3D MRI analysis of the lower legs of treated idiopathic congenital talipes equinovarus (clubfoot)

Suzanne L Duce, Mariella D'Alessandro, Yimeng Du, Baljit Jagpal, Fiona J Gilbert, Lena Crichton, Simon Barker, J Martin Collinson, Zosia Miedzybrodzka

Research output: Contribution to journalArticle

12 Citations (Scopus)
4 Downloads (Pure)

Abstract

Background

Idiopathic congenital talipes equinovarus (CTEV) is the commonest form of clubfoot. Its exact cause is unknown, although it is related to limb development. The aim of this study was to quantify the anatomy of the muscle, subcutaneous fat, tibia, fibula and arteries in the lower legs of teenagers and young adults with CTEV using 3D magnetic resonance imaging (MRI), and thus to investigate the anatomical differences between CTEV participants and controls.

Methodology/Principal Findings

The lower legs of six CTEV (2 bilateral, 4 unilateral) and five control young adults (age 12–28) were imaged using a 3T MRI Philips scanner. 5 of the CTEV participants had undergone soft-tissue and capsular release surgery. 3D T1-weighted and 3D magnetic resonance angiography (MRA) images were acquired. Segmentation software was used for volumetric, anatomical and image analysis. Kolmogorov-Smirnov tests were performed. The volumes of the lower affected leg, muscle, tibia and fibula in unilateral CTEV participants were consistently smaller compared to their contralateral unaffected leg, this was most pronounced in muscle. The proportion of muscle in affected CTEV legs was significantly reduced compared with control and unaffected CTEV legs, whilst proportion of muscular fat increased. No spatial abnormalities in the location or branching of arteries were detected, but hypoplastic anomalies were observed.

Conclusions/Significance

Combining 3D MRI and MRA is effective for quantitatively characterizing CTEV anatomy. Reduction in leg muscle volume appears to be a sensitive marker. Since 5/6 CTEV cases had soft-tissue surgery, further work is required to confirm that the treatment did not affect the MRI features observed. We propose that the proportion of muscle and intra-muscular fat within the lower leg could provide a valuable addition to current clinical CTEV classification. These measures could be useful for clinical care and guiding treatment pathways, as well as treatment research and clinical audit.
Original languageEnglish
Article numbere54100
Number of pages10
JournalPloS ONE
Volume8
Issue number1
DOIs
Publication statusPublished - 30 Jan 2013

Fingerprint

Clubfoot
Magnetic resonance
magnetic resonance imaging
Muscle
Leg
legs
Magnetic Resonance Imaging
Imaging techniques
muscles
Angiography
Fats
fibula
Muscles
Surgery
Volumetric analysis
tibia
young adults
Tissue
arteries
Fibula

Cite this

3D MRI analysis of the lower legs of treated idiopathic congenital talipes equinovarus (clubfoot). / Duce, Suzanne L; D'Alessandro, Mariella; Du, Yimeng; Jagpal, Baljit; Gilbert, Fiona J; Crichton, Lena; Barker, Simon; Collinson, J Martin; Miedzybrodzka, Zosia.

In: PloS ONE, Vol. 8, No. 1, e54100, 30.01.2013.

Research output: Contribution to journalArticle

Duce SL, D'Alessandro M, Du Y, Jagpal B, Gilbert FJ, Crichton L et al. 3D MRI analysis of the lower legs of treated idiopathic congenital talipes equinovarus (clubfoot). PloS ONE. 2013 Jan 30;8(1). e54100. https://doi.org/10.1371/journal.pone.0054100
Duce, Suzanne L ; D'Alessandro, Mariella ; Du, Yimeng ; Jagpal, Baljit ; Gilbert, Fiona J ; Crichton, Lena ; Barker, Simon ; Collinson, J Martin ; Miedzybrodzka, Zosia. / 3D MRI analysis of the lower legs of treated idiopathic congenital talipes equinovarus (clubfoot). In: PloS ONE. 2013 ; Vol. 8, No. 1.
@article{1b1d93cfddfb4c9ba548c79c5526fb9e,
title = "3D MRI analysis of the lower legs of treated idiopathic congenital talipes equinovarus (clubfoot)",
abstract = "BackgroundIdiopathic congenital talipes equinovarus (CTEV) is the commonest form of clubfoot. Its exact cause is unknown, although it is related to limb development. The aim of this study was to quantify the anatomy of the muscle, subcutaneous fat, tibia, fibula and arteries in the lower legs of teenagers and young adults with CTEV using 3D magnetic resonance imaging (MRI), and thus to investigate the anatomical differences between CTEV participants and controls.Methodology/Principal FindingsThe lower legs of six CTEV (2 bilateral, 4 unilateral) and five control young adults (age 12–28) were imaged using a 3T MRI Philips scanner. 5 of the CTEV participants had undergone soft-tissue and capsular release surgery. 3D T1-weighted and 3D magnetic resonance angiography (MRA) images were acquired. Segmentation software was used for volumetric, anatomical and image analysis. Kolmogorov-Smirnov tests were performed. The volumes of the lower affected leg, muscle, tibia and fibula in unilateral CTEV participants were consistently smaller compared to their contralateral unaffected leg, this was most pronounced in muscle. The proportion of muscle in affected CTEV legs was significantly reduced compared with control and unaffected CTEV legs, whilst proportion of muscular fat increased. No spatial abnormalities in the location or branching of arteries were detected, but hypoplastic anomalies were observed.Conclusions/SignificanceCombining 3D MRI and MRA is effective for quantitatively characterizing CTEV anatomy. Reduction in leg muscle volume appears to be a sensitive marker. Since 5/6 CTEV cases had soft-tissue surgery, further work is required to confirm that the treatment did not affect the MRI features observed. We propose that the proportion of muscle and intra-muscular fat within the lower leg could provide a valuable addition to current clinical CTEV classification. These measures could be useful for clinical care and guiding treatment pathways, as well as treatment research and clinical audit.",
author = "Duce, {Suzanne L} and Mariella D'Alessandro and Yimeng Du and Baljit Jagpal and Gilbert, {Fiona J} and Lena Crichton and Simon Barker and Collinson, {J Martin} and Zosia Miedzybrodzka",
year = "2013",
month = "1",
day = "30",
doi = "10.1371/journal.pone.0054100",
language = "English",
volume = "8",
journal = "PloS ONE",
issn = "1932-6203",
publisher = "PUBLIC LIBRARY SCIENCE",
number = "1",

