Andrea S Doria

University of Toronto, Toronto, Ontario, Canada

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Publications (93)210 Total impact

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    ABSTRACT: Our aim was to test the feasibility of blood oxygen level dependent magnetic resonance imaging (BOLD MRI) and dynamic contrast-enhanced (DCE) MRI to monitor periarticular hypoxic/inflammatory changes over time in a juvenile rabbit model of arthritis.
    European Radiology 09/2014; · 4.34 Impact Factor
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    ABSTRACT: To assess the sequence and type of active joints in a cohort of newly diagnosed juvenile idiopathic arthritis (JIA) patients with full access to current treatment at first visit and during a follow-up period of 5-years, in order to identify an index joint/group of joints for magnetic resonance imaging in JIA. Patient charts of all consecutive newly diagnosed JIA patients with a follow-up duration of at least 5 years were analyzed. Patients were derived from two tertiary pediatric rheumatology centers. Patient characteristics and data concerning the presence of joints with arthritis and the use of medication were recorded. Findings from 95 JIA patients [39 (41 %) oligoarticular and 56 (59 %) polyarticular] were analyzed. At first visit, distribution of active joints among patients was as follows: knee (n = 70, 74 %), ankle (n = 55, 58 %), elbow (n = 23, 24 %), wrist (n = 23, 24 %), metacarpophalangeal (MCP) (n = 20, 21 %), proximal interphalangeal (PIP) (n = 13, 14 %), hip (n = 6, 6 %), shoulder (n = 5, 5 %), and distal interphalangeal (DIP) (n = 4, 4 %) joints. After a follow-up period of 5 years, the cumulative percentage of patients with specific joint involvement changed into: knee (n = 88, 93 %), ankle (n = 79, 83 %), elbow (n = 43, 45 %), wrist (n = 38, 40 %), MCP (n = 36, 38 %), PIP (n = 29, 31 %), shoulder (n = 20, 21 %), hip (n = 17, 19 %), and DIP (n = 9, 10 %) joints. Despite changes in treatment strategies over the years, the knee remains the most commonly involved joint at onset and during follow-up in JIA, followed by the ankle, elbow, and wrist. For the evaluation of outcome with MRI, the knee appears the most appropriate joint in JIA.
    Rheumatology International 08/2014; · 2.21 Impact Factor
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    ABSTRACT: Dual-energy absorptiometry (DXA) is the current reference standard for assessing pediatric osteoporosis; however due to its areal nature, it has limitations. Thus, quantitative ultrasound (QUS), a modality free of ionizing radiation, has been proposed as a potential surrogate for DXA.
    Pediatric Radiology 06/2014; · 1.57 Impact Factor
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    ABSTRACT: Traumatic lumbar punctures with blasts (TLP+) in children with acute lymphoblastic leukaemia (ALL) obscure central nervous system status and are associated with a poorer event-free survival (EFS). We conducted a retrospective cohort study of all lumbar punctures (LPs) for children with ALL diagnosed at our institution from 2005 to 2009. We utilised random-effects and fixed-effects repeated-measures logistic regression analyses to identify risk factors for TLPs. Fixed-effects models use each patient as his or her own control. We used survival analysis to describe outcomes after a TLP+. 264 children underwent 5267 evaluable lumbar punctures (LPs), of which 944 (17.9%) were traumatic. In the multivariable random-effects model, variables significantly associated with TLPs were age <1year (odds ratio (OR) 3.46, 95% confidence interval (CI) 2.06-5.81) or age ⩾10years (OR 2.00, CI 1.66-2.40); body mass index percentile ⩾95 (OR 1.44, CI 1.19-1.75); platelet count <100×10(3)/μL (OR 1.49, CI 1.08-20.7); fewer days since previous LP (OR 5.13, CI 2.34-11.25 for ⩾16days versus 0-3days); and a preceding TLP (OR 1.43, CI 1.19-1.73). In the fixed-effects model, image-guidance reduced the odds of TLP (OR 0.55, CI 0.32-0.95). The 5-year EFS (±SE) for children with TLP+ (77±8%) was significantly lower than for children with CNS1 status (93±2%; p=0.002). The frequency of TLP remains high. Consistent with previous studies, a TLP+ at diagnosis was associated with a poorer EFS. These risk factors can allow identifying interventions to reduce TLPs and directing interventions to those at highest risk.
