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Fulltext A comparison of subtraction MRI with the standard contrast-enhanced imaging in Perthes' disease

Jamil K, Walker T, Onikul E, Munns CF, Little DG

J Child Orthop, 2019 Feb 01;13(1):82-88.
PMID: 30838080 DOI: 10.1302/1863-2548.13.180136

PURPOSE: Perthes' disease (PD) results from loss of blood supply to the hip and can progress to femoral head deformity. MRI in the early course of the disease can provide data on the initial extent of infarct. Vascularity of the femoral head is assessed by gadolinium-enhanced MRI (contrast MRI), which may be improved by the digital subtraction technique (subtraction MRI). We hypothesized that gadolinium-enhanced MRI without subtraction was comparable with subtraction MRI in depicting the femoral head perfusion.
METHODS: In all, 34 patients (34 hips) with unilateral PD had gadolinium-enhanced MRI as part of a prospectively randomized study. Nine patients had three MRIs, 15 had two and ten had a single MRI. Measurement of perfusion of the femoral head (MRI perfusion index) was obtained using digital image analysis on all the MRIs, including both before and after subtraction. A paired sample t-test was performed to compare the measurements.
RESULTS: The mean age of the patients was 8.9 years (sd 1.6). At the time of diagnosis, the subtraction MRI did not elicit a statistically significant difference in MRI perfusion index measurements when compared with the contrast MRI (p = 0.19). The same findings were found when including all patients at various stages of the disease (p = 0.30). Qualitatively, although some subtraction MRI images showed superior delineation of epiphysis, there are no significant differences throughout the whole series.
CONCLUSION: Although the current literature supports the increasing role of the subtraction MRI for PD management, our study proposed that the contrast MRI without subtraction technique appears adequate in assessing femoral head perfusion.
LEVEL OF EVIDENCE: Level I - Diagnostic study.
Reliability and sensitivity of radiographic measures of hip dysplasia in childhood Charcot-Marie-Tooth disease

Dwan LN, Gibbons P, Jamil K, Little D, Birke O, Menezes MP, et al.

Hip Int, 2023 Mar;33(2):323-331.
PMID: 34180253 DOI: 10.1177/11207000211027591

BACKGROUND: Hip dysplasia is a lack of femoral head coverage and disruption of hip and acetabular alignment and congruency, with severity ranging from mild subluxation in nascent at-risk hips to complete dislocation. Presentation of hip dysplasia in neuromuscular conditions can be sub-clinical or associated with a limp with or without hip pain, abductor and flexor weakness and reduced hip range of motion. Untreated hip dysplasia leads to early onset osteoarthritis requiring hip arthroplasty in early adulthood. Hip dysplasia occurs in 6-20% of children with Charcot-Marie-Tooth disease, however little is known about the reliability and sensitivity of detection on plain film pelvic radiographs.
METHODS: 14 common measures of hip dysplasia on anteroposterior pelvis radiographs were independently assessed by 2 orthopaedic specialists in 30 ambulant children with Charcot-Marie-Tooth disease. Hip health was also categorised based on clinical impression to assess the sensitivity of radiographic measures to identify hip dysplasia status.
RESULTS: 8 measures (acetabular index, head width, lateral centre-edge angle, lateral uncoverage, medial joint width, migration percentage, neck shaft angle, triradiate status) exhibited 'excellent' reliability between clinical evaluators. 5 of the 30 patients (17%) were identified as having nascent hip dysplasia. Reliable radiographic measures that significantly distinguished between nascent hip dysplasia and healthy hips were acetabular index, lateral centre edge angle, medial joint width and migration percentage.
CONCLUSIONS: We have identified a subset of reliable and sensitive radiographic hip measures in children with Charcot-Marie-Tooth disease to prioritise during hip screening to mitigate the deleterious effects of hip dysplasia, pain and disability in adulthood.
Fulltext Factors Influencing Consumption Behaviour towards Aquatic Food among Asian Consumers: A Systematic Scoping Review

Budhathoki M, Campbell D, Belton B, Newton R, Li S, Zhang W, et al.

Foods, 2022 Dec 14;11(24).
PMID: 36553785 DOI: 10.3390/foods11244043

Asia accounts for over 70% of total global aquatic food consumption, but aquatic food consumption behaviours and attitudes among Asian consumers are poorly documented and understood. This paper synthesises literature on factors influencing aquatic food consumption behaviour in Asia and the potential to support transitions toward more sustainable food consumption patterns. We identified 113 studies for inclusion in a scoping review, and identified five clusters of publications: (1) product attributes, availability, and accessibility (24% of publications); (2) willingness to pay for aquatic foods (25%); (3) psychosocial factors (e.g., attitudes and subjective norms) (17%); (4) sociodemographic and lifestyle factors (21%); and (5) miscellaneous factors, including food safety and social status (13%). This study indicates that multiple interacting factors influence aquatic food consumption behaviours among Asian consumers, among which price is central. Knowledge of, and attitudes toward, the perceived quality and safety of aquatic foods were identified as important but were mediated by household characteristics. Sustainable production practices, country of origin, and ecolabels were found to be less influential on consumption behaviour. We found that improving consumers' knowledge and attitudes about the quality and safety of aquatic foods might positively influence aquatic food consumption behaviour. Future multidisciplinary research is required to better understand interactions among the multiple factors that influence Asian consumers' aquatic food consumption behaviour.

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