}

TY - JOUR

T1 - 3D MRI analysis of the lower legs of treated idiopathic congenital talipes equinovarus (clubfoot)

AU - Duce, Suzanne L

AU - D'Alessandro, Mariella

AU - Du, Yimeng

AU - Jagpal, Baljit

AU - Gilbert, Fiona J

AU - Crichton, Lena

AU - Barker, Simon

AU - Collinson, J Martin

AU - Miedzybrodzka, Zosia

PY - 2013/1/30

Y1 - 2013/1/30

N2 - BackgroundIdiopathic congenital talipes equinovarus (CTEV) is the commonest form of clubfoot. Its exact cause is unknown, although it is related to limb development. The aim of this study was to quantify the anatomy of the muscle, subcutaneous fat, tibia, fibula and arteries in the lower legs of teenagers and young adults with CTEV using 3D magnetic resonance imaging (MRI), and thus to investigate the anatomical differences between CTEV participants and controls.Methodology/Principal FindingsThe lower legs of six CTEV (2 bilateral, 4 unilateral) and five control young adults (age 12–28) were imaged using a 3T MRI Philips scanner. 5 of the CTEV participants had undergone soft-tissue and capsular release surgery. 3D T1-weighted and 3D magnetic resonance angiography (MRA) images were acquired. Segmentation software was used for volumetric, anatomical and image analysis. Kolmogorov-Smirnov tests were performed. The volumes of the lower affected leg, muscle, tibia and fibula in unilateral CTEV participants were consistently smaller compared to their contralateral unaffected leg, this was most pronounced in muscle. The proportion of muscle in affected CTEV legs was significantly reduced compared with control and unaffected CTEV legs, whilst proportion of muscular fat increased. No spatial abnormalities in the location or branching of arteries were detected, but hypoplastic anomalies were observed.Conclusions/SignificanceCombining 3D MRI and MRA is effective for quantitatively characterizing CTEV anatomy. Reduction in leg muscle volume appears to be a sensitive marker. Since 5/6 CTEV cases had soft-tissue surgery, further work is required to confirm that the treatment did not affect the MRI features observed. We propose that the proportion of muscle and intra-muscular fat within the lower leg could provide a valuable addition to current clinical CTEV classification. These measures could be useful for clinical care and guiding treatment pathways, as well as treatment research and clinical audit.

AB - BackgroundIdiopathic congenital talipes equinovarus (CTEV) is the commonest form of clubfoot. Its exact cause is unknown, although it is related to limb development. The aim of this study was to quantify the anatomy of the muscle, subcutaneous fat, tibia, fibula and arteries in the lower legs of teenagers and young adults with CTEV using 3D magnetic resonance imaging (MRI), and thus to investigate the anatomical differences between CTEV participants and controls.Methodology/Principal FindingsThe lower legs of six CTEV (2 bilateral, 4 unilateral) and five control young adults (age 12–28) were imaged using a 3T MRI Philips scanner. 5 of the CTEV participants had undergone soft-tissue and capsular release surgery. 3D T1-weighted and 3D magnetic resonance angiography (MRA) images were acquired. Segmentation software was used for volumetric, anatomical and image analysis. Kolmogorov-Smirnov tests were performed. The volumes of the lower affected leg, muscle, tibia and fibula in unilateral CTEV participants were consistently smaller compared to their contralateral unaffected leg, this was most pronounced in muscle. The proportion of muscle in affected CTEV legs was significantly reduced compared with control and unaffected CTEV legs, whilst proportion of muscular fat increased. No spatial abnormalities in the location or branching of arteries were detected, but hypoplastic anomalies were observed.Conclusions/SignificanceCombining 3D MRI and MRA is effective for quantitatively characterizing CTEV anatomy. Reduction in leg muscle volume appears to be a sensitive marker. Since 5/6 CTEV cases had soft-tissue surgery, further work is required to confirm that the treatment did not affect the MRI features observed. We propose that the proportion of muscle and intra-muscular fat within the lower leg could provide a valuable addition to current clinical CTEV classification. These measures could be useful for clinical care and guiding treatment pathways, as well as treatment research and clinical audit.

U2 - 10.1371/journal.pone.0054100

DO - 10.1371/journal.pone.0054100

M3 - Article

VL - 8

JO - PloS ONE

JF - PloS ONE

SN - 1932-6203

IS - 1

M1 - e54100

ER -