DXA images vs. pelvic radiographs: Reliability of hip morphology measurements

Objective: Dual-energy x-ray absorptiometry (DXA) images are increasingly used to study hip morphology. Whether hip morphology measurements are consistent between DXA images and radiographs is unknown. Therefore, we investigated the agreement and reliability of the measurements performed on DXA images and radiographs. Design: We included participants from the Rotterdam study, a population-based cohort study, who received a hip DXA image and pelvic radiograph on the same day. The acetabular depth-width ratio (ADR), modified acetabular index (mAI), alpha angle (AA), Wiberg and lateral center edge angle (WCEA, LCEA), extrusion index (EI) and triangular index ratio (TIR) were automatically determined on both imaging modalities. The intraobserver and intermethod agreement were studied using Bland-Altman methods, and the reliability was assessed using intraclass correlation coefficients (ICC). Secondly, the diagnostic agreement regarding dysplasia, cam, and pincer morphology was assessed using percent agreement and Cohen's kappa. Results: A total of 750 hips from 411 individuals, median age 67.3 years (range 52.2 – 90.6), 45.5% male, were included. The following intermethod ICCs (95% CI) were obtained: ADR 0.85 (0.74–0.91), mAI 0.75 (0.52–0.85), AA 0.72 (0.68–0.75), WCEA 0.81 (0.74–0.85), LCEA 0.93 (0.91–0.94), EI 0.88 (0.84–0.91), and TIR 0.81 (0.79–0.84). We found comparable intraobserver ICCs for each morphological measurement. Conclusion: DXA images and pelvic radiographs could both reliably be used to study hip morphology. Due to the lower radiation burden, DXA images could be an excellent alternative to pelvic radiographs for research purposes.