Consistency of 3D Femoral Torsion Measurement from MRI Compared to CT Gold Standard

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2021 Aug 29

PMID 34454445

Citations 3

Authors

Thomas Vincent Haller

Pascal Schenk

Lukas Jud

Armando Hoch

Tobias Gotschi

Patrick Oliver Zingg

Affiliations

Soon will be listed here.

Abstract

Background: Several hip and knee pathologies are associated with aberrant femoral torsion. Diagnostic workup includes computed tomography (CT) and magnetic resonance imaging (MRI). For three-dimensional (3D) analysis of complex deformities it would be desirable to measure femoral torsion from MRI data to avoid ionizing radiation of CT in a young patient population. 3D measurement of femoral torsion from MRI has not yet been compared to measurements from CT images. We hypothesize that agreement will exist between MRI and CT 3D measurements of femoral torsion.

Methods: CT and MRI data from 29 hips of 15 patients with routine diagnostic workup for suspected femoroacetabular impingement (FAI) were used to generate 3D bone models. 3D measurement of femoral torsion was performed by two independent readers using the method of Kim et al. which is validated for CT. Inter-modalitiy and inter-reader intraclass correlation coefficients (ICC) were calculated.

Results: Between MRI and CT 3D measurements an ICC of 0.950 (0.898; 0.976) (reader 1) respectively 0.950 (0.897; 0.976) (Reader 2) was found. The ICC (95% CI) expressing the inter-reader reliability for both modalities was 0.945 (0.886; 0.973) for MRI and 0.957 (0.910; 0.979) for CT, respectively. Mean difference between CT and MRI measurement was 0.42° (MRI - CT, SD: 2.77°, p = 0.253).

Conclusions: There was consistency between 3D measurements of femoral torsion between computer rendered MRI images compared to measurements with the "gold standard" of CT images. ICC for inter-modality and inter-reader consistency indicate excellent reliability. Accurate, reliable and reproducible 3D measurement of femoral torsion is possible from MRI images.

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References

Ito K, Minka 2nd M, Leunig M, Werlen S, Ganz R . Femoroacetabular impingement and the cam-effect. A MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br. 2001; 83(2):171-6. DOI: 10.1302/0301-620x.83b2.11092. View

Botser I, Ozoude G, Martin D, Siddiqi A, Kuppuswami S, Domb B . Femoral anteversion in the hip: comparison of measurement by computed tomography, magnetic resonance imaging, and physical examination. Arthroscopy. 2012; 28(5):619-27. DOI: 10.1016/j.arthro.2011.10.021. View

Milone M, Bedi A, Poultsides L, Magennis E, Byrd J, Larson C . Novel CT-based three-dimensional software improves the characterization of cam morphology. Clin Orthop Relat Res. 2013; 471(8):2484-91. PMC: 3705074. DOI: 10.1007/s11999-013-2809-x. View

Tibor L, Liebert G, Sutter R, Impellizzeri F, Leunig M . Two or more impingement and/or instability deformities are often present in patients with hip pain. Clin Orthop Relat Res. 2013; 471(12):3762-73. PMC: 3825892. DOI: 10.1007/s11999-013-2918-6. View

Tonnis D, Heinecke A . Diminished femoral antetorsion syndrome: a cause of pain and osteoarthritis. J Pediatr Orthop. 1991; 11(4):419-31. DOI: 10.1097/01241398-199107000-00001. View

Tomczak R, Guenther K, Rieber A, Mergo P, Ros P, Brambs H . MR imaging measurement of the femoral antetorsional angle as a new technique: comparison with CT in children and adults. AJR Am J Roentgenol. 1997; 168(3):791-4. DOI: 10.2214/ajr.168.3.9057536. View

Tresch F, Dietrich T, Pfirrmann C, Sutter R . Hip MRI: Prevalence of articular cartilage defects and labral tears in asymptomatic volunteers. A comparison with a matched population of patients with femoroacetabular impingement. J Magn Reson Imaging. 2016; 46(2):440-451. DOI: 10.1002/jmri.25565. View

Heyworth B, Dolan M, Nguyen J, Chen N, Kelly B . Preoperative three-dimensional CT predicts intraoperative findings in hip arthroscopy. Clin Orthop Relat Res. 2012; 470(7):1950-7. PMC: 3369089. DOI: 10.1007/s11999-012-2331-6. View

Gelberman R, Cohen M, Shaw B, Kasser J, Griffin P, WILKINSON R . The association of femoral retroversion with slipped capital femoral epiphysis. J Bone Joint Surg Am. 1986; 68(7):1000-7. View

10.

Sutter R, Dietrich T, Zingg P, Pfirrmann C . Assessment of Femoral Antetorsion With MRI: Comparison of Oblique Measurements to Standard Transverse Measurements. AJR Am J Roentgenol. 2015; 205(1):130-5. DOI: 10.2214/AJR.14.13617. View

11.

Mygind-Klavsen B, Lund B, Nielsen T, Maagaard N, Kraemer O, Holmich P . Danish Hip Arthroscopy Registry: predictors of outcome in patients with femoroacetabular impingement (FAI). Knee Surg Sports Traumatol Arthrosc. 2018; 27(10):3110-3120. DOI: 10.1007/s00167-018-4941-3. View

12.

Dunn D . Anteversion of the neck of the femur; a method of measurement. J Bone Joint Surg Br. 1952; 34-B(2):181-6. DOI: 10.1302/0301-620X.34B2.181. View

13.

Wedge J, Wasylenko M . The natural history of congenital disease of the hip. J Bone Joint Surg Br. 1979; 61-B(3):334-8. DOI: 10.1302/0301-620X.61B3.158025. View

14.

Amis Jr E, Butler P, Applegate K, Birnbaum S, Brateman L, Hevezi J . American College of Radiology white paper on radiation dose in medicine. J Am Coll Radiol. 2007; 4(5):272-84. DOI: 10.1016/j.jacr.2007.03.002. View

15.

Jud L, Vlachopoulos L, Haller T, Fucentese S, Rahm S, Zingg P . The impact of mal-angulated femoral rotational osteotomies on mechanical leg axis: a computer simulation model. BMC Musculoskelet Disord. 2020; 21(1):50. PMC: 6979061. DOI: 10.1186/s12891-020-3075-1. View

16.

Malloy P, Gasienica J, Dawe R, Espinoza Orias A, Nwachukwu B, Inoue N . 1.5 T magnetic resonance imaging generates accurate 3D proximal femoral models: Surgical planning implications for femoroacetabular impingement. J Orthop Res. 2020; 38(9):2050-2056. DOI: 10.1002/jor.24596. View

17.

Souza R, Powers C . Concurrent criterion-related validity and reliability of a clinical test to measure femoral anteversion. J Orthop Sports Phys Ther. 2009; 39(8):586-92. DOI: 10.2519/jospt.2009.2996. View

18.

Park T, Park S, Kim J, Kim I, Kim S . Measurement of femoral neck anteversion in 3D. Part 2: 3D modelling method. Med Biol Eng Comput. 2001; 38(6):610-6. DOI: 10.1007/BF02344865. View

19.

Koo T, Li M . A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J Chiropr Med. 2016; 15(2):155-63. PMC: 4913118. DOI: 10.1016/j.jcm.2016.02.012. View

20.

Neubert A, Wilson K, Engstrom C, Surowiec R, Paproki A, Johnson N . Comparison of 3D bone models of the knee joint derived from CT and 3T MR imaging. Eur J Radiol. 2017; 93:178-184. DOI: 10.1016/j.ejrad.2017.05.042. View