    European journal of cancer (Oxford, England: 1990) 03/2014; · 4.12 Impact Factor
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    ABSTRACT: Recent advances in hemophilia prophylaxis have raised the need for accurate noninvasive methods for assessment of early cartilage damage in maturing joints to guide initiation of prophylaxis. Such methods can either be semiquantitative or quantitative. Whereas semiquantitative scores are less time-consuming to be performed than quantitative methods, they are prone to subjective interpretation. To test the feasibility of a manual segmentation and a quantitative methodology for cross-sectional evaluation of articular cartilage status in growing ankles of children with blood-induced arthritis, as compared with a semiquantitative scoring system and clinical-radiographic constructs. Twelve boys, 11 with hemophilia (A, n = 9; B, n = 2) and 1 with von Willebrand disease (median age: 13; range: 6-17), underwent physical examination and MRI at 1.5 T. Two radiologists semiquantitatively scored the MRIs for cartilage pathology (surface erosions, cartilage loss) with blinding to clinical information. An experienced operator applied a validated quantitative 3-D MRI method to determine the percentage area of denuded bone (dAB) and the cartilage thickness (ThCtAB) in the joints' MRIs. Quantitative and semiquantitative MRI methods and clinical-radiographic constructs (Hemophilia Joint Health Score [HJHS], Pettersson radiograph scores) were compared. Moderate correlations were noted between erosions and dAB (r = 0.62, P = 0.03) in the talus but not in the distal tibia (P > 0.05). Whereas substantial to high correlations (r range: 0.70-0.94, P < 0.05) were observed between erosions, cartilage loss, HJHS and Pettersson scores both at the distal tibia and talus levels, moderate/borderline substantial (r range: 0.55-0.61, P < 0.05) correlations were noted between dAB/ThCtAB and clinical-radiographic constructs. Whereas the semiquantitative method of assessing cartilage status is closely associated with clinical-radiographic scores in cross-sectional studies of blood-induced arthropathy, quantitative measures provide independent information and are therefore less applicable for that research design.
    Pediatric Radiology 02/2014; · 1.57 Impact Factor
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    ABSTRACT: OBJECTIVE. Our objective was to evaluate the diagnostic accuracy and reliability of MRI and its ability to depict responsiveness to treatment for the evaluation of the axial joints (temporomandibular joint [TMJ], spinal joints, and sacroiliac joints) in juvenile idiopathic arthritis (JIA). CONCLUSION. There is fair (grade B) evidence that MRI is an accurate diagnostic method for evaluating early and intermediate changes in the TMJ in JIA and insufficient evidence to indicate MRI is an accurate diagnostic method for detecting JIA in the spinal (grade I) and sacroiliac (grade I) joints.
    American Journal of Roentgenology 01/2014; 202(1):199-210. · 2.90 Impact Factor
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    ABSTRACT: Blood-oxygen-level-dependent (BOLD) MRI has the potential to identify regions of early hypoxic and vascular joint changes in inflammatory arthritis. There is no standard protocol for analysis of BOLD MRI measurements in musculoskeletal disorders. To optimize the following BOLD MRI reading parameters: (1) statistical threshold values (low, r > 0.01 versus high, r > 0.2); (2) summary measures of BOLD contrast (percentage of activated voxels [PT%] versus percentage signal difference between on-and-off signal intensities [diff_on_off]); and (3) direction of BOLD response (positive, negative and positive + negative). Using BOLD MRI protocols at 1.5 T, arthritic (n = 21) and contralateral (n = 21) knees of 21 juvenile rabbits were imaged at baseline and on days 1, 14 and 28 after a unilateral intra-articular injection of carrageenan. Nine non-injected rabbits served as external control knees (n = 18). By comparing arthritic to contralateral knees, receiver operating characteristic curves were used to determine diagnostic accuracy. Using diff_on_off and positive + negative responses, a threshold of r > 0.01 was more accurate than r > 0.2 (P = 0.03 at day 28). Comparison of summary measures yielded no statistically significant difference (P > 0.05). Although positive + negative (AUC = 0.86 at day 28) and negative responses (AUC = 0.90 at day 28) for PT% were the most diagnostically accurate, positive + negative responses for diff_on_off (AUC = 0.78 at day 28) also had acceptable accuracy. The most clinically relevant reading parameters included a lower threshold of r > 0.01 and a positive + negative BOLD response. We propose that diff_on_off is a more clinically relevant summary measure of BOLD MRI, while PT% can be used as an ancillary measure.
