Correlation of contrast-enhanced power Doppler sonography and conventional angiography of abduction-induced hip ischemia in piglets.

OBJECTIVE The purpose of this study was to determine if enhanced power Doppler sonography can detect early ischemia of the capital femoral epiphysis induced by hip hyperabduction in piglets and to correlate these findings with angiography. MATERIALS AND METHODS Proximal femoral perfusion was evaluated in 18 studies of 10 piglet hips with unenhanced power Doppler sonography, enhanced power Doppler sonography with IV contrast agent, and digital angiography, in neutral position, hyperabduction, and after release to neutral position. Enhancement ratios between pixel intensities of power Doppler sonography and enhanced power Doppler images in each position were calculated. Angiograms were analyzed for differences in flow with changes in hip position. RESULTS With the piglet in neutral position, power Doppler sonography revealed few vessels in the femoral head. Contrast administration resulted in a temporary marked increase in the visualization of vessels in the femoral head. Quantitative enhanced power Doppler sonography revealed a marked decrease in pixel intensity with abduction (p < 0.001) that was not apparent on unenhanced studies (p = 0.28). The enhancement ratio decreased from 0.45 (mean +/- SD, +/- 0.26) in neutral position to 0.10 (+/- 0.21) after abduction; it returned to 0.41 (+/- 0.14) after release of abduction (p < 0.001 for each comparison). Angiographic studies in hyperabduction revealed a variable level of ischemia. CONCLUSION Enhanced power Doppler sonography can be used to visualize the vascular supply to the cartilaginous femoral head in piglets and can detect reversible ischemia induced by hip hyperabduction. These differences correlate with digital angiographic evidence of ischemia.

[1]  K. Iwasaki.  Management after application of the Pavlik harness in congenital dislocation of the hip , 2004, Archives of orthopaedic and traumatic surgery.

[2]  S. Weinstein,et al.  Developmental Hip Dysplasia and Dislocation , 2003 .

[3]  T. Laor,et al.  Gadolinium-enhanced MR imaging of pediatric patients after reduction of dysplastic hips: assessment of femoral head position, factors impeding reduction, and femoral head ischemia. , 1998, AJR. American journal of roentgenology.

[4]  C. Barnewolt,et al.  Normal gadolinium-enhanced MR images of the developing appendicular skeleton: Part I. Cartilaginous epiphysis and physis. , 1997, AJR. American journal of roentgenology.

[5]  G. Taylor,et al.  Renal cortical perfusion in rabbits: visualization with color amplitude imaging and an experimental microbubble-based US contrast agent. , 1996, Radiology.

[6]  P. Bearcroft,et al.  Vascularity of the neonatal femoral head: in vivo demonstration with power Doppler US. , 1996, Radiology.

[7]  B. Ransil,et al.  Gadolinium-enhanced MR imaging demonstrates abduction-caused hip ischemia and its reversal in piglets. , 1996, AJR. American journal of roentgenology.

[8]  J. Guille,et al.  Congenital dislocation of the hip in boys. , 1995, The Journal of bone and joint surgery. American volume.

[9]  J M Rubin,et al.  Power Doppler US: a potentially useful alternative to mean frequency-based color Doppler US. , 1994, Radiology.

[10]  F Forsberg,et al.  Ultrasound contrast agents: a review. , 1994, Ultrasound in medicine & biology.

[11]  J. Glutting,et al.  Prognostic factors in congenital dislocation of the hip treated with closed reduction. The importance of arthrographic evaluation. , 1992, The Journal of bone and joint surgery. American volume.

[12]  G. Macewen,et al.  Growth disturbance of the proximal part of the femur after treatment for congenital dislocation of the hip. , 1991, The Journal of bone and joint surgery. American volume.

[13]  W. Cole,et al.  Avascular necrosis following closed reduction of congenital dislocation of the hip. Review of influencing factors and long-term follow-up. , 1990, The Journal of bone and joint surgery. British volume.

[14]  H. Bensahel,et al.  The Pavlik Harness in the Treatment of Congenital Dislocating Hip: Report on a Multicenter Study of the European Paediatric Orthopaedic Society , 1988, Journal of pediatric orthopedics.

[15]  M. Millis,et al.  The early identification and classification of growth disturbances of the proximal end of the femur. , 1986, The Journal of bone and joint surgery. American volume.

[16]  G. Macewen,et al.  Avascular necrosis following treatment of congenital dislocation of the hip. , 1980, The Journal of bone and joint surgery. American volume.

[17]  G. Macewen,et al.  Congenital dislocation of the hip. Use of the Pavlik harness in the child during the first six months of life. , 1976, The Journal of bone and joint surgery. American volume.

[18]  R. Salter.  Role of innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip in the older child. , 1966, The Journal of bone and joint surgery. American volume.