A team of researchers from the University of Washington, Seattle Children’s Hospital, Seattle Children’s Research Institute (all in Seattle, WA), and Monash University (Clayton, Australia) turned to optical projection tomography and contrast-enhanced microCT scanning to study 10 specimens collected at autopsy from male fetuses with lower urinary tract obstructions (LUTOs). Optical projection tomography uses visible, infrared, and ultraviolet light to image small, transparent specimens, and microCT scanning is x-ray-based computed tomography (CT) scanning of small specimens made up of soft tissue or bone.
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LUTO is a prenatal condition associated with a number of severe complications, including serious disorders like prune belly syndrome that often lead to infant mortality. Primarily affecting males, LUTO has been classified into several different types and often proves difficult to diagnose. Currently, researchers are working on better ways to detect LUTO in utero and gain a clearer understanding of its causes.
Conventional light microscopy was used to verify the findings of each scan. The results were then compared with 9 age-matched controls (with no obstructions). The scans showed more of the lower urinary tract and urethra than previous techniques, and the blockages that caused fetal mortality were clearer than on a regular fetal ultrasound performed in utero.
Microtomography performed at autopsy was able to capture 360° 3D images that are not available with the current ultrasound technology used while the fetus is in utero. Optical projection tomography and microCT scanning did, however, give clear pictures of the anatomy of the lower urinary tract and urethra that will be invaluable when diagnosing LUTO. They offered a clearer, more complete image of the condition in intact organs. This technology is currently available for use in a research setting. Hopefully, this approach may in the future by moved to the clinical arena and aid physicians to more quickly identify LUTO in the future.
The use of both optical projection scanning and microCT scanning allowed the researchers to gain a clear image of the obstructions without dissecting the organs. Now there are lasting scans of the organs fully intact that can be used to gain a better understanding of the anatomy of both normal and obstructed urinary tracts. It is also the researchers’ hope that as technology evolves, so will higher resolution ultrasounds for detection of LUTO, and as more is learned about the disorder, in utero therapies and family counseling will continue to develop, eventually contributing to the prevention of this disease.
Full details of the work appear in the journal Pediatric and Developmental Pathology; for more information, please visit http://www.pedpath.org/doi/full/10.2350/13-08-1359-OA.1.
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