title: 3D MRI analysis of the lower legs of treated idiopathic congenital talipes equinovarus (clubfoot).
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.
  
  
  RESULTS
  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
  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.
authors: Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee, Dundee, United Kingdom. s.duce@dundee.ac.uk
authors: Suzanne L
authors: SL
authors: Duce
authors: Mariella
authors: M
authors: D'Alessandro
authors: Yimeng
authors: Y
authors: Du
authors: Baljit
authors: B
authors: Jagpal
authors: Fiona J
authors: FJ
authors: Gilbert
authors: Lena
authors: L
authors: Crichton
authors: Simon
authors: S
authors: Barker
authors: J Martin
authors: JM
authors: Collinson
authors: Zosia
authors: Z
authors: Miedzybrodzka
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003025:Clubfoot / Q000145:classification / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007866:Leg / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D011859:Radiography; D055815:Young Adult
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