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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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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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Arthroscopic Technique for Reduction and Fixation of an Acetabular Rim Fracture. Arthrosc Tech 2021; 11:e25-e30. [PMID: 35127425 PMCID: PMC8807715 DOI: 10.1016/j.eats.2021.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/24/2021] [Indexed: 02/03/2023] Open
Abstract
Acetabular rim fractures can accompany patients with femoroacetabular impingement. Frequently, the acetabular rim fracture is excised. However, if the osseous fragment of the acetabular rim fracture is large enough to result in instability, then the acetabular rim fracture should be reduced and secured with internal fixation. The purpose of this technical note was to describe the arthroscopic technique of internal fixation of an acetabular rim fracture.
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Samim M, Eftekhary N, Vigdorchik JM, Elbuluk A, Davidovitch R, Youm T, Gyftopoulos S. 3D-MRI versus 3D-CT in the evaluation of osseous anatomy in femoroacetabular impingement using Dixon 3D FLASH sequence. Skeletal Radiol 2019; 48:429-436. [PMID: 30182297 DOI: 10.1007/s00256-018-3049-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/07/2018] [Accepted: 08/14/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if hip 3D-MR imaging can be used to accurately demonstrate femoral and acetabular morphology in the evaluation of patients with femoroacetabular impingement. MATERIALS AND METHODS We performed a retrospective review at our institution of 17 consecutive patients (19 hips) with suspected femoroacetabular impingement who had both 3D-CT and 3D-MRI performed of the same hip. Two fellowship-trained musculoskeletal radiologists reviewed the imaging for the presence and location of cam deformity, anterior-inferior iliac spine variant, lateral center-edge angle, and neck-shaft angle. Findings on 3D-CT were considered the reference standard. The amount of radiation that was spared following introduction of 3D-MRI was also assessed. RESULTS All 17 patients suspected of FAI had evidence for cam deformity on 3D-CT. There was 100% agreement for diagnosis (19 out of 19) and location (19 out of 19) of cam deformity when comparing 3D-MRI with 3D-CT. There were 3 type I and 16 type II anterior-inferior iliac spine variants on 3D-CT imaging with 89.5% (17 out of 19) agreement for the anterior-inferior iliac spine characterization between 3D-MRI and 3D-CT. There was 64.7% agreement when comparing the neck-shaft angle (11 out of 17) and LCEA (11 out of 17) measurements. The use of 3D-MRI spared each patient an average radiation effective dose of 3.09 mSV for a total reduction of 479 mSV over a 4-year period. CONCLUSION 3D-MR imaging can be used to accurately diagnose and quantify the typical osseous pathological condition in femoroacetabular impingement and has the potential to eliminate the need for 3D-CT imaging and its associated radiation exposure, and the cost for this predominantly young group of patients.
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Affiliation(s)
- Mohammad Samim
- Department of Radiology, New York University Langone Medical Center, 333 East 38th street, New York, NY, 10016, USA.
| | - Nima Eftekhary
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, 10003, USA
| | - Jonathan M Vigdorchik
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, 10003, USA
| | - Ameer Elbuluk
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, 10003, USA
| | - Roy Davidovitch
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, 10003, USA
| | - Thomas Youm
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, 10003, USA
| | - Soterios Gyftopoulos
- Department of Radiology, New York University Langone Medical Center, 333 East 38th street, New York, NY, 10016, USA
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Yan K, Xi Y, Sasiponganan C, Zerr J, Wells JE, Chhabra A. Does 3DMR provide equivalent information as 3DCT for the pre-operative evaluation of adult Hip pain conditions of femoroacetabular impingement and Hip dysplasia? Br J Radiol 2018; 91:20180474. [PMID: 30048144 DOI: 10.1259/bjr.20180474] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE: Femoroacetabular impingement (FAI) and hip dysplasia (HD) are frequently evaluated by isotropic CT (3DCT) for preoperative planning at the expense of radiation. The aim was to determine if isotropic MRI (3DMR) imaging can provide similar quantitative and qualitative morphological information as 3DCT. METHODS: 25 consecutive patients with a final diagnosis of FAI or HD were retrospectively selected from December 2016-December 2017. Two readers (R1, R2) performed quantitative angular measurements on 3DCT and 3DMR, blinded to the diagnosis and each other's measurements. 3DMR and 3DCT of the hips were qualitatively and independently evaluated by a radiologist (R3), surgeon (R4), and fellow (R5). Interobserver and intermodality comparisons were performed. RESULTS: The ICC was good to excellent for all measurements between R1 and R2 (ICC:0.60-0.98) and the majority of intermodality measurements for R1 and R2. Average inter-reader and inter-modality PABAK showed good to excellent agreement for qualitative reads. On CT, all alpha angles (AA) were significantly lower in dysplasia patients than in cam patients (p < 0.05). All lateral center-edge angle (LCEA) were significantly lower in dysplasia than in cam patients (p < 0.05). On MR, AA at 12, 1, and 2 o'clock, and LCEA at center were significantly lower in dysplasia patients than in cam patients (p < 0.05). CONCLUSION: 3DMR offers similar qualitative and quantitative analysis as 3DCT in adult painful hip conditions. ADVANCES IN KNOWLEDGE: 3DMR has good potential to replace 3DCT and serve as a one-stop modality for bone and soft tissue characterizations in the pre-operative evaluation of FAI and HD.
