Inter- and intra-observer agreement of femoroacetabular impingement (FAI) parameters comparing plain radiographs and advanced, 3D computed tomographic (CT)-generated hip models in a surgical patient cohort.

PURPOSE: The purpose of our study was to investigate whether advanced, 3D computed tomographic (CT)-generated hip models improves inter-and intra-observer agreement when compared to plain radiographs in identifying femoroacetabular impingement (FAI) morphology. METHODS: Eight consecutive patients who underwent surgery for FAI pathology were selected for this study. Preoperative CT scan image data were used to create high resolution, 3D hip reconstruction models. Four observers (two attending hip surgeons and radiologists) performed a blinded review of preselected radiographs and 3D CT hip models. Alpha and lateral center-edge angle measurements, location of cam lesion and the presence of a "crossover sign" were assessed. Inter- and intra-observer agreement was determined by calculating the intra-class correlation coefficients (ICC) or kappa coefficients to evaluate agreement for categorical variables. RESULTS: The parameter that demonstrated the highest and poorest inter-observer agreement was the presence of a "crossover sign" using 3D CT-generated high resolution hip models (ICC = 0.76, p = 0.00) and anteroposterior pelvis radiography, respectively (ICC = 0.20, p = 0.02). Alpha angle values were significantly higher using plain radiographs when compared to 3D hip reconstruction models (61.1° ± 10.4° versus 55.4° ± 14.4°, p = 0.003). Furthermore, when compared to radiographs, 3D hip reconstruction models demonstrated significantly higher intra-observer agreement (ICC = 0.856 versus 0.405, p = 0.005) when determining the presence of a "crossover sign". CONCLUSIONS: Our findings were suggestive that for most commonly used FAI morphology parameters, CT-generated hip models demonstrated little benefit over plain radiographs in improving inter-observer agreement among providers. LEVEL OF EVIDENCE: III.

Diagnostic value of tissue harmonic imaging compared with conventional sonography.

The purpose of this study was to determine if tissue harmonic imaging (THI) produced diagnostic images more frequently than conventional sonography. A prospective study was performed on 33 patients, to compare the diagnostic value of THI with conventional sonography. Each examination was performed using THI (transmit frequency=2.0 MHz, receive frequency=4.0 MHz) and conventional sonography at 2.5 and 4.0 MHz. The different sonographic techniques were then graded as to whether they produced diagnostic images. THI produced diagnostic images in 33 of 33 examinations (100%), 2.5 MHz conventional sonography produced diagnostic images in 26 of 33 examinations (79%), and 4.0 MHz conventional sonography produced diagnostic images in 26 of 33 examinations (79%). THI produced diagnostic images significantly more frequently than 2.5 MHz conventional sonography (p=.0233) and 4.0 MHz conventional sonography (p=.0233). The THI technique produced diagnostic images more frequently than conventional sonography.