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Widening of the femoral proximal diaphysis--metaphysis angle in fetuses with achondroplasia.
[achondroplasia]
It
has
recently
been
reported
that
fetuses
with
achondroplasia
have
a
wider
than
expected
femoral
proximal
diaphysis-metaphysis
angle
(
femoral
angle
)
.
The
aim
of
this
case-control
study
was
to
investigate
this
finding
.
Cases
with
confirmed
achondroplasia
(
n
 
=
 
6
)
,
small
-for-gestational-age
fetuses
(
n
 
=
 
70
)
and
a
group
of
normal
fetuses
(
n
 
=
 
377
)
were
included
in
this
study
.
The
ultrasound
image
of
the
femur
was
examined
by
two
independent
experienced
observers
blinded
to
the
diagnosis
,
who
measured
the
femoral
angle
.
These
values
were
converted
into
multiples
of
the
expected
median
(
MoM
)
,
after
adjustment
for
gestational
age
and
femur
length
.
Prevalence
of
various
prenatal
ultrasound
signs
of
achondroplasia
was
determined
in
affected
fetuses
.
Intra-
and
interobserver
agreement
of
measurement
of
femoral
angle
was
assessed
using
95
%
limits
of
agreement
and
kappa
statistics
.
The
femoral
angle
can
be
measured
accurately
by
ultrasound
,
and
increases
with
both
increasing
gestational
age
and
increasing
femur
length
.
The
femoral
angle-
MoM
was
significantly
higher
in
fetuses
with
achondroplasia
than
in
the
control
group
(
1
.
36
vs
1
.
00
MoM
,
P
 
<
 
0
.
001
)
and
in
the
SGA
group
(
1
.
36
vs
1
.
04
MoM
,
P
 
<
 
0
.
001
)
.
It
measured
more
than
130
°
in
five
of
the
six
cases
with
achondroplasia
(
83
.
3
%
)
,
which
was
the
most
consistent
finding
other
than
shortening
of
the
long
bones
.
The
femoral
angle
is
wider
in
fetuses
with
achondroplasia
.
This
new
ultrasound
sign
appears
promising
as
an
additional
discriminatory
marker
when
clinicians
are
faced
with
a
case
of
short
long
bones
in
the
third
trimester
.
Diseases
Validation
Diseases presenting
"femoral angle"
symptom
achondroplasia
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