1
|
Iwasaka-Neder J, Bedoya MA, Connors J, Warfield S, Bixby SD. Morphometric and clinical comparison of MRI-based synthetic CT to conventional CT of the hip in children. Pediatr Radiol 2024; 54:743-757. [PMID: 38421417 DOI: 10.1007/s00247-024-05888-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/03/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND MRI-based synthetic CT (sCT) generates CT-like images from MRI data. OBJECTIVE To evaluate equivalence, inter- and intraobserver reliability, and image quality of sCT compared to conventional (cCT) for assessing hip morphology and maturity in pediatric patients. MATERIALS AND METHODS We prospectively enrolled patients <21 years old with cCT and 3T MRI of the hips/pelvis. A dual-echo gradient-echo sequence was used to generate sCT via a commercially available post-processing software (BoneMRI v1.5 research version, MRIguidance BV, Utrecht, NL). Two pediatric musculoskeletal radiologists measured seven morphologic hip parameters. 3D surface distances between cCT and sCT were computed. Physeal status was established at seven locations with cCT as reference standard. Images were qualitatively scored on a 5-point Likert scale regarding diagnostic quality, signal-to-noise ratio, clarity of bony margin, corticomedullary differentiation, and presence and severity of artifacts. Quantitative evaluation of Hounsfield units (HU) was performed in bone, muscle, and fat tissue. Inter- and intraobserver reliability were measured by intraclass correlation coefficients. The cCT-to-sCT intermodal agreement was assessed via Bland-Altman analysis. The equivalence between modalities was tested using paired two one-sided tests. The quality parameter scores of each imaging modality were compared via Wilcoxon signed-rank test. For tissue-specific HU measurements, mean absolute error and mean percentage error values were calculated using the cCT as the reference standard. RESULTS Thirty-eight hips in 19 patients were included (16.6 ± 3 years, range 9.9-20.9; male = 5). cCT- and sCT-based morphologic measurements demonstrated good to excellent inter- and intraobserver correlation (0.77 CONCLUSION sCT is equivalent to cCT for the assessment of hip morphology, physeal status, and radiodensity assessment in pediatric patients.
Collapse
Affiliation(s)
- Jade Iwasaka-Neder
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
| | - M Alejandra Bedoya
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - James Connors
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Simon Warfield
- Computational Radiology Laboratory, Boston Children's Hospital, 401 Park Drive, Boston, MA, 02215, USA
| | - Sarah D Bixby
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| |
Collapse
|
2
|
Iwasaka-Neder J, Bixby SD, Bedoya MA, Liu E, Jarrett DY, Agahigian D, Tsai A. Virtual 3D femur model to assess femoral version: comparison to the 2D axial slice approach. Pediatr Radiol 2023; 53:2411-2423. [PMID: 37740782 DOI: 10.1007/s00247-023-05758-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Quantifying femoral version is crucial in diagnosing femoral version abnormalities and for accurate pre-surgical planning. There are numerous methods for measuring femoral version, however, reliability studies for most of these methods excluded children with hip deformities. OBJECTIVE To propose a method of measuring femoral version based on a virtual 3D femur model, and systematically compare its reliability to the widely used Murphy's 2D axial slice technique. MATERIALS AND METHODS We searched our imaging database to identify hip/femur CTs performed on children (<18 years old) with a clinical indication of femoral version measurement (September 2021-August 2022). Exclusion criteria were prior hip surgery, and inadequate image quality or field-of-view. Two blinded radiologists independently measured femoral version using the virtual 3D femur model and Murphy's 2D axial slice method. To assess intrareader variability, we randomly selected 20% of the study sample for re-measurements by the two radiologists >2 weeks later. We analyzed the reliability and correlation of these techniques via intraclass correlation coefficient (ICC), Bland-Altman analysis, and deformity subgroup analysis. RESULTS Our study sample consisted of 142 femurs from 71 patients (10.6±4.4 years, male=31). Intra- and inter-reader correlations for both techniques were excellent (ICC≥0.91). However, Bland-Altman analysis revealed that the standard deviation (SD) of the absolute difference between the two radiologists for the Murphy method (mean 13.7°) was larger than that of the 3D femur model technique (mean 4.8°), indicating higher reader variability. In femurs with hip flexion deformity, the SD of the absolute difference for the Murphy technique was 17°, compared to 6.5° for the 3D femur model technique. In femurs with apparent coxa valga deformity, the SD of the absolute difference for the Murphy technique was 10.4°, compared to 5.2° for the 3D femur model technique. CONCLUSION The 3D femur model technique is more reliable than the Murphy's 2D axial slice technique in measuring femoral version, especially in children with hip flexion and apparent coxa valga deformities.
