Purpose or Case Report: Evaluating the alignment and blood flow in the femoral head in patients with congenital hip dysplasia following reduction is essential to the treatment of dysplastic hips. Current practice involves an immediate postoperative contrast enhanced MRI of the casted child to identify hips that may be at risk for avascular necrosis. Contrast enhanced ultrasound (CEUS) is an emerging imaging modality that is feasible to evaluate the perfusion of the cartilaginous proximal femoral epiphysis intraoperatively, after hip reduction and prior to spica casting. This educational exhibit describes the procedure of intraoperative CEUS of the hip from the sonographers’ perspective.
Methods & Materials: The procedure takes place in the operating room immediately after the Orthopedic surgeon has reduced the affected hip. While the orthopedist holds the hip in place, ultrasound images are obtained from an anterior approach in the transverse plane with the hip in abduction (the position that the child will be casted). Initial grayscale images of the hip are taken using a linear array transducer. The contrast mode is selected and the grayscale and pre-contrast contrast mode images are optimized. Following intravenous ultrasound contrast administration, static images and cinematic clips are obtained throughout all phases of contrast enhancement. The contrast agent dose may vary by ultrasound equipment and transducer.
Results: By selecting the appropriate transducer, optimizing the image and contrast agent dose, perfusion of the proximal femoral epiphysis after reduction can reasonably be determined.
Conclusions: CEUS is a low cost, easy to perform, portable, radiation-free imaging modality in pediatrics that can evaluate cartilaginous femoral head perfusion and alignment by following these outlined steps. This technique gives immediate, important information to the surgeon that may prove to supplant the use of MRI in this population.