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Doppler Sonography of the Anterior Ascending Cervical Arteries of the Hip

Evaluation of Healthy and Painful Hips in Children

Simon G. F. Robben1, Maarten H. Lequin1, Ad F. M. Diepstraten2, Wim C. J. Hop3 and Morteza Meradji1

1 Department of Pediatric Radiology, Sophia Children's Hospital, University Hospital Rotterdam, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands.
2 Department of Pediatric Orthopedic Surgery, Sophia Children's Hospital, University Hospital Rotterdam, 3015 GJ Rotterdam, The Netherlands.
3 Department of Epidemiology and Biostatistics, Erasmus University, Dr. Molewaterplein 50, Rotterdam, The Netherlands.



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  		Fig. 1A. —Drawings show arterial blood supply to femoral head. Cross section of femoral neck at level of insertion of joint capsule.

 


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  		Fig. 1B. —Drawings show arterial blood supply to femoral head. Oblique sagittal section along femoral neck, corresponding to sonographic plane. Anterior recess of joint space is larger to better depict anatomic relationships. A = anterior layer of capsule, P = posterior layer of capsule, E = osseous nucleus of epiphysis of femoral head, C = articular cartilage of acetabulum and femoral head.

 


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  		Fig. 2. —5-year-old boy with asymptomatic hip. Color Doppler sonogram shows ascending cervical artery situated in posterior layer of capsule, running toward femoral head parallel to femoral neck. Waveform resembles low-resistance vascular bed. F = femoral head.

 


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  		Fig. 3. —4-year-old boy with transient synovitis. Duplex Doppler sonogram shows decreased diastolic velocity, resulting in resistive index of 0.81. F = femoral neck, E = effusion.

 


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  		Fig. 4. —5-year-old boy with transient synovitis. Duplex Doppler sonogram shows absent diastolic flow. F = femoral neck, E = effusion.

 


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  		Fig. 5A. —3-year-old girl with transient synovitis. Duplex Doppler sonogram shows reversal of diastolic flow, resulting in resistive index of 1.33. F = femoral neck, E = effusion.

 


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  		Fig. 5B. —3-year-old girl with transient synovitis. One month after A, duplex Doppler sonogram shows no effusion and normal waveform (r = 0.58). F = femoral neck.

 


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  		Fig. 6. —Scatterplot shows resistive index (RI) to be function of amount of effusion (expressed as distention of capsule compared with contralateral healthy hip or thickness of effusion itself). [UNK] = transient synovitis, {triangleup} = no pathology, • = Perthes' disease, {diamond} = miscellaneous.

 


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  		Fig. 7. —3-year-old boy with asymptomatic hip. Duplex Doppler sonogram shows artery in anterior layer of joint capsule. Note high-resistance vascular bed. Artery does not supply blood to femoral head. F = femoral neck.

 

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