MR Imaging in Postreduction Assessment of Developmental Dysplasia of the Hip: Goals and Obstacles

Rosenbaum, Daniel G.; Servaes, Sabah; Bogner, Eric; Jaramillo, Diego; Mintz, Douglas N.

doi:10.1148/rg.2016150159

Cited by 40 publications

(31 citation statements)

References 56 publications

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“…However, there is few studies to systematically explore the abilities of MRI in DDH to detect the various obstacles, including thickened fibrofatty pulvinar tissue, joint effusion, thickened ligamentum teres, inversion of the labrum, hypertrophy of the cartilage of the acetabular roof, and iliopsoas muscle atrophy, to concentric reductions, which is the treatment goal of DDH and critical for better prognosis [15,16].…”

Section: Introductionmentioning

confidence: 99%

Assessment of irreducible aspects in developmental hip dysplasia by magnetic resonance imaging

et al. 2020

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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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Section: Introductionmentioning

confidence: 99%

Assessment of irreducible aspects in developmental hip dysplasia by magnetic resonance imaging

et al. 2020

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“…Osteonecrosis can occur as a complication of open or closed hip reduction in children who have developmental dysplasia of the hip, with a prevalence of 6%-47% (83). It is thought to be caused by hyperabduction and increased intracapsular pressure.…”

Section: Hyperabduction Osteonecrosismentioning

confidence: 99%

Imaging of Pediatric Growth Plate Disturbances

et al. 2017

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The growth plates, or physes, are visible on virtually all images obtained in skeletally immature children. The proper function of these growth plates depends on an intricate balance between chondrocyte proliferation, which requires nourishment from the epiphyseal vessels, and chondrocyte death, which requires the integrity of the metaphyseal vessels. Therefore, injury to the growth plate (ie, direct insult) or vascular compromise on either side of the growth plate (ie, indirect insult) can cause growth plate dysfunction. Direct growth plate insults occur most commonly with Salter-Harris fractures, and injuries that allow the transphyseal communication of vessels are at a higher risk for subsequent transphyseal bone bridge formation. Indirect insults lead to different sequelae that are based on whether the epiphyseal blood supply or metaphyseal blood supply is compromised. Epiphyseal osteonecrosis can result in slowed longitudinal bone growth, with possible growth plate closure, and is often accompanied by an abnormal secondary ossification center. In contrast, the disruption of metaphyseal blood supply alters endochondral ossification and allows the persistence of chondrocytes within the metaphysis, which appear as focal or diffuse growth plate widening. Imaging remains critical for detecting acute injuries and identifying subsequent growth disturbances. Depending on the imaging findings and patient factors, these growth disturbances may be amenable to conservative or surgical treatment. Therefore, an understanding of the anatomy and physiologic features of the normal growth plate and the associated pathophysiologic conditions can increase diagnostic accuracy, enable radiologists to anticipate future growth disturbances, and ensure optimal imaging, with the ultimate goal of timely and appropriate intervention. RSNA, 2017.

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“…The epiphyses of femoral heads may have delayed development when DDH is present for a long time (1). Children with DDH who do not respond to treatment using the Pavlik harness require closed reduction followed by immobilization in spica casting (2). Salter et al (3) concluded that excessive hip abduction could lead to avascular necrosis (AVN).…”

Section: Introductionmentioning

confidence: 99%

Increased diffusion and decreased perfusion in epiphyses of femoral heads detected via intravoxel incoherent motion after closed reduction in children with developmental dysplasia of the hip

et al. 2017

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Background Patients with developmental dysplasia of the hip (DDH) may have decreased blood supply to the femoral heads. Finding a non-invasive method to evaluate whether the femoral heads in patients with DDH are ischemic is paramount for orthopedic surgeons. Purpose To identify whether parameters reflecting perfusion and diffusion in intravoxel incoherent motion (IVIM) sequences can be used to assess ischemia in femoral heads in patients with DDH after closed reduction. Material and Methods Twenty-eight patients with DDH who had undergone closed reduction were enrolled. IVIM data were acquired using a 3-T magnetic resonance scanner, regions of interest were placed on the epiphyses; ADC, ADC, f, and ADC×f were measured. A Mann-Whitney U test was performed to compare ADC, ADC, f, and ADC×f between the lesion and control sides. Receiver operating characteristic curves were generated with respective cut-off values. The lesion sides were classified based on the International Hip Dysplasia Institute (IHDI) classification. ADC, ADC, f, and ADC×f were compared among the groups. Results ADC was higher and ADC, f, and ADC×f were lower on the lesion sides ( P = 0.000-0.002). The optimal cut-off value for ADC×f, ADC, ADC, and f were 0.030, 0.626, 0.000251, and 0.636, respectively. Higher IHDI classification scores on the lesion side were associated with lower ADC, f, and ADC×f, and higher ADC values. Conclusion IVIM is a promising method to investigate the perfusion and diffusion of epiphyses of femoral heads.

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MR Imaging in Postreduction Assessment of Developmental Dysplasia of the Hip: Goals and Obstacles

Cited by 40 publications

References 56 publications

Assessment of irreducible aspects in developmental hip dysplasia by magnetic resonance imaging

Assessment of irreducible aspects in developmental hip dysplasia by magnetic resonance imaging

Imaging of Pediatric Growth Plate Disturbances

Increased diffusion and decreased perfusion in epiphyses of femoral heads detected via intravoxel incoherent motion after closed reduction in children with developmental dysplasia of the hip

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