Novel Applications and Refinements of Current Imaging Techniques in Perinatal and Childhood Death Investigation

当前成像技术在围产期和儿童死亡调查中的新应用和改进

• 批准号: MR/R002118/1
• 负责人: Susan Cheng Shelmerdine
• 金额: $ 34.91万
• 依托单位: University College London
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2017
• 资助国家: 英国
• 起止时间: 2017 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FR002118%2F1
• 关键词: Novel; Applications; Refinements; Current; Imaging

Background:It is estimated that 1 in 80 pregnancies in the UK will result in a termination or stillbirth due to an abnormality of the baby. An autopsy can provide information on the cause of death and help change management in future pregnancies (1), however many parents refuse this examination as they feel their child has suffered through enough. This means they miss out on valuable information about why their child died and whether future children will suffer a similar fate.'Less invasive' ways for investigating the cause of death using imaging have been pioneered at our institution and shown that by using magnetic resonance imaging (MRI) together with 'key-hole' surgery methods to obtain tissue samples, we get the same answer as autopsy in >90% (2) cases. This method is however expensive and unfortunately not widely available. We believe we can improve on this technique by using ultrasound imaging with needle biopsies which makes fewer and smaller marks to the skin and would be easier to roll-out nationally if it can achieve a similar level of accuracy as a full autopsy.Aims:This study will test how good ultrasound guided needle tissue biopsies are compared to autopsy. We will also investigate how good different imaging tests are when used alone and in combination with tissue samplingMethods:Parents who consent for childhood autopsy will be offered a series of imaging tests and less invasive needle biopsies. We will then compare these results with our current autopsy results and test for any differences in findings. Applications and benefits:Parents tell us that they want the 'minimum necessary' approach to autopsy during this very difficult and emotional time for them. By showing that a less invasive, imaging-led technique is achievable and can give accurate results, we intend to offer parents an alternative method for discovering the cause for their child's death. This means not only offering needle biopsies, but also understanding when imaging alone would be sufficient in coming to a diagnosis.The information gathered by using an alternative, more acceptable method of investigation may help parents in their grieving process by providing closure and understanding for reasons behind their child's death, and help to understand whether future children are at increased risk of similar diseases.Increasing the rate of uptake of this investigation may also mean we can better understand and explore reasons behind why children die. This can help inform public health policies and initiatives in improving maternal and child health. At present not all centres in the UK can offer a less invasive method of investigation. If this research can provide evidence for better practice, we hope this will set the foundations of a new NHS autopsy service. (1) Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: When? Where? Why? Lancet 2005; 365:891-900(2) Thayyil S, Sebire NJ, Chitty LS et al Post-mortem MRI versus conventional autopsy in fetuses and children: a prospective validation study. Lancet 2013; 382: 223-233

背景：据估计，在英国，每80例妊娠中就有1例会因婴儿异常而导致终止妊娠或死胎。尸检可以提供有关死亡原因的信息，并有助于改变未来怀孕的管理[1]，但许多父母拒绝这种检查，因为他们觉得他们的孩子已经遭受了足够的痛苦。这意味着他们错过了关于孩子死亡原因以及未来孩子是否会遭受类似命运的宝贵信息。我们的研究机构率先采用了“微创”的成像方法来调查死因，并表明通过使用磁共振成像（MRI）和“锁孔”手术方法来获取组织样本，我们在>90%（2）的病例中得到了与尸检相同的答案。然而，这种方法是昂贵的，不幸的是，不能广泛使用。我们相信，我们可以通过使用超声成像与针活检，使更少，更小的标记，皮肤，将更容易推出全国如果它可以达到类似的准确性水平，作为一个完整的autoscopy.Aims：这项研究将测试如何良好的超声引导针组织活检相比，尸检。我们还将调查单独使用和与组织取样结合使用时不同的成像检查的效果如何方法：同意儿童尸检的父母将提供一系列成像检查和微创针吸活检。然后，我们将这些结果与我们目前的尸检结果进行比较，并测试结果的任何差异。应用和好处：父母告诉我们，他们希望在这个非常困难和情绪化的时期，他们希望采用“最低限度的必要”尸检方法。通过展示一种侵入性较小的成像技术是可以实现的，并且可以给出准确的结果，我们打算为父母提供一种发现孩子死亡原因的替代方法。这意味着不仅要提供针吸活检，而且要了解何时仅凭成像就足以做出诊断。通过使用替代的、更可接受的调查方法收集的信息可能有助于父母在悲伤的过程中，通过提供关闭和理解孩子死亡背后的原因，并有助于了解未来的儿童是否会增加患类似疾病的风险。增加这项调查的吸收率也可能意味着我们可以更好地理解和探索儿童患类似疾病的原因。死的这有助于为改善孕产妇和儿童健康的公共卫生政策和举措提供信息。目前，并不是所有的中心在英国可以提供一个侵入性较小的调查方法。如果这项研究能够为更好的实践提供证据，我们希望这将为新的NHS尸检服务奠定基础。(1)Lawn JE，Cousens S，Zupan J. 400万新生儿死亡：何时？在哪？在哪？为什么？为什么？《柳叶刀》2005; 365：891-900（2）Thayyil S，Sebire NJ，Chitty LS等Post-mortem MRI versus conventional autopsy in fetus and children：a prospective validation study.柳叶刀2013; 382：223-233

项目成果

Current and future funding streams for paediatric postmortem imaging: European Society of Paediatric Radiology survey results.

• DOI: 10.1007/s00247-022-05485-6
• 发表时间: 2023-03
• 期刊: PEDIATRIC RADIOLOGY
• 影响因子: 2.3
• 作者: Chambers, Greg;Shelmerdine, Susan C.;Aertsen, Michael;Dohna, Martha;Goergen, Stacy K.;Johnson, Karl;Klein, Willemijn M.;Miller, Elka;Paertan, Gerald;Perry, David;Rao, Padma;Robinson, Claire;Stegmann, Joachim;Taranath, Ajay;Whitby, Elspeth;van Rijn, Rick R.;Arthurs, Owen J.
• 通讯作者: Arthurs, Owen J.

Ligamentum arteriosum calcification on paediatric postmortem computed tomography.

儿科尸检计算机断层扫描显示动脉韧带钙化。

• DOI: 10.1007/s00247-020-04839-2
• 发表时间: 2021
• 期刊: Pediatric radiology
• 影响因子: 2.3
• 作者: Davendralingam N

CRAN-32. CASE BASED LEARNING: THREE CENTURIES OF LESSONS FROM TWO CRANIOPHARYNGEOMA PATIENTS

CRAN-32。

• DOI: 10.1093/neuonc/noy059.068
• 发表时间: 2018
• 期刊: Neuro-Oncology
• 影响因子: 15.9
• 作者: Apps J

Central Venous Catheter Malfunction in Children: A Bioengineering Approach.

• DOI: 10.2215/cjn.01470222
• 发表时间: 2022-07
• 期刊: Clinical journal of the American Society of Nephrology : CJASN
• 作者: C. Bruno;Rayan Moumneh;Emilie Sauvage;L. Stronach;K. Waters;I. Simcock;O. Arthurs;S. Schievano;C. Capelli;R. Shroff