Hu Anna,  Kim Jane,  Peck Jeffrey,  Haroyan Harutyun

Final Pr. ID: Poster #: EDU-059

Idiopathic hip chondrolysis (ICH) is a rare pediatric musculoskeletal disorder characterized by rapid and extensive loss of articular cartilage at the femoral head and acetabulum. Symptoms of ICH, such as pain, stiffness, and limping, are often nonspecific and may overlap with other pathologies. Diagnosis of ICH is multifactorial and relies on the correlation of imaging with the clinical presentation. Due to both the rarity of this entity and nonspecific clinical symptoms, ICH may be underdiagnosed.
In this educational poster, we will review the clinical presentation, describe the imaging findings of ICH with a special emphasis on MRI features using examples from our own institution, and discuss the treatment options as well as the natural progression of disease. Recognition of the imaging features is vital in early identification of ICH which may help prevent further irreversible cartilage loss. Read More

Authors:  Hu Anna , Kim Jane , Peck Jeffrey , Haroyan Harutyun

Keywords:  idiopathic, hip chondrolysis, MRI

Milks Kathryn,  Whitaker Amanda,  Mesi Erin,  Ruess Lynne

Final Pr. ID: Paper #: 109

International data have shown that a hip surveillance program decreased and even prevented hip dislocations in children with cerebral palsy (CP). There are however, no published guidelines on reporting hip abnormalities in these children. Radiologic terminology and measurement technique varied widely in our department. The purpose of our quality improvement initiative was to standardize radiographic hip surveillance imaging and reporting as part of the newly implemented screening program at our institution. Read More

Authors:  Milks Kathryn , Whitaker Amanda , Mesi Erin , Ruess Lynne

Keywords:  cerebral palsy, hip surveillance, pelvis radiograph

Benitez Steven,  Levin Terry

Final Pr. ID: Poster #: EDU-063

With the expansion of the internet and the development of new media tools, learning methods among medical students and residents in all specialties particularly Radiology have changed. While didactic lectures and personal interaction with mentors each play an important part in education, self learning via a variety of internet sources has gained a significant role and has come to replace the use of standard textbooks. Existing online modules are minimally interactive and present radiographic images concurrently with text. In most, users use the cursor to hover over the image in order to display the abnormality. Read More

Authors:  Benitez Steven , Levin Terry

Keywords:  learning module, hips, pediatric

Saez Fermin,  Vazquez Victor,  Saez Javier,  Pijoan Jose

Final Pr. ID: Poster #: SCI-036

To assess the relevance of asymmetrical skin folds as a clinical sign for the diagnosis of developmental dysplasia of the hip (DDH). Read More

Authors:  Saez Fermin , Vazquez Victor , Saez Javier , Pijoan Jose

Keywords:  developmental dysplasia of the hip, hip ultrasound screening, hip dysplasia

Boyd Kevin,  Thakrar Pooja

Final Pr. ID: Poster #: EDU-055

The purpose of the exhibit is: 1. Illustrate the presence of multiple and accessory ossification centers about the hip that can make it challenging to diagnosis fractures on radiographs in adolescence. 2. Demonstrate that posterior acetabular fractures are typically hidden behind the femoral head on radiographs. 3. Review variant os acetabuli that are commonly encountered in patients with hip pain and demonstrate that the orientation of the fragments compared with posterior acetabular fractures can help to make a distinction. 4. Highlight that a complete pelvis radiograph (AP or AP/Frog leg lateral) in trauma patients or hip pain NOS can aid in the detection of fractures and assess for asymmetry of normal variants. Read More

Authors:  Boyd Kevin , Thakrar Pooja

Keywords:  Acetabular Fractures, Pediatric Hip, Hip variant

Cho Yeon Jin,  Park Hyoung Suk,  Jeon Kiwan,  Choi Young Hun,  Choi Gayoung,  Lee Seul Bi,  Lee Seunghyun,  Cheon Jung-eun,  Kim Woo Sun,  Ryu Young Jin,  Hwang Jae-yeon

Final Pr. ID: Paper #: 060

The purpose of this study was to develop a convolutional neural network (CNN)-based deep learning algorithm for the automated detection of developmental dysplasia of the hip (DDH) on conventional radiography and to assess its feasibility and diagnostic performance. Read More

Authors:  Cho Yeon Jin , Park Hyoung Suk , Jeon Kiwan , Choi Young Hun , Choi Gayoung , Lee Seul Bi , Lee Seunghyun , Cheon Jung-eun , Kim Woo Sun , Ryu Young Jin , Hwang Jae-yeon

Keywords:  Artificial intelligence, Developmental dysplasia of the hip, Conventional radiography

