Diagnosis of acetabular retroversion: Three signs positive and increased retroversion index have higher specificity and higher diagnostic accuracy compared to isolated positive cross over sign
Objectives: The crossover-sign (COS) is a radiographic sign for diagnosis of acetabular-retroversion(AR) in patients with femoroacetabular-impingement (FAI) but overestimates AR. Three signs combined with retroversion-index (RI) could potentially improve diagnostic-accuracy. Aims: (1) To calculate...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-01-01
|
| Series: | European Journal of Radiology Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352047722000144 |
| _version_ | 1811299679808258048 |
|---|---|
| author | Till D. Lerch Malin K. Meier Adam Boschung Simon D. Steppacher Klaus A. Siebenrock Moritz Tannast Florian Schmaranzer |
| author_facet | Till D. Lerch Malin K. Meier Adam Boschung Simon D. Steppacher Klaus A. Siebenrock Moritz Tannast Florian Schmaranzer |
| author_sort | Till D. Lerch |
| collection | DOAJ |
| description | Objectives: The crossover-sign (COS) is a radiographic sign for diagnosis of acetabular-retroversion(AR) in patients with femoroacetabular-impingement (FAI) but overestimates AR. Three signs combined with retroversion-index (RI) could potentially improve diagnostic-accuracy. Aims: (1) To calculate central acetabular-version (AV, CT/MRI) in patients with isolated positive COS and in patients with three radiographic signs for AR on radiographs (AP). (2) To calculate diagnostic performance of positive COS and of three signs combined with retroversion-index (RI) > 30% on radiographs (AP) to detect global AR (AV < 10°, CT/MRI). Methods: A retrospective, IRB-approved, controlled diagnostic study comparing radiographic signs for AR (AP radiographs) with MRI/CT-based measurement of central AV was performed. 462 symptomatic patients (538 hips) with FAI or hip-dysplasia were compared to control-group (48 hips). Three signs for AR(on radiographs) were analyzed: COS, posterior-wall-sign and ischial-spine-sign. RI (synonym cross-over-index) quantifies overlap of anterior and posterior wall in case of positive COS. Diagnostic performance for COS and for three signs positive combined with RI > 30% to detect central AV < 10° (global AR) was calculated. Results: (1) Central AV was significantly (p < 0.001) decreased (13 ± 6°, CT/MRI) in patients with three signs positive for AR and RI > 30% on radiographs compared to patients with positive COS (18 ± 7°). (2) Sensitivity and specificity of three signs combined with RI > 30% on radiographs was 85% and 63% (87% and 23% for COS). Negative-predictive-value (NPV) was 94% (93% for COS) to rule out global AR (AV < 10°, CT/MRI). Diagnostic accuracy increased significantly (p < 0.001) from 31% (COS) to 68% using three signs. Conclusion: Improved specificity and diagnostic accuracy for diagnosis of global AR can help to avoid misdiagnosis. Global AR can be ruled out with a probability of 94% (NPV) in the absence of three radiographic signs combined with retroversion-index < 30% (e.g. isolated COS positive). |
| first_indexed | 2024-04-13T06:39:29Z |
| format | Article |
| id | doaj.art-876b9e8696c04c51936edce08ecf3c2d |
| institution | Directory Open Access Journal |
| issn | 2352-0477 |
| language | English |
| last_indexed | 2024-04-13T06:39:29Z |
| publishDate | 2022-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | European Journal of Radiology Open |
| spelling | doaj.art-876b9e8696c04c51936edce08ecf3c2d2022-12-22T02:57:47ZengElsevierEuropean Journal of Radiology Open2352-04772022-01-019100407Diagnosis of acetabular retroversion: Three signs positive and increased retroversion index have higher specificity and higher diagnostic accuracy compared to isolated positive cross over signTill D. Lerch0Malin K. Meier1Adam Boschung2Simon D. Steppacher3Klaus A. Siebenrock4Moritz Tannast5Florian Schmaranzer6Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, Bern, University of Bern, Switzerland; Correspondence to: Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Freiburgstrasse, 3010 Bern, Switzerland.Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, Bern, University of Bern, Switzerland; Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, SwitzerlandDepartment of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, SwitzerlandDepartment of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, Bern, University of Bern, SwitzerlandObjectives: The crossover-sign (COS) is a radiographic sign for diagnosis of acetabular-retroversion(AR) in patients with femoroacetabular-impingement (FAI) but overestimates AR. Three signs combined with retroversion-index (RI) could potentially improve diagnostic-accuracy. Aims: (1) To calculate central acetabular-version (AV, CT/MRI) in patients with isolated positive COS and in patients with three radiographic signs for AR on radiographs (AP). (2) To calculate diagnostic performance of positive COS and of three signs combined with retroversion-index (RI) > 30% on radiographs (AP) to detect global AR (AV < 10°, CT/MRI). Methods: A retrospective, IRB-approved, controlled diagnostic study comparing radiographic signs for AR (AP radiographs) with MRI/CT-based measurement of central AV was performed. 