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Matheney T, Shore B, Miller P, Barnewolt C, Kim YJ, Paltiel H. Comparison of Contrast-enhanced Ultrasound and Contrast-enhanced Magnetic Resonance Imaging in the Assessment of Infant Hip Perfusion and Prediction of Proximal Femoral Growth Disturbance Following Closed and Open Reduction for Developmental Dysplasia of the Hip: A Preliminary Study. J Pediatr Orthop 2024; 44:e335-e343. [PMID: 38193395 DOI: 10.1097/bpo.0000000000002614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Proximal femoral growth disturbance (PFGD) is a significant complication associated with surgical treatment of infant hip dislocation. Contrast-enhanced magnetic resonance imaging (CEMRI) has been utilized to assess perfusion in these hips and avoid PFGD. Contrast-enhanced ultrasound (CEUS) is an imaging technique utilized to evaluate perfusion in other organs. The aims of this study were to compare perfusion of dysplastic infant hips with CEUS and CEMRI after surgical treatment and to determine whether CEUS was as effective as CEMRI at predicting PFGD. METHODS A retrospective analysis of patients undergoing closed or open reduction for infant hip dislocation between 2012 and 2019 was performed. All patients underwent intraoperative CEUS and postoperative CEMRI to assess femoral epiphyseal perfusion using intravenous contrast. Perfusion status was rated as normal, partially decreased, or globally decreased in both modalities. Agreement in perfusion status between CEUS and CEMRI was assessed. Patients were followed for a minimum of 2 years postoperatively and assessed for PFGD. RESULTS Eighteen patients (28% males) underwent closed or open reduction at an average age of 8 months (3 to 16 mo). The agreement in perfusion status between CEUS and CEMRI was substantial (α = 0.74). Patients were followed for a median of 3 years. PFGD developed in 3 hips (17%). For the detection of PFGD, both imaging modalities performed very well and with no difference in the diagnostic utility of CEUS compared with CEMRI. Considering normal perfusion alone the accuracy, sensitivity, and specificity for CEUS were 83%, 100%, and 80%, and for CEMRI were 78%, 100%, and 73%, respectively. Considering global decreased perfusion alone, the accuracy, sensitivity, and specificity for CEUS were 94%, 67%, and 100%, and for CEMRI were 89%, 67%, and 93%, respectively. CONCLUSIONS CEUS is a viable intraoperative method to assess infant hip perfusion. This pilot study appears to be comparable to CEMRI at visualizing perfusion of infant hips and as good or better in predicting PFGD after hip reduction. Prospective studies of this imaging technique should be performed to confirm the findings of this retrospective review. LEVEL OF EVIDENCE Level II-development diagnostic criteria on the basis of consecutive patients (with generally preferred standard).
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Samet JD, Alizai H, Chalian M, Costelloe C, Deshmukh S, Kalia V, Kamel S, Mhuircheartaigh JN, Saade J, Walker E, Wessell D, Fayad LM. Society of skeletal radiology position paper - recommendations for contrast use in musculoskeletal MRI: when is non-contrast imaging enough? Skeletal Radiol 2024; 53:99-115. [PMID: 37300709 DOI: 10.1007/s00256-023-04367-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/01/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023]
Abstract
The following White Paper will discuss the appropriateness of gadolinium administration in MRI for musculoskeletal indications. Musculoskeletal radiologists should consider the potential risks involved and practice the judicious use of intravenous contrast, restricting administration to cases where there is demonstrable added value. Specific nuances of when contrast is or is not recommended are discussed in detail and listed in table format. Briefly, contrast is recommended for bone and soft tissue lesions. For infection, contrast is reserved for chronic or complex cases. In rheumatology, contrast is recommended for early detection but not for advanced arthritis. Contrast is not recommended for sports injuries, routine MRI neurography, implants/hardware, or spine imaging, but is helpful in complex and post-operative cases.
