imaging following preterm birth.

Materials And Methods: An observational study of 40 preterm infants who had MR imaging of the brain around term-equivalent age, including conventional fast spin-echo (FSE) and ultrafast single-shot fast spin-echo (SSFSE) T2-weighted sequences in the axial plane. Images were anonymised and scored twice by four observers for the presence of DEHSI. Inter- and intra-observer agreement were calculated.

Results: Sixty-five percent of conventional and 100% of the ultrafast images were of diagnostic quality. DEHSI was noted in between 0% and 69.2% of conventional images and 27.5-90% of the ultrafast images. Inter- and intra-observer agreement ranged from none to moderate.

Conclusion: The visual appearances of DEHSI on conventional FSE and ultrafast SSFSE T2-W images are highly subjective, limiting its clinical application.
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http://dx.doi.org/10.1007/s00247-010-1633-7DOI Listing
August 2010

Diffusion-weighted imaging of cerebral white matter and the cerebellum following preterm birth.

Dev Med Child Neurol 2010 Jul 28;52(7):652-9. Epub 2010 Jan 28.

Department of Neonatology, Sheffield Teaching Hospital NHS Foundation Trust, Tree Root Walk, Sheffield, UK.

Aim: The aim of this study was to determine if apparent diffusion coefficients (ADCs) generated with diffusion-weighted imaging of cerebral white matter and the cerebellum are affected by white matter damage.

Method: Seventy-two preterm infants (32 males, 40 females; mean gestational age at birth 30.3 wks, SD 3.0 wks; mean birthweight 1458g, SD 534g) underwent magnetic resonance imaging of the brain around term-equivalent age and were categorized into three groups: normal, overt abnormality, and diffuse excessive high signal intensity (DEHSI). ADC values were calculated from cerebral white matter, cerebellar hemispheres, and cerebellar midline, and were compared between groups. Regression analysis identified clinical parameters correlated with ADC values.

Results: Imaging was normal in 27 infants, and revealed overt abnormalities in 14 and DEHSI in 31. ADC values did not differ between groups. ADC values from cerebral white matter were negatively correlated with the number of episodes of postnatal sepsis (p=0.002). ADC values from cerebellar hemispheres (p=0.007) and cerebellar midline (p=0.036) correlated with gestational age at birth.

Interpretation: ADC values from white matter are not altered in preterm infants with DEHSI but are negatively correlated with the number of episodes of postnatal sepsis. ADC values in the cerebellum are not altered by white matter damage, but are affected by preterm birth itself.
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http://dx.doi.org/10.1111/j.1469-8749.2009.03590.xDOI Listing
July 2010

Minimally invasive autopsy.

Authors:
Elspeth Whitby

Lancet 2009 Aug;374(9688):432-3

Unit of Academic Radiology, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.

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http://dx.doi.org/10.1016/S0140-6736(09)61433-1DOI Listing
August 2009

Magnetic resonance imaging and developmental outcome following preterm birth: review of current evidence.

Dev Med Child Neurol 2008 Sep;50(9):655-63

Neonatal Intensive Care Unit, Jessop Wing, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.

Preterm birth is associated with an increased risk of developmental difficulties. Magnetic resonance imaging (MRI) is increasingly being used to identify damage to the brain following preterm birth. It is hoped this information will aid prognostication and identify neonates who would benefit from early therapeutic intervention. Cystic periventricular white matter damage has traditionally been associated with abnormal motor developmental and cerebral palsy, but its presence on MRI does not preclude normal cognitive development. This has led to increasing interest in the identification of diffuse periventricular white matter damage with conventional and sophisticated MRI. However, the correlation between these appearances and developmental outcome remains unclear. Measurements of the size, volumes, and growth rates of many regions of the brain, such as the corpus callosum, ventricular system, cortex, deep grey matter, and cerebellum, are all also altered following preterm birth, but there is insufficient evidence to use this data in the clinical setting. This article is a review of the current evidence on MRI and developmental outcome, suggesting possible indications for the use of MRI following preterm birth.
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http://dx.doi.org/10.1111/j.1469-8749.2008.03050.xDOI Listing
September 2008

Cranial vault defects: the description of three cases that illustrate a spectrum of anomalies.

Pediatr Dev Pathol 2009 Mar-Apr;12(2):96-102. Epub 2008 Apr 28.

Sheffield Children's Hospital, Western Bank Sheffield, UK.

Three cases of cranial vault defects in fetuses are described. All 3 cases underwent postmortem examination, and in 2 of them postmortem magnetic resonance imaging was also performed. The phenotypical differences between the cases illustrate a spectrum of cranial vault defects, associated anomalies, and pathogenic mechanisms involved in the etiology of this rare malformation. All 3 cases were male, and the cranial vault defects corresponded to exencephaly with acrania/acalvaria caused by amniotic band syndrome, acalvaria, and acrania presenting in a chorangiopagus parasiticus twin.
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http://dx.doi.org/10.2350/08-02-0415.1DOI Listing
April 2009

Less invasive autopsy: benefits and limitations of the use of magnetic resonance imaging in the perinatal postmortem.

Pediatr Dev Pathol 2008 Jan-Feb;11(1):1-9

Department of Histopathology, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield S10 2TH, United Kingdom.

The decline in the postmortem (PM) autopsy rate in the United Kingdom paralleled the change in public perception of this procedure after the organ retention crisis in 2000. The introduction of magnetic resonance imaging (MRI) in the fetal, perinatal, and pediatric autopsy led some investigators to propose that MRI could replace the conventional PM. We assessed the role of MRI in fetal autopsy as an addition or a potential replacement method to the conventional PM and to evaluate the benefits and limitations of each technique. We retrospectively reviewed the PM and MRI examination of 100 fetuses. The MRI was limited to the brain or brain and spinal cord. Forty-six cases involved termination of pregnancy; 30 were intrauterine fetal deaths/stillbirths; 16 were premature deliveries followed by neonatal death; and 8 were miscarriages. The mean gestational age of all cases was 25.54 weeks (range: 13-41 weeks). In 54 of the 90 full PMs, there was a complete agreement between the MRI and autopsy findings on the morphology of the brain and spine. Despite this agreement, the information gained at the PM was relevant to find the cause or mechanism of death in 20 of 54 cases (37%). In 24 autopsies the MRI added valuable information to the autopsy. However, if MRI had been the only investigation, essential information would have been lost in 17 of 24 cases (71%). In 12 cases the PM was clearly superior to the MRI. The integrated result obtained from the traditional autopsy remains crucial in determining the cause or mechanism of the malformation or of the fetal/perinatal death and accordingly is important for the counseling offered to parents regarding the recurrence risk for future pregnancies.
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http://dx.doi.org/10.2350/07-01-0213.1DOI Listing
April 2008
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