Developmental Hip Dysplasia Diagnosis at Three-dimensional US: A Multicenter Study

Abstract

Purpose To validate accuracy of diagnosis of developmental dysplasia of the hip (DDH) from geometric properties of acetabular shape extracted from three-dimensional (3D) ultrasonography (US). Materials and Methods In this retrospective multi-institutional study, 3D US was added to conventional two-dimensional (2D) US of 1728 infants (mean age, 67 days; age range, 3-238 days) evaluated for DDH from January 2013 to December 2016. Clinical diagnosis after more than 6 months follow-up was normal (n = 1347), borderline (Graf IIa, later normalizing spontaneously; n = 140) or dysplastic (Graf IIb or higher, n = 241). Custom software accessible through the institution's research portal automatically calculated indexes including 3D posterior and anterior alpha angle and osculating circle radius from hip surface models generated with less than 1 minute of user input. Logistic regression predicted clinical diagnosis (normal = 0, dysplastic = 1) from 3D indexes (ie, age and sex). Output represented probability of hip dysplasia from 0 to 1 (output: >0.9, dysplastic; 0.11-0.89, borderline; <0.1, normal). Software can be accessed through the research portal. Results Area under the receiver operating characteristic curve was equivalently high for 3D US indexes and 2D US alpha angle (0.996 vs 0.987). Three-dimensional US helped to correctly categorize 97.5% (235 of 241) dysplastic and 99.4% (1339 of 1347) normal hips. No dysplastic hips were categorized as normal. Correct diagnosis was provided at initial 3D US scan in 69.3% (97 of 140) of the studies diagnosed as borderline at initial 2D US scans. Conclusion Automatically calculated 3D indexes of acetabular shape performed equivalently to high-quality 2D US scans at tertiary medical centers to help diagnose DDH. Three-dimensional US reduced the number of borderline studies requiring follow-up imaging by over two-thirds.

Using 3‐dimensional ultrasound islice technology for the diagnosis of developmental dysplasia of the hip

“…With iSlice technology, it is easy to find a more‐or‐less standard plane for measuring the 3D volume data. With 3D ultrasound, the novices produced no false‐positive or false‐negative results, suggesting that 3D ultrasound is more reliable than 2D ultrasound …”

Can Medialization of Acetabular Rim Be a Prognostic Factor in Treatment of Developmental Dysplasia of Hip?

“…In addition, in type III and IV hips due to the great extent of dysplasia of bony roof, measurement of alpha and beta angles becomes harder. 11 To overcome this difficulty, we searched for an alternative measurement that will make the subjective interpretation more objective in severely dysplastic hips. For this purpose, we measured the distance of medial displacement of the acetabular rim and investigated its effect on treatment and follow-up procedure in DDH.…”

Three-dimensional US as an Optimal Diagnostic Tool for Evaluating Developmental Dysplasia of the Hip

“…We read with great interest the article by Dr Zonoobi and colleagues (1), "Developmental Hip Dysplasia Diagnosis at Three-dimensional US: A Multicenter Study," which was published in the June 2018 issue of Radiology.…”