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Affiliation(s)
- Kevin Yan
- 1 Department of Radiology, UT South western Medical Center , Dallas, TX , USA
| | - Yin Xi
- 1 Department of Radiology, UT South western Medical Center , Dallas, TX , USA
| | | | - Joseph Zerr
- 1 Department of Radiology, UT South western Medical Center , Dallas, TX , USA
| | - Joel E Wells
- 2 Department of Orthopedics, UT South western Medical Center , Dallas, TX , USA
| | - Avneesh Chhabra
- 1 Department of Radiology, UT South western Medical Center , Dallas, TX , USA.,2 Department of Orthopedics, UT South western Medical Center , Dallas, TX , USA
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Abstract
BACKGROUND Acetabular development is a complex process that involves both endochondral growth from the triradiate cartilage (TRC) and intramembranous growth from the primary and secondary ossification centers of the innominate bones. Ponseti and others have described these centers including their contribution toward the development of normal acetabular shape. Prior studies have not utilized advanced imaging to study the appearance and closure of these secondary centers. The purpose of this study was to determine the chronological age at which the secondary ossification centers of the acetabulum appear and close and where there are any sex differences. METHODS Patients who underwent abdominal and pelvic computed tomography (CT) scans between January 2009 and December 2014 at a pediatric hospital were retrospectively reviewed. Patients between age 6 and 16 years with adequate imaging of acetabulum were included. CT scans were assessed for the appearance and closure of the 3 acetabular secondary ossification centers [anterior (os pubis), superior (os ilium), and posterior (os ischium)] and closure of the TRC. RESULTS A total of 159 CT scans met inclusion criteria (66 males and 93 females). The median age of appearance of the secondary ossification centers was: posterior (10.1 females, 12.8 males), anterior (10.7 females, 13.4 males), and superior (11.1 females, 13.6 males). The median age of closure of the secondary ossification centers was: posterior (12.8 females, 13.6 males), anterior (12.8 females, 13.9 males), superior (14.5 females, 13.9 males), and TRC (14.5 females, 14.3 males). Most ossification centers in females appeared and closed approximately 2 to 3 years before males. CONCLUSIONS Secondary ossification centers in the acetabulum appear sequentially (first posterior, then anterior, then superior), with almost all centers closing just before TRC. Closure occurs earlier in females than males. Knowledge of these centers and their closure patterns allows better radiologic readings (especially CT studies) and understanding of acetabular growth, allowing more informed management of childhood hip conditions including dysplasia, trauma, and over-use sports injuries. LEVEL OF EVIDENCE Level III-Diagnostic.
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Alapati S, Wadhwa V, Komarraju A, Guidry C, Pandey T. Magnetic Resonance Imaging of Nonneoplastic Musculoskeletal Pathologies in the Pelvis. Semin Ultrasound CT MR 2017; 38:291-308. [PMID: 28705373 DOI: 10.1053/j.sult.2016.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Musculoskeletal pathologies in the pelvis encompass a wide variety of lesions including femoroacetabular impingement, athletic pubalgia, ischiofemoral impingement, and apophyseal avulsion injuries. Magnetic resonance imaging is the noninvasive imaging modality of choice for the diagnosis and management of these lesions. In this article, the authors discuss the nonneoplastic musculoskeletal lesions in the pelvis, with illustrations and relevant case examples.