Collapse
Affiliation(s)
- Jade Iwasaka-Neder
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
| | - Sarah D Bixby
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - M Alejandra Bedoya
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Enju Liu
- Department of Pediatrics, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Delma Y Jarrett
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
- Department of Radiology, New York Presbyterian Hospital-Weill Cornell, 525 East 68th Street, New York, NY, 10065, USA
| | - Donna Agahigian
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Andy Tsai
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| |
Collapse
|
3
|
Appelhaus S, Schoenberg SO, Weis M. [Septic arthritis and transient synovitis of the hip]. Radiologie (Heidelb) 2023; 63:729-735. [PMID: 37407747 DOI: 10.1007/s00117-023-01179-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/07/2023]
Abstract
CLINICAL/METHODICAL ISSUE Differentiating between septic arthritis and transient synovitis can be challenging but is very important as a late diagnosis of septic arthritis can lead to sepsis and joint damage. For correct diagnosis and prediction of complications, the right combination of physical examination, laboratory and radiological studies is needed. STANDARD RADIOLOGICAL METHODS Hip ultrasound is easy to learn and has a high sensitivity for joint effusion. Faster diagnosis and therapy are possible due to increasing use of ultrasound. Magnetic resonance imaging (MRI) is primarily used to rule out co-infections (osteomyelitis, pyomyositis) and differential diagnoses. X‑ray is typically nonremarkable in septic arthritis. PRACTICAL RECOMMENDATIONS Routine use of ultrasound in nontraumatic pediatric hip pain. Generous use of MRI in case of elevated inflammatory markers or inconclusive clinical findings. Using only few sequences may be appropriate to avoid sedation, primarily fluid sensitive sequences (fat-saturated T2, TIRM, STIR), in case of positive findings, accompanied by T1-weighted images.
Collapse
Affiliation(s)
- S Appelhaus
- Klinik für Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - S O Schoenberg
- Klinik für Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - M Weis
- Klinik für Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| |
Collapse
|
4
|
Bojicic KM, Meyer NB, Yablon CM, Brigido MK, Gaetke-Udager K. Hip Pain: Imaging of Intra-articular and Extra-articular Causes. Clin Sports Med 2021; 40:713-729. [PMID: 34509207 DOI: 10.1016/j.csm.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hip pain is a common and complex clinical entity. The causes of hip injuries in athletes are many and diverse, requiring efficient, accurate diagnosis for proper management. Imaging is an important step in the clinical evaluation of hip pain, and familiarity with multiple imaging modalities as well as characteristic imaging findings is a helpful tool for sports medicine clinicians. This article discusses imaging recommendations and gives imaging examples of common causes of intra-articular and extra-articular hip pain including femoroacetabular impingement, labral tears, cartilage defects, ligamentum teres injuries, snapping hip syndrome, femoral stress injuries, thigh splints, athletic pubalgia, avulsion injuries, and hip dislocation.
Collapse
Affiliation(s)
- Katherine M Bojicic
- Diagnostic Radiology Resident, University of Michigan Medical Center, 1500 E Medical Center Drive, B1 D502, Ann Arbor, MI 48103, USA
| | - Nathaniel B Meyer
- University of Michigan Medical Center, 1500 E Medical Center Drive, TC 2910, Ann Arbor, MI 48103, USA
| | - Corrie M Yablon
- University of Michigan Medical Center, 1500 E Medical Center Drive, TC 2910, Ann Arbor, MI 48103, USA
| | - Monica Kalume Brigido
- University of Michigan Medical Center, 1500 E Medical Center Drive, TC 2910, Ann Arbor, MI 48103, USA
| | - Kara Gaetke-Udager
- University of Michigan Medical Center, 1500 E Medical Center Drive, TC 2910, Ann Arbor, MI 48103, USA.
| |
Collapse
|
5
|
Schwaiger BJ, Gersing AS, Lee S, Nardo L, Samaan MA, Souza RB, Link TM, Majumdar S. Longitudinal assessment of MRI in hip osteoarthritis using SHOMRI and correlation with clinical progression. Semin Arthritis Rheum 2016; 45:648-55. [PMID: 27162009 DOI: 10.1016/j.semarthrit.2016.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/26/2016] [Accepted: 04/04/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE To assess the evolution of MR imaging findings in normal volunteers and subjects with hip osteoarthritis (OA) over 1.5 years described by the semi-quantitative Scoring Hip OA with MRI (SHOMRI) scoring system and their correlation with the evolution of clinical parameters. MATERIALS AND METHODS Hip MRI studies of 18 subjects with [Kellgren-Lawrence (KL) score = 2/3; mean age = 54.4 ± 11.2 years; 27.8% women] and 36 controls without radiographic OA [KL = 0/1; mean age = 43.7 ± 12.8 years; 50.0% women] were assessed at baseline and after 1.5 years by using SHOMRI, and their clinical status was evaluated by using Harris Hip Score and Hip Disability and Osteoarthritis Outcome Score (HOOS). Imaging and clinical parameters at baseline and their change over time were compared between groups using Mann-Whitney U and Fisher׳s exact tests. Spearman׳s rank correlations and generalized linear models adjusted for age, sex, BMI, and KL were used to assess associations between imaging and clinical findings. RESULTS At baseline, OA subjects had significantly higher SHOMRI total scores than controls [median (IQR): 12.5 (6-19.5) vs. 7 (4-13.5); p = 0.024]. Over 1.5 years, only the progression rate of subchondral cysts was significantly higher in OA subjects than in controls (16.7% vs. 0.0%; p = 0.033), while no significant differences were found for any of the other SHOMRI subscales. Baseline bone-marrow edema pattern (BMEP) was significantly associated with worsening pain (HOOS subscale; p = 0.018) and hip-related quality of life (HOOS subscale; p = 0.044). Progression of subchondral cysts was significantly associated with worsening symptoms other than pain (HOOS subscale, p = 0.030). Baseline KL did not significantly correlate with worsening of any clinical symptoms (each, p > 0.05). CONCLUSION In this relatively young study population without or with mild to moderate radiographic hip OA, only minimal differences were found between groups regarding the progression of hip abnormalities as assessed by SHOMRI over 1.5 years. However, BMEP predicted clinical worsening and subchondral cyst progression was associated with worsening symptoms. Although longer follow-up periods are required, this suggests that SHOMRI is a useful tool to monitor hip abnormalities and their progression longitudinally.
