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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] [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.
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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
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Kohli A, Xia S, Wells JE, Chhabra A. Three-Dimensional CT and 3D MRI of Hip- Important Aids to Hip Preservation Surgery. Semin Ultrasound CT MR 2023; 44:252-270. [PMID: 37437966 DOI: 10.1053/j.sult.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Common hip internal derangements include femoroacetabular impingement (FAI), developmental dysplasia of hip (DDH) dysplasia, and avascular necrosis (AVN) of the femoral head. These are initially screened by radiographs. For preoperative planning of hip preservation, 3-dimensional (3D) CT is commonly performed to assess bony anatomy and its alterations. Magnetic resonance imaging (MRI) is used to evaluate labrum, hyaline cartilage, tendons, synovium, and loose bodies, and provides vital information for surgical decision-making. However, conventional 2D MRI techniques are limited by lack of isotropic multiplanar reconstructions and partial volume artifacts. With advancements in hardware and software, novel isotropic 3D MR Proton Density images are acquired with acceptable acquisition times leading to improved visualization of soft tissue and osseous structures for various hip conditions. Three-Dimensional MRI allows multiplanar non-gap reconstructions along the structures of interest. It results in detection of small, otherwise inconspicuous labral tears without the need for MR arthrogram, which can be subsequently measured. In addition, radial reconstructions of the femoral head can be performed from original 3D volume MR imaging and CT imaging without the need for individual different plane acquisitions. Three-Dimensional MRI thus impacts surgical decision-making for the important common hip derangement conditions. For example, femoral head hyaline cartilage loss may make hip preservation difficult or impossible. In this review, we discuss the advantages and technical details of 3D CT and MRI and their significant role in aiding hip preservation surgery for common hip conditions. The conditions discussed in this article include FAI, DDH, AVN, synovial disorders, cartilaginous tumors, and hip fractures.
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Affiliation(s)
- Ajit Kohli
- Department of Radiology, UT Southwestern, Dallas, TX
| | - Shuda Xia
- Department of Radiology, UT Southwestern, Dallas, TX
| | - Joel E Wells
- Baylor Scott & White Comprehensive Hip Center and Associate Professor Texas A&M School of Medicine
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern, Dallas, TX; Department of Orthopedic Surgery, UT Southwestern, Dallas, TX.
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Jawetz ST, Fox MG, Blankenbaker DG, Caracciolo JT, Frick MA, Nacey N, Said N, Sharma A, Spence S, Stensby JD, Subhas N, Tubb CC, Walker EA, Yu F, Beaman FD. ACR Appropriateness Criteria® Chronic Hip Pain: 2022 Update. J Am Coll Radiol 2023; 20:S33-S48. [PMID: 37236751 DOI: 10.1016/j.jacr.2023.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Chronic hip pain is a frequent chief complaint for adult patients who present for evaluation in a variety of clinical practice settings. Following a targeted history and physical examination, imaging plays a vital role in elucidating the etiologies of a patient's symptoms, as a wide spectrum of pathological entities may cause chronic hip pain. Radiography is usually the appropriate initial imaging test following a clinical examination. Depending on the clinical picture, advanced cross-sectional imaging may be subsequently performed for further evaluation. This documents provides best practice for the imaging workup of chronic hip pain in patients presenting with a variety of clinical scenarios. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Michael G Fox
