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Pelvis radiographs in children with cerebral palsy: effects of patient positioning on calculating migration percentages

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Abstract

Background

Hip displacement in children with cerebral palsy (CP) is monitored by measuring migration percentage on anteroposterior pelvis radiographs. However, proper positioning for radiography in children with spasticity is difficult. The reliability and accuracy of migration percentage as a function of patient positioning is unknown.

Objective

To determine the effects of patient positioning on migration percentage measurements in children with CP.

Materials and methods

We identified children with CP (≤18-year-old) with pelvis CT and anteroposterior pelvis radiograph obtained <6 months apart (10/2018–11/2021). Digitally reconstructed radiographs were generated from each pelvis CT, to simulate nine different patient positions: neutral; 10° and 20° lordosis and kyphosis; and 10° and 20° right rotation and left rotation. Two radiologists measured migration percentages from the simulated and real pelvis radiographs. We used Spearman’s rho to assess inter-rater reliability, and Wilcoxon signed rank test to determine statistical significance.

Results

We studied sixty-three children (male=41; median age=8 years; range=4–18 years). The two radiologists’ migration percentage measurements were highly correlated with each other across all simulated and real radiographs (Spearman’s rho=0.86–0.99, P<0.01). For both readers and hips, migration percentages measured from real radiographs were significantly different from those measured from neutral simulated radiographs (P<0.01), with median absolute difference=5–6 percentage points (PP) and interquartile range (IQR)=9–12 PP. When comparing migration percentage measurements from neutral simulated radiographs to those in kyphosis/lordosis and right/left rotations, median absolute differences were 2–4 PP (IQR=3–8 PP) and 4–15 PP (IQR=6–17 PP), respectively.

Conclusion

Inter-rater reliability of measured migration percentages is high, but accuracy decreases with patient positional changes.

Graphical abstract

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Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.

Code availability

Not applicable

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Authors and Affiliations

  1. Divisions of Pediatric Radiology and Musculoskeletal Radiology, Weill Cornell Medical School, New York, NY, USA

    Delma Y. Jarrett

  2. Department of Radiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA

    Delma Y. Jarrett & Andy Tsai

  3. Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Catherine Stamoulis

  4. Department of Orthopedics, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Benjamin J. Shore

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  1. Delma Y. Jarrett
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  2. Catherine Stamoulis
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  3. Benjamin J. Shore
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  4. Andy Tsai
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Correspondence to Andy Tsai.

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Jarrett, D.Y., Stamoulis, C., Shore, B.J. et al. Pelvis radiographs in children with cerebral palsy: effects of patient positioning on calculating migration percentages. Pediatr Radiol 53, 2662–2671 (2023). https://doi.org/10.1007/s00247-023-05783-7

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  • DOI: https://doi.org/10.1007/s00247-023-05783-7

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