Correlation between AI algorithm generated radiographic hip measurements for hip dysplasia patients and internal derangement findings on advanced MRI

Abstract

Background

Hip dysplasia (HD) involves abnormal acetabular development, resulting in reduced femoral head coverage, labral tears, and cartilage injury. Machine learning (AI) advancements have enabled reproducible radiographic measurements for HD, such as lateral center edge angle (LCEA), Tonnis, and extrusion index. Moreover, incorporating 3D magnetic resonance imaging (MRI) alongside 2D MRI enhances diagnostic capabilities.

Purpose

To correlate advanced MRI-assessed labral and cartilage injuries with validated AI-generated radiographic measurements.

Material and Methods

This study enrolled 139 patients (age range = 16–68 years) with HD, comprising a total of 156 hips. All patients had 2D and 3D MRI scans, four-view X-rays, and AI-generated radiographic measurements using a commercial AI program that utilized bony landmarks to generate measurements. Labral reconstructions were obtained for each hip, and a multi-reader study was conducted. Inter-reader (ICC) analysis and Spearman correlations were calculated.

Results

The predominant location for the largest labral tear was anterosuperior (133/156, 90%), and paralabral cysts were observed in 53/156 (34%) cases. No statistically significant correlations were found between the length of labral tears and radiographic measurements. However, statistically significant correlations were observed between paralabral cysts and femoral head coverage, extrusion index, LCEA, and Tonnis measurements.

Conclusion

AI-generated radiographic measurements in HD exhibited weak correlations with advanced MRI findings, likely due to the condition's complex pathophysiology.

Keywords

Artificial intelligence hip magnetic resonance imaging

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References

Barrera

Cohen

Sankar

, et al. Imaging of developmental dysplasia of the hip: ultrasound, radiography and magnetic resonance imaging. Pediatr Radiol 2019;49:1652–1668.

Yang

Zusman

Lieberman

, et al. Developmental dysplasia of the hip. Pediatrics 2019;143:e20181147.

Lage

Patel

Villar

. The acetabular labral tear: an arthroscopic classification. Arthroscopy 1996;12:269–272.

Yoon

Moon

Yoon

, et al. A novel arthroscopic classification of labral tear in hip dysplasia. PLoS One 2020;15:e0240993.

Vaudreuil

McClincy

. Evaluation and treatment of borderline dysplasia: moving beyond the lateral center edge angle. Curr Rev Musculoskelet Med 2020;13:28–37.

McQuivey

Secretov

Domb

, et al. A multicenter study of radiographic measures predicting failure of arthroscopy in borderline hip dysplasia: beware of the Tonnis angle. Am J Sports Med 2020;48:1608–1615.

Atkins

Agrawal

Mozingo

, et al. Prediction of femoral head coverage from articulated statistical shape models of patients with developmental dysplasia of the hip. J Orthop Res 2022;40:2113.

Wang

. Superiority of the modified Tonnis angle over the Tonnis angle in the radiographic diagnosis of acetabular dysplasia. Exp Ther Med 2014;8:1934–1938.

Hert

Bartak

Fulin

, et al.

Does the femoral CCD angle measurement in a standard AP projection correlate with the true anatomical shape of the femur?

Acta Chir Orthop Traumatol Cech 2021;88:169–175.

10.

Mannava

Geeslin

Frangiamore

, et al. Comprehensive clinical evaluation of femoroacetabular impingement: part 2, plain radiography. Arthrosc Tech 2017;6:e2003–e2009.

11.

Archer H, Reine S, Alshaikhsalama A, et al. Artificial intelligence–generated hip radiological measurements are fast and adequate for reliable assessment of hip dysplasia: an external validation study. Bone Jt Open 2022;3:877–884.

12.

Anderson

Riley

Gold

, et al. Hip-femoral acetabular impingement. Clin Sports Med 2013;32:409–425.

13.

Blankenbaker

. Update in hip imaging. Semin Musculoskelet Radiol 2013;17:227–228.

14.

Ashikyan O, Wells J, Chhabra A. 3D MRI of the hip joint: technical considerations, advantages, applications, and current perspectives. Semin Musculoskelet Radiol 2021;25:488–500.

15.

Tannast

Hanke

Zheng

, et al.

What are the radiographic reference values for acetabular under- and overcoverage?

Clin Orthop Relat Res 2015;473:1234–1246.

16.

Sutter R, Zubler V, Hoffmann A, et al. Hip MRI: how useful is intraarticular contrast material for evaluating surgically proven lesions of the labrum and articular cartilage? AJR Am J Roentgenol. 2014;202:160–169.

17.

Kohli A, Xia S, Wells JE, Chhabra A. Three-Dimensional CT and 3D MRI of Hip- Important Aids to Hip Preservation Surgery. Semin Ultrasound CT MR. 2023;44:252–270.