    Pediatric Radiology 12/2013; · 1.57 Impact Factor
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    ABSTRACT: PURPOSE To evaluate the inter-reader reliability for interpretation of TMJ exams utilizing a core vs complete MRI protocol, and to assess readers’ capability for visualization of anatomic structures using core vs complete protocols at 1.5 and 3T. METHOD AND MATERIALS MRI exams of 25 JIA patients (20 F/5 M; age range,8-17 years; mean,13.7 years) were acquired on a 1.5T Philips Systems scanner and of 23 JIA patients (18 F/5 M; age range,7.7-17 years; mean,13.2 years) on a 3T Philips Systems scanner. All MRI exams were independently scored by 3 blinded readers (scores 0-3, normal-severe) with regard to specific items (synovitis [0-3, none-severe]/synovial thickness [mm], extension[0-3]/ bone erosions depth [mm]) using a core (3 planes T1 fat saturated [FS] post-gadolinium [Gd]) and an expanded (coronal T1, sagittal T2FS, sagittal PD, 3 planes T1FSGd) protocol. Readers scored individual MRI sequences according to the capability of visualization of anatomic structures (scores 0-5, 0=not visible, 5=excellent visibility). RESULTS Total scan time for core/expanded MRI protocols at 1.5 and 3T were 13.86 / 27.36 min and 12.39 / 20.41 min, respectively. Inter-reader agreement for semi-quantitative scores was poor to moderate for synovitis both at 1.5T (intraclass correlation coefficient [ICC], 0.37-0.46) and 3T (0.48-0.62), which improved for quantitative measurements: variable/substantial ICCs for synovial thickness (variable ICcs at 1.5T and 0.80-0.82 at 3T) and variable/substantial for bone erosion depth (ICC, 0.37-0.76 at 1.5T and 0.79-0.84 at 3T). The reader's capability for visualization of anatomic structures was not different between core and complete protocols for synovitis at 1.5T (mean, SD, 3.96 [0.87] and 3.87 [0.54], P>0.05); or at 3T (4.39 [0.71] and 4.13 [0.81], P>0.05), or for bone erosions extent at 1.5T (3.16 [1.01] and 2.96 [1.05], P>0.05) or at 3T (4.17 [0.93] and 4.13 [0.86], P>0.05). CONCLUSION Regardless of the MRI strength field further improvement of semi-quantitative assessment of JIA TMJs is required. Optimization of MRI protocols towards decreasing scanning times does not significantly affect the capability of readers for interpretation of basic findings in TMJs of JIA patients which do not require pre- and post-contrast assessment, either at 1.5 or 3T. CLINICAL RELEVANCE/APPLICATION A faster MRI protocol for TMJ in JIA can obtain diagnostic information for specific clinical questions regardless the strengh of the magnet.
    Complete MRI Protocols for Diagnostic Assessment of Temporomandibular Joints (TMJ) in Juvenile Idiopathic Arthritis (JIA). Is There a Diagnostic Interpretation Difference at 1.5 and 3T?. Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: Recent advances in magnetic resonance imaging (MRI) techniques have substantially improved the evaluation of joint pathologies in juvenile idiopathic arthritis (JIA). Because of the current availability of highly effective antirheumatic therapies and the unique and useful features of MRI, there is a growing need for an accurate and reproducible MRI assessment scoring system for JIA, such as the rheumatoid arthritis MRI Scoring (RAMRIS) for patients with rheumatoid arthritis (RA). To effectively evaluate the efficacy of treatment in clinical research trials, we need to develop and validate scoring methods to accurately measure joint outcomes, standardize imaging protocols for data acquisition and interpretation, and create imaging atlases to differentiate physiologic and pathologic joint findings in childhood and adolescence. Such a standardized, validated, JIA-MRI scoring method could be used as an outcome measure in clinical trials.