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Affiliation(s)
- Sindhura Alapati
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Vibhor Wadhwa
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Aparna Komarraju
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Carey Guidry
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Tarun Pandey
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
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MRI of the Hip: What the Surgeon Wants to Know. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0219-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Nordeck SM, Koerper CE, Adler A, Malhotra V, Xi Y, Liu GT, Chhabra A. Simulated radiographic bone and joint modeling from 3D ankle MRI: feasibility and comparison with radiographs and 2D MRI. Skeletal Radiol 2017; 46:651-664. [PMID: 28265698 DOI: 10.1007/s00256-017-2596-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 12/30/2016] [Accepted: 02/08/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this work is to simulate radiographs from isotropic 3D MRI data, compare relationship of angle and joint space measurements on simulated radiographs with corresponding 2D MRIs and real radiographs (XR), and compare measurement times among the three modalities. MATERIALS AND METHODS Twenty-four consecutive ankles were included, eight males and 16 females, with a mean age of 46 years. Segmented joint models simulating radiographs were created from 3D MRI data sets. Three readers independently performed blinded angle and joint space measurements on the models, corresponding 2D MRIs, and XRs at two time points. Linear mixed models and the intraclass correlation coefficient (ICC) was ascertained, with p values less than 0.05 considered significant. RESULTS Simulated radiograph models were successfully created in all cases. Good agreement (ICC > 0.65) was noted among all readers across all modalities and among most measurements. Absolute measurement values differed between modalities. Measurement time was significantly greater (p < 0.05) on 2D versus simulated radiographs for most measurements and on XR versus simulated radiographs (p < 0.05) for nearly half the measurements. CONCLUSIONS Simulated radiographs can be successfully generated from 3D MRI data; however, measurements differ. Good inter-reader and moderate-to-good intra-reader reliability was observed and measurements obtained on simulated radiograph models took significantly less time compared to measurements with 2D and generally less time than XR.
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Affiliation(s)
- Shaun M Nordeck
- University of Texas Southwestern Medical College, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA. .,Musculoskeletal Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Conrad E Koerper
- University of Texas Southwestern Medical College, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Aaron Adler
- University of Texas Southwestern Medical College, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Vidur Malhotra
- Musculoskeletal Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yin Xi
- Musculoskeletal Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - George T Liu
- Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Avneesh Chhabra
- Musculoskeletal Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Sun DM, Pan SN, Wang EB, Zheng LQ, Guo WL, Fu XH. Magnetic Resonance Three-dimensional Cube Technique in the Measurement of Piglet Femoral Anteversion. Chin Med J (Engl) 2016; 129:1584-91. [PMID: 27364796 PMCID: PMC4931266 DOI: 10.4103/0366-6999.184462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The accurate measurement of the femoral anteversion (FA) angle is always a topic of much debate in the orthopedic surgery and radiology research. We aimed to explore a new FA measurement method to acquire accurate results without radiation damage using piglet model. METHODS A total of thirty piglets were assigned to two groups based on the age. Bilateral femora were imaged with 3.0-T magnetic resonance (MR) and 64-slice computed tomography (CT) examinations on all piglets. FA was measured on MR-three-dimensional (3D) postprocessing software with a four-step method: initial validation of the femoral condylar axis, validation of the condylar plane, validation of the femoral neck axis, and line-plane angle measurement of FA. After MR and CT examinations, all piglets were sacrificed and their degree of FA was measured using their excised, dried femora. MR, CT, and dried-femur measurement results were analyzed statistically; MR and CT measurements were compared for accuracy against each other and against the gold standard dried femur measurement. RESULTS In both groups, the mean FA value measured by MR was lower than that measured by CT. A statistically significant difference was observed between CT- and dried-femur measurements but not between MR- and dried-femur measurements. A higher correlation (0.783 vs. 0.408) and a higher consistency (0.863 vs. 0.578) with dried-femur measurement results were seen for MR measurements than CT measurements in the 1-week age group. However, in the 8-week age group, similar correlations (0.707 vs. 0.669) and consistencies (0.864 vs. 0.821) were observed. CONCLUSIONS Noninvasive MR-3D-Cube reconstruction was able to accurately measure FA in piglets. Particularly in the 1-week age group with a larger proportion of cartilaginous structures, the correlation and consistency between MR- and dried-femur measurement results were higher than those between CT- and dried-femur measurements, suggesting that MR may be a new useful examination tool for FA-related diseases in children.
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Affiliation(s)
- Dong-Mei Sun
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
| | - Shi-Nong Pan
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
| | - En-Bo Wang
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
| | - Li-Qiang Zheng
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
| | - Wen-Li Guo
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
| | - Xi-Hu Fu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
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