- Panel Chair, Program Director, Diagnostic Radiology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jamie T Caracciolo
- Moffitt Cancer Center and University of South Florida Morsani College of Medicine, Tampa, Florida; MSK-RADS (Bone) Committee
| | - Matthew A Frick
- Chair of Education, Department of Radiology, Chair of Musculoskeletal Imaging, Mayo Clinic, Rochester, Minnesota
| | - Nicholas Nacey
- University of Virginia Health System, Charlottesville, Virginia
| | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
| | - Akash Sharma
- Mayo Clinic, Jacksonville, Florida; Commission on Nuclear Medicine and Molecular Imaging
| | - Susanna Spence
- University of Texas McGovern Medical School, Houston, Texas; Committee on Emergency Radiology-GSER; Member of the Board of Advisors and Board of Directors for Texas Radiological Society
| | | | | | - Creighton C Tubb
- UT Health San Antonio, San Antonio, Texas; American Academy of Orthopaedic Surgeons
| | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania and Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Florence Yu
- Section Head, Musculoskeletal Imaging, Weill Cornell Medical College, New York, New York; Primary care physician; Chair, ACR sponsored BONE-RADS Committee
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Montin E, Kijowski R, Youm T, Lattanzi R. A radiomics approach to the diagnosis of femoroacetabular impingement. FRONTIERS IN RADIOLOGY 2023; 3:1151258. [PMID: 37492381 PMCID: PMC10365279 DOI: 10.3389/fradi.2023.1151258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/28/2023] [Indexed: 07/27/2023]
Abstract
Introduction Femoroacetabular Impingement (FAI) is a hip pathology characterized by impingement of the femoral head-neck junction against the acetabular rim, due to abnormalities in bone morphology. FAI is normally diagnosed by manual evaluation of morphologic features on magnetic resonance imaging (MRI). In this study, we assess, for the first time, the feasibility of using radiomics to detect FAI by automatically extracting quantitative features from images. Material and methods 17 patients diagnosed with monolateral FAI underwent pre-surgical MR imaging, including a 3D Dixon sequence of the pelvis. An expert radiologist drew regions of interest on the water-only Dixon images outlining femur and acetabulum in both impingement (IJ) and healthy joints (HJ). 182 radiomic features were extracted for each hip. The dataset numerosity was increased by 60 times with an ad-hoc data augmentation tool. Features were subdivided by type and region in 24 subsets. For each, a univariate ANOVA F-value analysis was applied to find the 5 features most correlated with IJ based on p-value, for a total of 48 subsets. For each subset, a K-nearest neighbor model was trained to differentiate between IJ and HJ using the values of the radiomic features in the subset as input. The training was repeated 100 times, randomly subdividing the data with 75%/25% training/testing. Results The texture-based gray level features yielded the highest prediction max accuracy (0.972) with the smallest subset of features. This suggests that the gray image values are more homogeneously distributed in the HJ in comparison to IJ, which could be due to stress-related inflammation resulting from impingement. Conclusions We showed that radiomics can automatically distinguish IJ from HJ using water-only Dixon MRI. To our knowledge, this is the first application of radiomics for FAI diagnosis. We reported an accuracy greater than 97%, which is higher than the 90% accuracy for detecting FAI reported for standard diagnostic tests (90%). Our proposed radiomic analysis could be combined with methods for automated joint segmentation to rapidly identify patients with FAI, avoiding time-consuming radiological measurements of bone morphology.
