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High Frequency Ultrasound for the Analysis of Fetal and Placental Development In Vivo
Published on: November 8, 2018
Prediction of Late Dysplasia Based on Ultrasound and Plain X-Ray at 6 Months
Reba L Salton1, Patrick M Carry1,2, Nancy Hadley-Miller3,2
1Musculoskeletal Research Center.
Insights
Early hip imaging at 6 months can predict developmental dysplasia of the hip (DDH) in children. Combining ultrasound and x-ray measurements improves prediction accuracy for residual hip dysplasia.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Developmental Dysplasia of the Hip
Background:
- Developmental dysplasia of the hip (DDH) can lead to long-term issues like osteoarthritis.
- Predicting residual dysplasia at 2 years old is crucial for timely intervention.
- Early identification of DDH risk factors is essential for optimal patient outcomes.
Purpose of the Study:
- To compare the prognostic value of 6-month imaging modalities for predicting residual hip dysplasia.
- To identify optimal diagnostic metrics for early detection of DDH.
- To evaluate the effectiveness of current and proposed imaging cutoffs.
Main Methods:
- Retrospective review of patients treated for DDH with 2-year follow-up.
- Analysis of 6-month ultrasound (US) and radiograph (x-ray) data, including alpha angle (AA), femoral head coverage (FHC), and acetabular index (AI).
- Receiver operating characteristic (ROC) curves and Youden's index (YI) used to assess prognostic ability and compare diagnostic metrics.
Main Results:
- At 2 years, 28.8% of patients had acetabular dysplasia.
- Six-month AA and AI showed better prognostic ability (AUC: 0.80 and 0.79) than FHC (AUC: 0.77).
- Existing 6-month cutoffs for AA, AI, and FHC had poor predictive value (YI: 0.08, 0.0, 0.06).
- A composite of proposed cutoffs (AA ≥73°, FHC >62%, AI ≤24°) significantly improved prediction (YI: 0.63).
Conclusions:
- The rate of residual hip dysplasia remains a concern.
- Six-month x-ray and US are valuable in managing DDH.
- A combined assessment of imaging metrics, using proposed cutoffs, maximizes dysplasia prediction.
- New validated cutoffs (AA ≥73°, FHC >62%, AI ≤24°) are recommended for improved DDH management.
Background:
Developmental dysplasia of the hip represents a spectrum of deformity. Residual dysplasia at 2 years of age is associated with an increased risk for osteoarthritis and functional limitations. We compared the prognostic value of 6-month imaging modalities and aimed to identify optimal diagnostic metrics for the prediction of residual dysplasia.
Methods:
After IRB approval, patients who underwent Pavlik treatment between 2009 and 2018 with 2-year follow-up were identified. Sonographs [ultrasound (US)] and radiographs (x-ray) were obtained at 6-month and 2-year-old visits. Dysplasia at 2 years was defined as an acetabular index (AI) >24 degrees. Receiver operating characteristic curves were constructed to quantitatively compare the prognostic ability of US and x-ray-based measures at 6 months. Youden's index [(YI) (values range from 0 (poor test) to 1 (perfect test)] was used to evaluate existing cutoffs at 6 months of age (normal measurements: alpha angle (AA) ≥60 degrees, femoral head coverage (FHC) ≥50%, and AI <30 degrees) relative to newly proposed limits.
Results:
Fifty-nine patients were included, of which 28.8% of patients (95% CI: 17.3 to 40.4%) had acetabular dysplasia at 2 years. After adjusting for sex, AA [Area under the Curve (AUC): 80] and AI (AUC: 79) at 6 months of age were better tests than FHC (AUC: 0.77). Current diagnostic cutoffs for AA (YI: 0.08), AI (YI: 0.0), and FHC (YI: 0.06) at 6 months had poor ability to predict dysplasia at 2 years. A composite test of all measures based on proposed cutoffs (AA ≥73 degrees, FHC > 62% and AI ≤24 degrees) was a better predictor of dysplasia at 2 years (Youden's index (YI): 0.63) than any single metric.
Conclusions:
The rate of residual dysplasia remains concerning. The 6-month x-ray and US both play a role in the ongoing management of the developmental dysplasia of the hip. The prediction of dysplasia is maximized when all metrics are considered collectively. Existing parameters were not accurate; We recommend the following cutoffs: AA ≥73 degrees, FHC > 62%, and AI ≤24 degrees. These cutoffs must be validated.
Level Of Evidence:
Prognostic Level II.
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