Fovea alta on MR images: is it a marker of hip dysplasia in young adults?

Objective: The objective of our study was to investigate the association between high fovea capitis (fovea alta) and hip dysplasia in young adults.

Materials And Methods: In a retrospective study, blinded observers reviewed 82 pelvic radiographic and hip MRI studies of three groups of patients: those with developmental dysplasia of the hip (DDH) (center-edge angle, ≤20°), those with borderline DDH (center-edge angle, 21°-25°), and control patients (center-edge angle, >25°). The center-edge angle and coxa valga (femoral neck-shaft angle, >135°) were assessed on pelvic radiographs, and fovea alta was assessed on MR images (delta angle, ≤10°). The Mann-Whitney and Fisher exact tests were used to correlate fovea alta with DDH and with coxa valga, respectively. Interobserver agreement for center-edge and delta angles and the diagnostic performance of fovea alta as a marker of DDH were calculated.

Results: Thirty-one patients with DDH, 23 with borderline DDH, and 28 without DDH were included. Excellent interobserver agreement was found for center-edge angle (concordance correlation coefficient, 0.94) and for delta angle (concordance correlation coefficient, 0.91). Fovea alta had a significant association with DDH (p<0.001) but no association with coxa valga (p>0.57). A significant difference (p<0.001) was found between patients with DDH (3.4°) and those without DDH (21.7°) with respect to mean delta angle measurements. Fovea alta had 69.4% sensitivity, 82.1% specificity, 67.2% positive predictive value, 81.0% negative predictive value, and 75.6% overall accuracy as an indicator of DDH.

Conclusion: Fovea alta shows promise as a strong MRI marker of DDH.