Collapse
Affiliation(s)
- Benedikt J Schwaiger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco 185 Berry St., Suite 350, San Francisco, CA 94107.
| | - Alexandra S Gersing
- Department of Radiology and Biomedical Imaging, University of California, San Francisco 185 Berry St., Suite 350, San Francisco, CA 94107
| | - Sonia Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco 185 Berry St., Suite 350, San Francisco, CA 94107
| | - Lorenzo Nardo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco 185 Berry St., Suite 350, San Francisco, CA 94107
| | - Michael A Samaan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco 185 Berry St., Suite 350, San Francisco, CA 94107
| | - Richard B Souza
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco 185 Berry St., Suite 350, San Francisco, CA 94107
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco 185 Berry St., Suite 350, San Francisco, CA 94107
| |
Collapse
|
6
|
Lattanzi R, Petchprapa C, Ascani D, Babb JS, Chu D, Davidovitch RI, Youm T, Meislin RJ, Recht MP. Detection of cartilage damage in femoroacetabular impingement with standardized dGEMRIC at 3 T. Osteoarthritis Cartilage 2014; 22:447-56. [PMID: 24418673 DOI: 10.1016/j.joca.2013.12.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 12/10/2013] [Accepted: 12/21/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aimed at identifying the optimal threshold value to detect cartilage lesions with Standardized delayed Gadolinium-Enhanced MRI of Cartilage (dGEMRIC) at 3 T and evaluate intra- and inter-observer repeatability. DESIGN We retrospectively reviewed 20 hips in 20 patients. dGEMRIC maps were acquired at 3 T along radial imaging planes of the hip and standardized to remove the effects of patient's age, sex and diffusion of gadolinium contrast. Two observers separately evaluated 84 Standardized dGEMRIC maps, both by visual inspection and using an average index for a region of interest (ROI) in the acetabular cartilage. A radiologist evaluated the acetabular cartilage on morphologic MR images at exactly the same locations. Using intra-operative findings as reference, the optimal threshold to detect cartilage lesions with Standardized dGEMRIC was assessed and results were compared with the diagnostic performance of morphologic magnetic resonance imaging (MRI). RESULTS Using z < -2 as threshold and visual inspection of the color-adjusted maps, sensitivity, specificity and accuracy for Observer 1 and Observer 2, were 83%, 60% and 75%, and 69%, 70% and 69%, respectively. Overall performance was 52%, 67% and 58%, when using an average z for the acetabular cartilage, compared to 37%, 90% and 56% for morphologic assessment. The kappa coefficient was 0.76 and 0.68 for intra- and inter-observer repeatability, respectively, indicating substantial agreement. CONCLUSIONS Standardized dGEMRIC at 3 T is accurate in detecting cartilage damage and could improve preoperative assessment in femoroacetabular impingement (FAI). As cartilage lesions in FAI are localized, visual inspection of the Standardized dGEMRIC maps is more accurate than an average z for the acetabular cartilage.
Collapse
Affiliation(s)
- R Lattanzi
- The Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Langone Medical Center, 660 First Avenue, New York, NY 10016, USA; Department of Radiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA.
| | - C Petchprapa
- Department of Radiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
| | - D Ascani
- The Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Langone Medical Center, 660 First Avenue, New York, NY 10016, USA
| | - J S Babb
- Department of Radiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
| | - D Chu
- Department of Radiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
| | - R I Davidovitch
- Department of Orthopedic Surgery, New York University Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA
| | - T Youm
- Department of Orthopedic Surgery, New York University Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA
| | - R J Meislin
- Department of Orthopedic Surgery, New York University Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA
| | - M P Recht
- Department of Radiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
| |
Collapse
|