    The Journal of Rheumatology 11/2013; · 3.26 Impact Factor
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    ABSTRACT: Our purposes were to determine: (i) whether there is direct evidence that currently available MRI techniques are accurate for early diagnosis of pathological findings in haemophilic arthropathy; (ii) whether there is an MRI scoring system that best correlates with clinical/radiological constructs for evaluation of haemophilic arthropathy; (iii) whether there is an MRI scoring system that best correlates with clinical/radiological constructs for evaluation of haemophilic arthropathy. Articles were screened using MEDLINE (n = 566), EMBASE (n = 201), and the Cochrane Library (n = 1). Two independent reviewers assessed articles for inclusion under the overarching purposes of the review by using the Standards for Reporting of Diagnostic Accuracy (STARD) tool, and the quality of the studies were graded using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. The electronic literature search retrieved 777 references (after duplicates were removed). A total of 32 studies were chosen for inclusion from the results of the search and review of bibliographical references. Using the STARD tool, seven studies were of excellent quality of reporting, and using the QUADAS-2 tool, 10 studies were judged to be of adequate quality. There is 'fair' evidence to recommend MRI as an accurate test for detecting evidence of haemophilic arthropathy and the use of second or third generation MRI scales for assessing haemophilic arthropathy. However, there is no evidence that screening of early intra-articular soft tissue bleed with MRI improves the functional status of joints over time.
    Haemophilia 08/2013; · 3.17 Impact Factor
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    Clinics (São Paulo, Brazil) 05/2013; 68(5). · 1.59 Impact Factor
  • Andrea S Doria
    Evidence-based medicine 03/2013;
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    ABSTRACT: PURPOSE To compare the extent of metal artifact reduction between conventional single energy (SE) computed tomography (CT) and rapid KVp switching dual energy (DE) CT with and without the use of metal artifact reduction software (MARS) in an animal model. METHOD AND MATERIALS 4 postmortem juvenile piglet specimens (mean weight 20.5 kg, range 18-22 kg) were scanned with a SE pediatric protocol followed by DE imaging after insertion of two 5.5 mm diameter stainless steel scoliosis rods into their paraspinal thoracolumbar regions. DE images were then extrapolated at 5 different monoenergetic levels: 64, 69, 75, 88 and 105 KeV with and without the use of MARS. The studies were evaluated according to a 0-4 point scoring system which evaluated 4 attributes: extent of metallic artifacts in soft tissue (ST) (1) and bone windows (2) and image interpretability in ST (3) and bone windows (4). Lower scores represented fewer artifacts/ better interpretability. Hounsfield unit (HU) analysis of artifact density was performed. RESULTS In studies without MARS use, higher energy reconstructions resulted in significantly lower artifacts and better image interpretability in both ST and bone windows (p< .0001 each). Artifact density decreased from -883 HU at 64 KeV to -157 HU at 105 KeV without MARS use. No significant difference was noted in the 4 attributes’ scores or in artifact density in studies with MARS use (p> .05). DE studies (105 KeV without MARS and all studies with MARS) showed significantly lower scores compared to SE with regard to all 4 attributes. Images obtained with 105 and 88 KeV without MARS demonstrated significantly better interpretability compared to images obtained with other energy levels in bone windows both on DE and SE scans (p< .05). Although MARS reduced the linear hypodense metal artifact compared to studies without MARS, a new multidirectional artifact and a peri-metallic hypodense halo were seen in all studies. CONCLUSION At similar monoenergetic levels DECT reduced metal artifact extent and enhanced image interpretability compared to SECT. Imaging obtained with higher energy extrapolations without use of MARS showed superior interpretability. CLINICAL RELEVANCE/APPLICATION DECT showed improved diagnostic performance in reducing artifacts compared to SECT regardless of MARS use. An optimal compromise should be reached between increased KeV and decreased artifact extent.
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
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    ABSTRACT: PURPOSE To evaluate the value of using metal artifact reduction software (MARS) for reducing metal artifact at different monoenergetic levels on rapid Kvp switching dual energy CT (DECT) scans in children. METHOD AND MATERIALS 13 CT scans of children (M:F 6:7, age range 2.1-18 yrs) who underwent DECT in the area of their metallic implants (spinal instrumentation, intramedullary rods, seizure grid) were reviewed. Two blinded radiologists independently reviewed DECT scans extrapolated at 5 different monoenergetic levels: 64, 69, 75, 88 and 105 KeV, with and without the use of MARS, in axial and reformatted sagittal and coronal planes, according to a 0-4point scoring system which evaluated 4 attributes: extent of metallic artifacts in soft tissue (ST) (1) and bone (2) windows and image interpretability in ST (3) and bone (4) windows. Lower scores represented fewer artifacts/better interpretability. RESULTS Excellent inter-reader reliability was noted in all 4 attributes at all energy levels with and without the use of MARS. In images with MARS, intraclass correlation coefficients (ICCs) ranged between 0.9 (95% CI,0.84-0.94) and 1. Without MARS, ICCs ranged between 0.92 (95% CI,0.83-0.96) and 1. At most energy levels in studies with MARS, scores for reformatted planes were significantly lower than for axial plane at all 4 attributes (p< 0.05). In studies without MARS, scores for reformats were lower than for axial plane only in bone windows. The extent of artifacts in both ST and bone windows was significantly decreased with increasing KeV across all energy settings with (p < 0.05) and without MARS (p < 0.05). Images generated at 105 KeV demonstrated maximum decrease in artifact in both windows. A peri-metal hypodense halo was noted in 84%(11/13) of studies with MARS and in 0% of studies without MARS. CONCLUSION The use of MARS did not demonstrate a measurable improved inter-reader reliability or decreased artifactual extent, with the additional challenge of generating faulty appearance of metal loosening. Regardless of the use of MARS, high energy reconstructions and reformmated planes reduced metal artifact in DECT. CLINICAL RELEVANCE/APPLICATION The use of MARS did not substantially improve the diagnostic performance of DECT in this study. Its clinical applicability should therefore be further assessed in future studies.