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Affiliation(s)
- Eros Montin
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, United States
- Center for Advanced Imaging Innovation and Research (CAIR), Department of Radiology, New York University Grossman School of Medicine, New York, NY, United States
| | - Richard Kijowski
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, United States
| | - Thomas Youm
- Department of Orthopedic Surgery, New York University Grossman School of Medicine, New York, NY, United States
| | - Riccardo Lattanzi
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, United States
- Center for Advanced Imaging Innovation and Research (CAIR), Department of Radiology, New York University Grossman School of Medicine, New York, NY, United States
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Morbée L, Chen M, Van Den Berghe T, Schiettecatte E, Gosselin R, Herregods N, Jans LBO. MRI-based synthetic CT of the hip: can it be an alternative to conventional CT in the evaluation of osseous morphology? Eur Radiol 2022; 32:3112-3120. [DOI: 10.1007/s00330-021-08442-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/12/2021] [Accepted: 10/25/2021] [Indexed: 12/13/2022]
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Florkow MC, Willemsen K, Mascarenhas VV, Oei EHG, van Stralen M, Seevinck PR. Magnetic Resonance Imaging Versus Computed Tomography for Three-Dimensional Bone Imaging of Musculoskeletal Pathologies: A Review. J Magn Reson Imaging 2022; 56:11-34. [PMID: 35044717 PMCID: PMC9305220 DOI: 10.1002/jmri.28067] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/31/2021] [Accepted: 01/05/2022] [Indexed: 12/18/2022] Open
Abstract
Magnetic resonance imaging (MRI) is increasingly utilized as a radiation‐free alternative to computed tomography (CT) for the diagnosis and treatment planning of musculoskeletal pathologies. MR imaging of hard tissues such as cortical bone remains challenging due to their low proton density and short transverse relaxation times, rendering bone tissues as nonspecific low signal structures on MR images obtained from most sequences. Developments in MR image acquisition and post‐processing have opened the path for enhanced MR‐based bone visualization aiming to provide a CT‐like contrast and, as such, ease clinical interpretation. The purpose of this review is to provide an overview of studies comparing MR and CT imaging for diagnostic and treatment planning purposes in orthopedic care, with a special focus on selective bone visualization, bone segmentation, and three‐dimensional (3D) modeling. This review discusses conventional gradient‐echo derived techniques as well as dedicated short echo time acquisition techniques and post‐processing techniques, including the generation of synthetic CT, in the context of 3D and specific bone visualization. Based on the reviewed literature, it may be concluded that the recent developments in MRI‐based bone visualization are promising. MRI alone provides valuable information on both bone and soft tissues for a broad range of applications including diagnostics, 3D modeling, and treatment planning in multiple anatomical regions, including the skull, spine, shoulder, pelvis, and long bones.
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Affiliation(s)
- Mateusz C Florkow
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Koen Willemsen
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Imaging Center, Hospital da Luz, Lisbon, Portugal
| | - Edwin H G Oei
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marijn van Stralen
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.,MRIguidance BV, Utrecht, The Netherlands
| | - Peter R Seevinck
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.,MRIguidance BV, Utrecht, The Netherlands
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MR Imaging of the Pelvic Bones: The Current and Cutting-Edge Techniques. J Belg Soc Radiol 2022; 106:123. [PMID: 36475022 PMCID: PMC9695217 DOI: 10.5334/jbsr.2874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/24/2022] [Indexed: 01/25/2023] Open
Abstract
UNLABELLED This review presents an overview of the spectrum of the current and cutting-edge MRI techniques for pelvic bone imaging in clinical practice. The current MRI sequences and their advantages, disadvantages and usefullness in the imaging of this complex anatomical region are addressed. Finally, cutting-edge techniques are discussed, including susceptibility weighted MRI, ultrashort echo time MRI, zero echo time MRI and a deep learning-based multiparametric MRI technique named 'synthetic CT,' creating CT-like images without ionizing radiaton. MAIN POINTS GRE, SWI, UTE, ZTE MRI and synthetic CT sequences depict the cortical outline of the bones better in comparison to conventional MR images.MRI-based synthetic CT can create HU maps and allows for automated segmentation of pelvic bones.The current and cutting-edge MR techniques for bone imaging are complementary in the characterization of a variety of musculoskeletal disorders.