Diederichs Chad,  Heath Alana,  Mabee Myles,  Hareendranathan Abhilash,  Zonoobi Dornoosh,  Thompson Adrienne,  Jaremko Jacob

Final Pr. ID: Poster #: SCI-042

Developmental dysplasia of the hip (DDH) is a common congenital problem affecting up to 3% of the the population. If untreated, DDH may lead to hip dislocation and premature osteoarthritis. Current DDH diagnosis is highly operator-dependent as it relies on 2D ultrasound. 3D ultrasound offers more complete, and potentially more reliable, imaging of infant hip geometry. However, it is unclear whether 3D ultrasound images, noisy with artifacts and reconstructed by proprietary algorithms from non-parallel beams, give accurate 3D shape information. We sought to validate the fidelity of acetabular surface models obtained by 3D ultrasound by comparison with those obtained concurrently from MRI. Read More

Authors:  Diederichs Chad , Heath Alana , Mabee Myles , Hareendranathan Abhilash , Zonoobi Dornoosh , Thompson Adrienne , Jaremko Jacob

Keywords:  DDH, 3D ultrasound, MRI, pediatric radiology, hip dysplasia

Vo Baotran,  Eklund Meryle,  Collins Heather

Final Pr. ID: Poster #: SCI-005

Developmental dysplasia of the hip (DDH) results from the abnormal development of the acetabulum, femoral head and mechanical instability of the hip joint. DDH often presents at birth, and if diagnosed early and treated successfully, children are able to develop a normal hip joint without functional limitation. If left untreated, DDH can lead to pain and osteoarthritis by early adulthood as well as discrepancy in leg length and functional disability. DDH risk factors include breech position in utero, oligohydramnios, female sex, primigravida, family history of DDH and improper swaddling. While there are recommendation for ultrasound screening in breech infants, only a few studies have dealt with the influence of gestational age on the development of DDH. Optimal timing of hip US and identification of patients who need follow-up are important to reduce unnecessary treatment and to avoid overtreatment. We aim to evaluate whether extremely premature infants (<28 weeks gestational age) warrant ultrasound screening for DDH in the absence of other risk factors. Read More

Authors:  Vo Baotran , Eklund Meryle , Collins Heather

Keywords:  Ultrasound, DDH, hip

Pérez-marrero Lizbet,  Monardez Pamela,  Besomi Javier,  Switt Margarita,  Avilés Carolina,  Herrera Cristhián,  Fuentealba Isabel,  Pose Georgette,  Silva Claudio

Final Pr. ID: Paper #: 004 (S)

Se realiza en Chile tamizaje universal de displasia de cadera (DDC) con radiografía de pelvis AP (Rx Pelvis) a los 3 meses de edad, sin embargo no hay una estandarización del informe radiológico para una correcta y óptima derivación al especialista.
Objetivo: Estandarizar y validar el informe de la Rx pelvis usada en el tamizaje de la DDC. Read More

Authors:  Pérez-marrero Lizbet , Monardez Pamela , Besomi Javier , Switt Margarita , Avilés Carolina , Herrera Cristhián , Fuentealba Isabel , Pose Georgette , Silva Claudio

Keywords:  Screening, Developmental Dysplasia of the Hip, HIRADS

Amaral Jason,  Schultz Rebecca,  Rosenfeld Scott,  Kan J.

Final Pr. ID: Poster #: EDU-067

This technical innovation describes our institution’s standardized technique for palliative steroid injections in children with symptomatic neuromuscular hip dysplasia. Children with neuromuscular hip dysplasia are at risk for developing painful hip dislocation, which can dramatically affect their quality of life. Read More

Authors:  Amaral Jason , Schultz Rebecca , Rosenfeld Scott , Kan J.

Keywords:  Hip Dysplasia, Cerebral Palsy, Steroid Injection

Mehlman Tracey,  Riley, Jr. Pat,  Person Allison

Final Pr. ID: Poster #: SCI-042

Hip pain in the active adolescent can be a diagnostic challenge. Labral tears are a common cause of pain, but on average, a lag time of greater than 2 years exists before a diagnosis is achieved. Leading etiologies of labral pathology include: trauma, femoroacetabular impingement, and dysplasia. A better understanding of hip pathology, in this age group and the development of less-invasive hip arthroscopy and surgical repair, has led to an increased number of pediatric MR hip arthrograms (MRA) being performed.