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
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    ABSTRACT: Background/objectives: Tailored primary prophylaxis (TPP) is a reduced-intensity treatment program for hemophiliacs with the goal of preventing arthropathy. Our primary aim was to evaluate the joint outcomes of treated subjects using MRI and physical examination as outcome measures. Methods: Ankles, elbows, and knees (index joints) of 24 subjects (median [range] age at start of therapy, 1.6 [1-2.5] years) with severe hemophilia A enrolled into the Canadian Hemophilia Primary Prophylaxis Study (CHPS) were examined by MRI at a median age of 8.8 years (range 6.2-11.5 years). Subjects were treated with TPP using a recombinant factor VIII concentrate starting once weekly and escalating in frequency and dose according to frequency of bleeding. Results: Osteochondral changes (cartilage loss/ subchondral bone damage) were detected in 9% (13/140) of the index joints and 50% (12/24) of study subjects. Osteochondral changes were restricted to joints with a history of clinically reported joint bleeding. Soft tissue changes were detected in 31% (20/65) of index joints with no history of clinically reported bleeding [ankles 75% (12/16); elbows 19% (6/32); and knees 12% (2/17)]. In these apparently "bleed free" index joints hemosiderin deposition was detected by MRI in 26% (17/65) of joints [ankles 63% (10/16); elbows 16% (5/32), and knees 12% (2/17)]. Conclusion: TPP did not completely avoid the development of MRI-detected structural joint changes in hemophilic boys in this prospective study. A longer period of follow-up is required for assessment of the longitudinal course of these early changes of hemophilic arthropathy detected using a sensitive imaging technique, MRI. © 2012 International Society on Thrombosis and Haemostasis.
    Journal of Thrombosis and Haemostasis 10/2012; · 6.08 Impact Factor
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    ABSTRACT: Evaluation of prophylactic treatment of haemophilia requires sensitive methods. To design and test a new magnetic resonance imaging (MRI) scale for haemophilic arthropathy, two scales of a combined MRI scoring scheme were merged into a single scale which includes soft tissue and osteochondral subscores. Sixty-one joint MRI's of 46 patients with haemophilia were evaluated by four radiologists using the new and older scales. Forty-six of the joints were evaluated using two X-ray scales. For all MRI scores, interreader agreement and correlations with X-ray scores and lifetime number of haemarthroses were analysed. The interreader agreement intraclass correlation coefficient was 0.82, 0.89 and 0.88 for the soft tissue and osteochondral subscores and the total score, as evaluated according to the new MRI scale, compared to 0.80 and 0.89 as for the older scales. The total score and osteochondral subscore according to the new scale, as well as scores according to the older scales were correlated (P < 0.01) with number of haemarthroses (Spearman correlation 0.35-0.68) and with the X-ray scores (Spearman correlation 0.40-0.76), but no correlation (P > 0.05) was found between the soft tissue subscore of the new MRI scale and the X-ray scores. The new MRI scale is simpler to apply than the older and has similar reader reliability and correlation with lifetime number of haemarthroses, and by separating soft tissue and osteochondral changes it gives additional information. The new scale is useful for analyses of early and moderate stages of arthropathy, and may help to evaluate prophylactic haemophilia treatment.