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Ratcliff TL, Chhabra A, Okpara SO, Lawson P, Kayfan S, Xi Y, Mulligan EP, Wells JE. Correlation of the Imaging Features of Femoroacetabular Impingement Syndrome With Clinical Findings and Patient Functional Scores. Orthopedics 2021; 44:e577-e582. [PMID: 34292835 DOI: 10.3928/01477447-20210618-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The relationship among the severity of the imaging features of femoroacetabular impingement syndrome (FAIS), patient symptoms, and function has not been elucidated. Understanding this relationship helps to improve the prognostic value of imaging. The goal of this study was to examine the correlation of clinical findings, patient pain, and function with severity, as measured with radiographic and 3-dimensional magnetic resonance imaging (3D-MRI). Data collected prospectively through a longitudinally maintained hip database were reviewed, and 37 hips from 31 patients were included. All patients were examined by an experienced orthopedic surgeon, and preoperative radiographs and 3D-MRI were obtained. Preoperatively, the patients completed validated patient-reported outcome measures (PROMs). Mean±SD alpha angles were 69.4°±10.3°, 70.0°±10.3°, 70.6°±8.4°, and 74.8°±9.2° at 12 o'clock, 1 o'clock, 2 o'clock, and 3 o'clock, respectively. Mean lateral center edge angle was 30.1°±5.3°. The authors did not observe a statistically significant correlation between PROMs and the features measured by radiographs and 3D-MRI (P>.05). In this subset of prospectively imaged patients with FAIS, the authors did not find a correlation between the severity of symptoms measured by PROMs and features on radiographs and 3D-MRI. The severity of dysfunction is multifactorial, and anatomic severity, as measured radiographically and with 3D-MRI, may not correlate with symptoms. Further investigation is necessary to address the sources of patient pain. [Orthopedics. 2021;44(4):e577-e582.].
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Ashikyan O, Wells J, Chhabra A. 3D MRI of the Hip Joint: Technical Considerations, Advantages, Applications, and Current Perspectives. Semin Musculoskelet Radiol 2021; 25:488-500. [PMID: 34547814 DOI: 10.1055/s-0041-1730910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Magnetic resonance imaging (MRI) is a common choice among various imaging modalities for the evaluation of hip conditions. Conventional MRI with two-dimensional acquisitions requires a significant amount of time and is limited by partial-volume artifacts and suboptimal fluid-to-cartilage contrast. Recent hardware and software advances have resulted in development of novel isotropic three-dimensional (3D) single-acquisition protocols that cover the volume of the entire hip and can be reconstructed in arbitrary planes for submillimeter assessment of bony and labro-cartilaginous structures in their planes of orientation. This technique facilitates superior identification of small labral tears and other hip lesions with better correlations with arthroscopy. In this review, we discuss technical details related to 3D MRI of the hip, its advantages, and its role in commonly encountered painful conditions that can be evaluated with great precision using this technology. The entities described are femoroacetabular impingement with acetabular labral tears, acetabular dysplasia, avascular necrosis, regional tendinopathies and tendon tears, bursitis, and other conditions.
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Affiliation(s)
| | - Joel Wells
- Department of Orthopedic Surgery, UT Southwestern, Dallas, Texas
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern, Dallas, Texas.,Department of Orthopedic Surgery, UT Southwestern, Dallas, Texas
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Abstract
PURPOSE OF REVIEW Femoroacetabular impingement (FAI) is one of the main causes of hip pain in young adults and poses clinical challenges which have placed it at the forefront of imaging and orthopedics. Diagnostic hip imaging has dramatically changed in the past years, with the arrival of new imaging techniques and the development of magnetic resonance imaging (MRI). This article reviews the current state-of-the-art clinical routine of individuals with suspected FAI, limitations, and future directions that show promise in the field of musculoskeletal research and are likely to reshape hip imaging in the coming years. RECENT FINDINGS The largely unknown natural disease course, especially in hips with FAI syndrome and those with asymptomatic abnormal morphologies, continues to be a problem as far as diagnosis, treatment, and prognosis are concerned. There has been a paradigm shift in recent years from bone and soft tissue morphological analysis towards the tentative development of quantitative approaches, biochemical cartilage evaluation, dynamic assessment techniques and, finally, integration of artificial intelligence (AI)/deep learning systems. Imaging, AI, and hip preserving care will continue to evolve with new problems and greater challenges. The increasing number of analytic parameters describing the hip joint, as well as new sophisticated MRI and imaging analysis, have carried practitioners beyond simplistic classifications. Reliable evidence-based guidelines, beyond differentiation into pure instability or impingement, are paramount to refine the diagnostic algorithm and define treatment indications and prognosis. Nevertheless, the boundaries of morphological, functional, and AI-aided hip assessment are gradually being pushed to new frontiers as the role of musculoskeletal imaging is rapidly evolving.