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Affiliation(s)
- Jonathan D Samet
- Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, USA.
| | - Hamza Alizai
- CHOP Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Majid Chalian
- Department of Radiology, University of Washington, Seattle, USA
| | | | | | - Vivek Kalia
- Children's Scottish Rite Hospital, Dallas, USA
| | - Sarah Kamel
- Thomas Jefferson University Hospital, Philadelphia, USA
| | | | - Jimmy Saade
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, USA
| | - Eric Walker
- Penn State Health Milton S Hershey Medical Center, Hershey, USA
| | - Daniel Wessell
- Mayo Clinic Jacksonville Campus: Mayo Clinic in Florida, Jacksonville, USA
| | - Laura M Fayad
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, USA.
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Qiu M, Chen M, Sun H, Li D, Cai Z, Zhang W, Xu J, Ma R. Avascular necrosis under different treatment in children with developmental dysplasia of the hip: a network meta-analysis. J Pediatr Orthop B 2022; 31:319-326. [PMID: 34751178 DOI: 10.1097/bpb.0000000000000932] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of this study was to evaluate the incidence of avascular necrosis (AVN) of the femoral head in children less than 3 years of age with developmental dysplasia of the hip (DDH) treated with closed reduction, open reduction alone and open reduction combined with osteotomy. We reviewed clinical trials from the PubMed, EMBASE and Cochrane Library databases (up to November 2020) that were related to closed reduction, open reduction alone and open reduction combined with osteotomy for the treatment of children under 3 years of age with DDH. The screening and quality evaluation of the literature were performed independently by two researchers. In case of disagreement, a third researcher resolved the discourse. Finally, the data were extracted, and the R software and GeMTC program package were used to conduct a network meta-analysis (NMA). The evaluation index was the incidence of AVN. Fourteen articles were included. The NMA showed that in terms of the incidence of AVN, cases treated with open reduction alone were higher than those with closed reduction, and the difference was statistically significant. Open reduction alone had the highest probability (94.4%) of having the highest incidence of AVN, followed by open reduction combined with osteotomy (5.5%) and closed reduction (0.1%). In the treatment of children with DDH who are younger than 3 years old, open reduction alone is most likely to be the treatment with the highest incidence of AVN, followed by open reduction combined with osteotomy. The closed reduction had the smallest probability of AVN.
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Affiliation(s)
- Meiling Qiu
- Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Cheon JE, Kim JY, Choi YH, Kim WS, Cho TJ, Yoo WJ. MRI risk factors for development of avascular necrosis after closed reduction of developmental dysplasia of the hip: Predictive value of contrast-enhanced MRI. PLoS One 2021; 16:e0248701. [PMID: 33735261 PMCID: PMC7971487 DOI: 10.1371/journal.pone.0248701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/03/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose The purpose of this study was to identify imaging risk factors on contrast-enhanced hip MRI after closed reduction of developmental dysplasia of the hip (DDH) that could predict future development of avascular necrosis (AVN) of the femoral head. Materials and methods Fifty-eight infants (F: M = 53: 5, aged 3–18 months) who underwent immediate postoperative contrast-enhanced hip MRI after closed reduction of DDH were included in this study. Quality of reduction (concentric vs eccentric reduction with or without obstacles), abduction angle of the hip, presence of ossific nucleus, and pattern of contrast enhancement of the femoral head were retrospectively evaluated on MRI. Interobserver agreement of contrast enhancement pattern on MRI were evaluated by two radiologists. Development of AVN was determined through radiographic findings at 1 year after reduction. Results AVN of the femoral head developed in 13 (22%) of 58 patients. Excessive abduction of the hip joint (OR 4.65, [95% CI 1.20, 18.06] and global decreased enhancement of the femoral head (OR 71.66, [95% CI 10.54, 487.31]) exhibited statistically significant differences between the AVN and non-AVN groups (P < 0.05). Eccentric reduction (P = 0.320) did not show statistically significant difference between two groups and invisible ossific nucleus (P = 0.05) showed borderline significance. Multi-variable logistic regression indicated that global decreased enhancement of the femoral head was a significant risk factor of AVN (OR 27.92, 95% CI [4.17, 350.18]) (P = 0.0031). Interobserver agreement of contrast enhancement pattern analysis and diagnosis of AVN were good (0.66, 95% CI [0.52, 0.80]). Conclusion Contrast-enhanced hip MRI provides accurate anatomical assessment of the hip after closed reduction of DDH. Global decreased enhancement of the femoral head could be used as a good predictor for future development of AVN after closed reduction of DDH.
