ArticlePediatric radiology2026
The radiographic metaphyseal migration index: a new proposed radiographic landmark for correct quantification of femoral head extrusion in preschool children.
Article in Pediatric radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe migration index (MI) is a quantitative measurement of femoral head extrusion used to help risk stratify neuromuscular hip dysplasia. However, MI relies upon the radiographically visible ossified capital femoral epiphysis which is only partially ossified in young children and therefore may potentially underestimate hip extrusion.
objectiveTo compare proof-of-concept accuracy of using a metaphyseal and traditional MI to measure femoral head extrusion in children compared with an MRI-based anatomic reference standard. MATERIALS AND
methodsWe reviewed 205 normal hips, each by MRI and x-ray, in patients aged 6 months - 6 years old. Three femoral head MI measurements were performed: (1) MRI-MI: percentage of the cartilaginous femoral head uncovered by the osseous acetabulum (anatomic reference standard); (2) traditional MI (TMI) x-ray: percentage of osseous capital femoral head uncovered by the osseous acetabulum; (3) metaphyseal MI x-ray (MeMI): percentage of the femoral head uncovered by the osseous acetabulum, using the metaphyseal vertex used as a surrogate for lateral margin of the cartilaginous femoral head. Statistical analysis of the three measurement techniques was performed using paired t-tests. Intraclass correlation coefficient was calculated.
resultsThere was a statistically significant underestimation of femoral head extrusion using TMI and MeMI (P<0.05) when compared with MRI-MI, but MeMI more closely approximated the MRI-MI. Inter-reader reliability showed excellent agreement.
conclusionThe MeMI better approximates the MRI anatomic landmarks for measuring the true degree of femoral head extrusion in children 6 months - 5 years of age. Its usage should be considered in lieu of the TMI in children under 5 years of age for radiographically determining MI.
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