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Affiliation(s)
- Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Imaging Center, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Avenida Lusíada 100, 1500-650, Lisbon, Portugal.
| | - António Caetano
- Radiology Department, Centro Hospitalar Universitário Lisboa Central, Hospital de Curry Cabral, Rua da Beneficiência, 8, 1050-099, Lisbon, Portugal
| | - Pedro Dantas
- Orthopaedic and Traumatology Center, Hospital CUF Descobertas, Rua Mario Botas, 1998-018, Lisbon, Portugal
| | - Paulo Rego
- Department of Orthopaedic Surgery, Hospital da Luz, Grupo Luz Saúde, Avenida Lusiada 100, 1500-650, Lisbon, Portugal
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Guirguis A, Polster J, Karim W, Obuchowski N, Rosneck J, Goodwin R, Subhas N. Interchangeability of CT and 3D "pseudo-CT" MRI for preoperative planning in patients with femoroacetabular impingement. Skeletal Radiol 2020; 49:1073-1080. [PMID: 31996983 DOI: 10.1007/s00256-020-03385-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether a 3D magnetic resonance imaging (MRI) sequence with postprocessing applied to simulate computed tomography (CT) ("pseudo-CT") images can be used instead of CT to measure acetabular version and alpha angles and to plan for surgery in patients with femoroacetabular impingement (FAI). MATERIALS AND METHODS Four readers retrospectively measured acetabular version and alpha angles on MRI and CT images of 40 hips from 20 consecutive patients (9 female patients, 11 male patients; mean age, 26.0 ± 6.5 years) with FAI. 3D models created from MRI and CT images were assessed by 2 orthopedic surgeons to determine the need for femoroplasty and/or acetabuloplasty. Interchangeability of MRI with CT was tested by comparing agreement between 2 readers using CT (intramodality) with agreement between 1 reader using CT and 1 using MRI (intermodality). RESULTS Intramodality and intermodality agreement values were nearly identical for acetabular version and alpha angle measurements and for surgical planning. Increases in inter-reader disagreement for acetabular version angle, alpha angle, and surgical planning when MRI was substituted for CT were - 2.1% (95% confidence interval [CI], - 7.7 to + 3.5%; p = 0.459), - 0.6% (95% CI, - 8.6 to + 7.3%; p = 0.878), and 0% (95% CI, - 15.1 to + 15.1%; p = 1.0), respectively, when an agreement criterion ≤ 5° was used for angle measurements. CONCLUSION Pseudo-CT MRI was interchangeable with CT for measuring acetabular version and highly favorable for interchangeability for measuring alpha angle and for surgical planning, suggesting that MRI could replace CT in assessing patients with FAI.