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Affiliation(s)
- Jung-Eun Cheon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology and Institute of Radiation Medicine, SNUMRC (Seoul National University Medical Research Center), Seoul National University Hospital, Seoul, Korea
- Division of Pediatric Radiology, Seoul National University Children’s Hospital, Seoul, Korea
| | - Ji Young Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology and Institute of Radiation Medicine, SNUMRC (Seoul National University Medical Research Center), Seoul National University Hospital, Seoul, Korea
- Division of Pediatric Radiology, Seoul National University Children’s Hospital, Seoul, Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology and Institute of Radiation Medicine, SNUMRC (Seoul National University Medical Research Center), Seoul National University Hospital, Seoul, Korea
- Division of Pediatric Radiology, Seoul National University Children’s Hospital, Seoul, Korea
| | - Woo Sun Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology and Institute of Radiation Medicine, SNUMRC (Seoul National University Medical Research Center), Seoul National University Hospital, Seoul, Korea
- Division of Pediatric Radiology, Seoul National University Children’s Hospital, Seoul, Korea
| | - Tae-Joon Cho
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
- Division of Pediatric Orthopedics, Seoul National University Children’s Hospital, Seoul, Korea
| | - Won Joon Yoo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
- Division of Pediatric Orthopedics, Seoul National University Children’s Hospital, Seoul, Korea
- * E-mail:
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Jia H, Wang L, Chang Y, Song Y, Liu Y, Zhang F, Feng J, Yang X, Sheng M. Assessment of irreducible aspects in developmental hip dysplasia by magnetic resonance imaging. BMC Pediatr 2020; 20:550. [PMID: 33278888 PMCID: PMC7718709 DOI: 10.1186/s12887-020-02420-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The developmental dysplasia of the hip (DDH) can cause a wide range of pathological changes, and often requires surgical treatment. Preoperative evaluation is very important for DDH. We aimed to assess the diagnostic capability of magnetic resonance imaging (MRI) for irreducible aspects preventing hip reduction in DDH. METHODS A total of 39 pediatric patients who received DDH evaluation in pediatric orthopedics from January 2015 to December 2019 were included. The samples included 4 cases of bilateral DDH and 35 cases of unilateral DDH, a total of 43 hip joint samples. All patients underwent surgical treatment, pathological examination and MRI of hip joint. RESULTS With pathological results or intraoperative findings as the gold standard, the sensitivity and specificity of MRI were 90.3% and 83.3% for the affected labrum, 92% and 83.3% for thickening of the round ligament, 90.0% and 91.3% for atrophy of the iliopsoas muscle, and 100% and 100% for fibrofatty pulvinar tissue and joint effusion, respectively. CONCLUTIONS The MRI showed an extraordinary capability of detecting these irreducible factors and helped surgeon choose the appropriate treatment strategies.
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Affiliation(s)
- Huihui Jia
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, 215000, PR China
| | - Liang Wang
- Department of Orthopaedics, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, 215000, PR China
| | - Yan Chang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, PR China
| | - Yongrui Song
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, 215000, PR China
| | - Yuqi Liu
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, 215000, PR China
| | - Fuyong Zhang
- Department of Orthopaedics, Children's Hospital of Soochow University, Suzhou, 215000, PR China
| | - Jie Feng
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, 215000, PR China
| | - Xiaodong Yang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, PR China
| | - Mao Sheng
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, 215000, PR China.
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