462 symptomatic patients (538 hips) with FAI or hip-dysplasia were compared to control-group (48 hips). Three signs for AR(on radiographs) were analyzed: COS, posterior-wall-sign and ischial-spine-sign. RI (synonym cross-over-index) quantifies overlap of anterior and posterior wall in case of positive COS. Diagnostic performance for COS and for three signs positive combined with RI > 30% to detect central AV < 10° (global AR) was calculated. Results: (1) Central AV was significantly (p < 0.001) decreased (13 ± 6°, CT/MRI) in patients with three signs positive for AR and RI > 30% on radiographs compared to patients with positive COS (18 ± 7°). (2) Sensitivity and specificity of three signs combined with RI > 30% on radiographs was 85% and 63% (87% and 23% for COS). Negative-predictive-value (NPV) was 94% (93% for COS) to rule out global AR (AV < 10°, CT/MRI). Diagnostic accuracy increased significantly (p < 0.001) from 31% (COS) to 68% using three signs. Conclusion: Improved specificity and diagnostic accuracy for diagnosis of global AR can help to avoid misdiagnosis. Global AR can be ruled out with a probability of 94% (NPV) in the absence of three radiographic signs combined with retroversion-index < 30% (e.g. isolated COS positive).http://www.sciencedirect.com/science/article/pii/S2352047722000144Acetabular retroversionFemoroacetabular impingement (FAI)Hip preservation surgeryAcetabular versionCross over sign |
| spellingShingle | Till D. Lerch Malin K. Meier Adam Boschung Simon D. Steppacher Klaus A. Siebenrock Moritz Tannast Florian Schmaranzer Diagnosis of acetabular retroversion: Three signs positive and increased retroversion index have higher specificity and higher diagnostic accuracy compared to isolated positive cross over sign European Journal of Radiology Open Acetabular retroversion Femoroacetabular impingement (FAI) Hip preservation surgery Acetabular version Cross over sign |
| title | Diagnosis of acetabular retroversion: Three signs positive and increased retroversion index have higher specificity and higher diagnostic accuracy compared to isolated positive cross over sign |
| title_full | Diagnosis of acetabular retroversion: Three signs positive and increased retroversion index have higher specificity and higher diagnostic accuracy compared to isolated positive cross over sign |
| title_fullStr | Diagnosis of acetabular retroversion: Three signs positive and increased retroversion index have higher specificity and higher diagnostic accuracy compared to isolated positive cross over sign |
| title_full_unstemmed | Diagnosis of acetabular retroversion: Three signs positive and increased retroversion index have higher specificity and higher diagnostic accuracy compared to isolated positive cross over sign |
| title_short | Diagnosis of acetabular retroversion: Three signs positive and increased retroversion index have higher specificity and higher diagnostic accuracy compared to isolated positive cross over sign |
| title_sort | diagnosis of acetabular retroversion three signs positive and increased retroversion index have higher specificity and higher diagnostic accuracy compared to isolated positive cross over sign |
| topic | Acetabular retroversion Femoroacetabular impingement (FAI) Hip preservation surgery Acetabular version Cross over sign |
| url | http://www.sciencedirect.com/science/article/pii/S2352047722000144 |
| work_keys_str_mv | AT tilldlerch diagnosisofacetabularretroversionthreesignspositiveandincreasedretroversionindexhavehigherspecificityandhigherdiagnosticaccuracycomparedtoisolatedpositivecrossoversign AT malinkmeier diagnosisofacetabularretroversionthreesignspositiveandincreasedretroversionindexhavehigherspecificityandhigherdiagnosticaccuracycomparedtoisolatedpositivecrossoversign AT adamboschung diagnosisofacetabularretroversionthreesignspositiveandincreasedretroversionindexhavehigherspecificityandhigherdiagnosticaccuracycomparedtoisolatedpositivecrossoversign AT simondsteppacher diagnosisofacetabularretroversionthreesignspositiveandincreasedretroversionindexhavehigherspecificityandhigherdiagnosticaccuracycomparedtoisolatedpositivecrossoversign AT klausasiebenrock diagnosisofacetabularretroversionthreesignspositiveandincreasedretroversionindexhavehigherspecificityandhigherdiagnosticaccuracycomparedtoisolatedpositivecrossoversign AT moritztannast diagnosisofacetabularretroversionthreesignspositiveandincreasedretroversionindexhavehigherspecificityandhigherdiagnosticaccuracycomparedtoisolatedpositivecrossoversign AT florianschmaranzer diagnosisofacetabularretroversionthreesignspositiveandincreasedretroversionindexhavehigherspecificityandhigherdiagnosticaccuracycomparedtoisolatedpositivecrossoversign |