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Affiliation(s)
- Albair Guirguis
- Department of Diagnostic Radiology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Joshua Polster
- Department of Diagnostic Radiology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Wadih Karim
- Department of Diagnostic Radiology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Nancy Obuchowski
- Department of Quantitative Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - James Rosneck
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Ryan Goodwin
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Naveen Subhas
- Department of Diagnostic Radiology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Blum S, Franken L, Hartmann A, Thielemann F, Plodeck V, Danowski D, Kühn JP, Hoffmann RT, Günther KP, Goronzy J. MRI-based static and functional assessment of complex hip deformities in comparison with CT: a validation study. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2020; 33:829-838. [PMID: 32323031 PMCID: PMC7669781 DOI: 10.1007/s10334-020-00845-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 03/03/2020] [Accepted: 04/07/2020] [Indexed: 11/29/2022]
Abstract
Objective This study aimed at investigating the agreement between predefined quantitative parameters of hip morphology derived from magnetic resonance imaging (MRI) and virtual range of motion (ROM) analysis using computed tomography (CT) as standard of reference. Methods Twenty patients (13 females, 7 males, 16–59 years) with hip deformities underwent MRI prior to surgery. Clockwise alpha angle, femoral head and neck diameter, collum caput diaphysis angle, femoral torsion, center-edge angles, acetabular coverage of the femoral head, sourcil angle, and acetabular anteversion were measured. Additionally, tern single and combined movements were simulated using a motion analysis program. The MRI findings were compared with the corresponding results obtained by CT. Correlation of MRI with CT was assessed using different statistical methods (intraclass correlation coefficient, Bland–Altmann plot, two one-sided t test), and linear regression analysis was performed. Results The results showed near-perfect intraclass correlation coefficients (ICCs) for anteversion (0.95), acetabular sector angles (0.98–0.99), sourcil angle (0.95), and acetabular coverage (anterior 0.96, posterior 0.99). Intermethod correlation for femoral parameters showed almost perfect agreement except for the alpha angle (0.73–0.97). No significant proportional bias was detected for traditional acetabular and femoral parameters. ROM analysis was performed for 370 movements in 37 hips. For 78.4% (290/370) of the movements analysed, neither CT nor MRI detected impingement across the physiological ROM. For 18.6% (69/370) of the movements, impingement was detected by both CT and MRI, while 2.2% (8/370) of the movements with impingement in CT showed no impingement in MRI, and 0.8% (3/370) of the movements with impingement in MRI had no corresponding result in CT. Conclusion Finally, it was concluded that MRI-based assessment of hip morphology and virtual ROM analysis is feasible and can be performed with good intermethod agreement in comparison to the gold standard (CT). Therefore, MRI appears to be substantially equivalent to CT for use in virtual ROM analysis and so may reasonably be used in place of CT for this purpose.
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Affiliation(s)
- Sophia Blum
- Department of Radiology, Institute and Policlinic of Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Lea Franken
- University Center of Orthopedics and Traumatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Albrecht Hartmann
- University Center of Orthopedics and Traumatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Falk Thielemann
- University Center of Orthopedics and Traumatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Verena Plodeck
- Department of Radiology, Institute and Policlinic of Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Dirk Danowski
- Department of Radiology, Institute and Policlinic of Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jens-Peter Kühn
- Department of Radiology, Institute and Policlinic of Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ralf-Thorsten Hoffmann
- Department of Radiology, Institute and Policlinic of Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Klaus-Peter Günther
- University Center of Orthopedics and Traumatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jens Goronzy
- University Center of Orthopedics and Traumatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Three-dimensional Computerized Tomography and Multiplanar Imaging of Developmental Hip Dysplasia. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2019; 53:103-109. [PMID: 32377066 PMCID: PMC7199829 DOI: 10.14744/semb.2019.79095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/18/2019] [Indexed: 11/20/2022]
Abstract
Developmental dysplasia of the hip (DDH) is still one of the biggest orthopedic problems in the world. Global poverty and refugee crises have led to it becoming a greater issue even in developed nations. Early diagnosis and effective treatment of DDH are required to prevent the possibility of arthrosis, limb shortening, pelvic asymmetry, and vertebral scoliosis. In late cases, surgery is the only choice for correction. Direct radiography has been used for many years and continues to have an important role, though ultrasonography is the primary source for early postnatal screening. Although magnetic resonance imaging (MRI) has become an important modality to provide sectional imaging in many cases, in late-period dysplasia, computed tomography (CT) and three-dimensional (3D) CT are preferred because it can more effectively demonstrate the cortical bony structures. The aim of this review was to demonstrate the effectiveness of 3D CT and multiplanar reconstruction based on previous studies.
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