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Reliability of 2D and 3D ultrasound for infant hip dysplasia in the hands of novice users

  • Ultrasound
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Abstract

Purpose

Developmental dysplasia of the hip (DDH) diagnosis by two-dimensional ultrasound (2DUS) can have poor inter-rater reliability. 3D ultrasound (3DUS) may be more reliably performed, particularly by novice users. We compared intra- and inter-rater reliability between expert and novice operators performing 2DUS and 3DUS for DDH.

Materials and methods

Infants with suspected DDH were assessed with 2DUS and 3DUS. Novice operators had 1.5 h of training and Experts had 5–15 years’ experience. Images included two 2DUS static and two 3DUS sweep images per operator. Image quality was assessed by 5-point system (yes/no: full femoral head; full acetabular roof; horizontal iliac wing; os ischium; absent motion/artifact). 2DUS indices (alpha angle, coverage) were measured centrally by a blinded reader with 2 years DDH US experience. 3DUS was post-processed by semi-automated custom software generating acetabular surface models, indices and estimated probability of DDH. Gold-standard diagnosis of each hip as normal, borderline or dysplastic was based on radiologist review of expert 2DUS.

Results

Thirty infants, mean age 10.8 weeks were enrolled. Quality scores were 2.7±1.2 Novice versus 4.9±0.3 Expert for 2DUS (p = 0.04), and 4.2±1.0 Novice versus 4.9±0.3 Expert for 3DUS (p = 0.99). Inter-rater reliability was poor for 2DUS (ICC=0.10 for alpha angle, 0.04 for acetabular coverage) and moderate to high for 3DUS (ICC=0.73-0.83 for alpha angle, 0.55 for acetabular coverage). Intra-rater reliability and diagnostic accuracy was higher for 3DUS than 2DUS.

Conclusion

Novice operators can perform 3DUS for DDH with reliability and accuracy approaching expert sonographers. Novices perform 2DUS with poor reliability and accuracy.

Key Points

• Novice/expert inter-rater reliability improved from poor with 2DUS to moderate/high with 3DUS.

• Novice operators using 3DUS correctly classified 57/58 (98%) of infant hips.

• DDH can be reliably assessed by novice operators using 3DUS.

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Abbreviations

2DUS:

Two-dimensional ultrasound

2Dα:

2D Alpha Angle

3DUS:

Three-dimensional ultrasound

ACR:

American College of Radiology

DDH:

Developmental dysplasia of the hip

ICC:

Intraclass correlation coefficients

POCUS:

Point-of-care ultrasound

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Funding

This study has received funding by: Capital Health Endowed Chair in Diagnostic Imaging; CIHR-IHDCYH New Investigator Research Grant; RSNA Research Seed Grant; AI-HS Postdoctoral Fellowship Award; CMA Joule Innovation Grant. Dr. Jaremko is supported by Medical Imaging Consultants. Mr. Mostofi was partly supported by the M.E. Ledingham Memorial Award.

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Authors and Affiliations

  1. Department of Radiology and Diagnostic Imaging, 2A2.41 WC Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada

    Emanuel Mostofi, Baljot Chahal, Dornoosh Zonoobi, Abhilash Hareendranathan, Koosha P. Roshandeh, Sukhdeep K. Dulai & Jacob L. Jaremko

Authors
  1. Emanuel Mostofi
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  2. Baljot Chahal
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  3. Dornoosh Zonoobi
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  4. Abhilash Hareendranathan
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  5. Koosha P. Roshandeh
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  6. Sukhdeep K. Dulai
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  7. Jacob L. Jaremko
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Corresponding author

Correspondence to Jacob L. Jaremko.

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Guarantor

The scientific guarantor of this publication is Dr. Jacob Jaremko, M.D., Ph.D, FRCPC.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Cross-sectional study

• Performed at one institution

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Cite this article

Mostofi, E., Chahal, B., Zonoobi, D. et al. Reliability of 2D and 3D ultrasound for infant hip dysplasia in the hands of novice users. Eur Radiol 29, 1489–1495 (2019). https://doi.org/10.1007/s00330-018-5699-1

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  • DOI: https://doi.org/10.1007/s00330-018-5699-1

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