    Haemophilia 07/2012; · 3.17 Impact Factor
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    ABSTRACT: Progressive joint destruction resulting from intra-articular bleeding is the major morbidity affecting patients with haemophilia (PWH), particularly those with inhibitors. Advances in understanding the detrimental processes set in motion by the exposure of joints to bleeding have shaped current management methods. However, to achieve optimal joint health in PWH, in addition to achieving haemostasis at the bleeding vessel, it may be appropriate to explore experimentally other conceptual frameworks. These include the possibilities that markers might help to identify individuals at the risk of more rapid joint deterioration, that clotting factors may have additional local action within tissues, and that outcomes might be improved with therapies that directly address wound healing and inflammation. Joint assessment tools are important. Conventional radiography is frequently used, but given the possibility of subclinical joint bleeds, accurate non-invasive imaging tools are required to detect soft tissue and cartilage changes. Magnetic resonance imaging and ultrasonography can prove valuable here. New imaging techniques should help to increase understanding of the biological basis of early events in haemophilic arthropathy. The optimal way to measure outcomes in haemophilia is to use several methods - in addition to imaging methods, a 360° approach will use physical, functional and quality-of-life instruments. In PWH, inhibitor development complicates treatment of joint bleeds and increases the risk of developing arthropathy. A new therapeutic approach for joint bleeds in inhibitor patients divides treatment into two phases: bleed control, with bypassing agent therapy until bleeding has definitely ceased, followed by regular dosing to prevent rebleeds until synovial recovery is complete.
    Haemophilia 07/2012; 18 Suppl 5:17-26. · 3.17 Impact Factor
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    Pediatric Rheumatology 07/2012; 10(1). · 1.47 Impact Factor
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    ABSTRACT: Color Doppler US (CDUS) has been used for evaluation of cerebral venous sinuses in neonates. However, there is very limited information available regarding the appearance of superficial and deep normal cerebral venous sinuses using CDUS and the specificity of the technique to rule out disease. To determine the specificity, inter-modality and inter-reader agreement of color Doppler US (CDUS). To evaluate normal cerebral venous sinuses in neonates in comparison to MR venography (MRV). Newborns undergoing a clinically indicated brain MRI were prospectively evaluated. All underwent a dedicated CDUS of the cerebral venous sinuses within 10 h (mean, 3.5 h, range, and 2-7.6 h) of the MRI study using a standard protocol. Fifty consecutive neonates participated in the study (30 males [60%]; 25-41 weeks old; mean, 37 weeks). The mean time interval between the date of birth and the CDUS study was 19.1 days. No cases showed evidence of thrombosis. Overall agreement for US reading was 97% (range, 82-100%), for MRV reading, 99% (range, 96-100%) and for intermodality, 100% (range, 96-100%). Excellent US-MRI agreement was noted for superior sagittal sinus, cerebral veins, straight sinus, torcular Herophili, sigmoid sinus, superior jugular veins (94-98%) and transverse sinuses (82-86%). In 10 cases (20%), MRV showed flow gaps whereas normal flow was demonstrated with US. Visualization of the inferior sagittal sinus was limited with both imaging techniques. Excellent reading agreement was noted for US, MRV and intermodality. CDUS is highly specific to rule out cerebral venous thrombosis in neonates and holds potential for clinical application as part of clinical-laboratory-imaging algorithms of pre/post-test probabilities of disease.
    Pediatric Radiology 04/2012; 42(9):1070-9. · 1.57 Impact Factor

Publication Stats

995 Citations
210.00 Total Impact Points

Institutions

  • 2001–2014
    • University of Toronto
      • Hospital for Sick Children
      Toronto, Ontario, Canada
  • 2002–2013
    • SickKids
      • • Department of Diagnostic Imaging
      • • Division of Paediatric Emergency Medicine
      • • Division of Rheumatology
      Toronto, Ontario, Canada
  • 2005–2012
    • Lund University
      • • Department of Clinical Sciences
      • • Department of Radiology
      Lund, Skane, Sweden
  • 2010
    • Hackensack University Medical Center
      Hackensack, New Jersey, United States
  • 2009
    • Christian Medical College Vellore
      • Department of Radiology
      Vellore, State of Tamil Nadu, India
    • McMaster University
      Hamilton, Ontario, Canada
  • 2007
    • University College London
      • Institute of Child Health
      London, ENG, United Kingdom
  • 2003
    • Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
      San Paulo, São Paulo, Brazil
  • 2001–2002
    • University of São Paulo
      • Hospital das Clínicas (FMUSP)
      San Paulo, São Paulo, Brazil