The purpose of this investigation was to evaluate the accuracy of our MRA reports with arthroscopic findings and create a pictorial radiologic-arthroscopic correlation. This study will assist both radiologists whom may be formally trained in pediatric radiology but have variable experience and/or training in musculoskeletal radiology, as well as our clinical colleagues to better understand the diagnostic utility of MRA. Read More

Authors:  Mehlman Tracey , Riley, Jr. Pat , Person Allison

Keywords:  MRA, Labrum, Hip

Motta Giovanna,  Chiovatto Alessandra,  Chiovatto Eduardo,  Rocha Lucas,  Abdala João,  Iared Wagner

Final Pr. ID: Poster #: SCI-004 (S)

Developmental dysplasia of the hip (DDH) is the designation given to a spectrum of structural changes in the developing hip. Ultrasound is the preferred imaging method for screening this condition in newborns and children under 1 year old. Pubofemoral distance (PFD) has been proposed as a new screening method for developmental dysplasia of the hip. The aim of this study is to assess the accuracy of PFD for developmental dysplasia of the hip using the Graf method as reference standard. Read More

Authors:  Motta Giovanna , Chiovatto Alessandra , Chiovatto Eduardo , Rocha Lucas , Abdala João , Iared Wagner

Keywords:  Ultrasound, Hip dysplasia, Pubofemoral distance

Albers Brittany

Final Pr. ID: Poster #: EDU-061

Femoroacetabular impingement (FAI) results from incongruence of the femoral head and acetabulum, and is a clinical diagnosis supported by imaging findings. Despite the traditional categorization of FAI into “pincer” and “cam” types in young and middle-aged adults, the etiology is often unclear with contributing factors from both sides of the hip joint, as well as the surrounding muscles and tendons. Many patients first become symptomatic during adolescence. Comprehensive early treatment, which includes both surgery and intensive physical therapy, both relieves symptoms and prevents the premature onset of osteoarthritis. Pediatric radiologists must provide relevant and actionable reporting on pre-operative imaging in order to maintain value. In addition to a descriptive assessment, the most commonly used quantitative measurements are acetabular version, α angle, and femoral version.

This image-rich exhibit reviews common acetabular and femoral morphologies associated with FAI , outlines our low-dose CT protocol, and simplifies obtaining proper reformations and measurements. At our institution, we utilize a low-dose CT protocol (equivalent to approximately 3-5 AP pelvis radiographs) for pre-operative planning, which allows for easy creation of the 2-D and 3-D reformatted images.

Normally, the acetabulum is anteverted 10-15 degrees to allow for physiologic movement. Decreased anteversion is correlated with pincer-type FAI. Measurement requires correction for pelvic tilt and is explained in Fig. 1. This method has been shown to be equivalent to the more complicated 3-D measurements.

The α angle is obtained from radial reformations. A normal α angle is 55-60 degrees or less, and an increased α angle is associated with cam-type FAI. Cam-type FAI most often results from deficient femoral head-neck offset in the anterosuperior quadrant, and α angles should be reported for each position in that quadrant. Creation of radial reformations and measurement of the α angle are explained in Fig. 2.

Assessing femoral version is important because many pediatric conditions that lead to FAI are associated with abnormal femoral version, including developmental hip dysplasia, Legg-Calve-Perthes disease, slipped capital femoral epiphyses, and septic arthritis/osteomyelitis. The femur is normally 10-20 degrees anteverted. Both decreased and increased femoral version are associated with FAI. The method for calculating femoral version is explained in Fig. 3. Read More

Authors:  Albers Brittany

Keywords:  Value, CT, Hip

Kozak Brandi,  Chauvin Nancy,  Sankar Wudbav,  Back Susan

Final Pr. ID: Poster #: EDU-017 (T)

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. Read More

Authors:  Kozak Brandi , Chauvin Nancy , Sankar Wudbav , Back Susan

Keywords:  Ultrasound, Contrast, Hip Dysplasia

Motta Giovanna,  Chiovatto Alessandra,  Chiovatto Eduardo,  Rocha Lucas,  Abdala João,  Iared Wagner

Final Pr. ID: Poster #: EDU-014 (S)

Hip ultrasonography is now considered the main method for screening, diagnosing and monitoring the treatment of development dysplasia of hip (DDH) in children, considering the advantages of the method and the excellent characterization of the anatomical elements of the infant hip which, at this stage of life, consists largely of cartilage. In 1980, Reinhard Graf, an Austrian pediatric orthopedist published child hip study work from about 20,000 stillbirths. He evaluated and studied through hip ultrasound the hip joint and determined in a single coronal section the hip classification. The purpose of this article is to explain in a didactic and detailed way the method of Graf, focusing on the reference points for its realization and proper interpretation. Read More

Authors:  Motta Giovanna , Chiovatto Alessandra , Chiovatto Eduardo , Rocha Lucas , Abdala João , Iared Wagner

Keywords:  Hip Dysplasia, Ultrasonography, Graf Method