Background: Three-dimensional imaging (CT and MRI) is the gold standard for detecting femoral head-neck junction malformations in femoroacetabular impingement, yet plain radiographs are used for initial diagnostic evaluation. It is unclear, however, whether the plain radiographs accurately reflect the findings on threedimensional imaging. Questions/Purposes: We therefore: (1) investigated the correlation of alpha angle measurements on plain radiographs and radial reformats of CT scans; (2) determined which radiographic views are most sensitive and specific in detecting head-neck deformities present on CT scans; and (3) determined if specific radiographic views correlated with specific locations on the radial oblique CT scan. Methods: We retrospectively reviewed 41 surgical patients with preoperative CT scans (radial oblique reformats) and plain radiographs (AP pelvis, 45° Dunn, frog lateral, and crosstable lateral). Alpha angles were measured on plain radiographs and CT reformats. Results: The complete radiographic series was 86% to 90% sensitive in detecting abnormal alpha angles on CT. The maximum alpha angle on plain radiographs was greater than that of CT reformats in 61% of cases. Exclusion of the crosstable lateral did not affect the sensitivity (86%-88%). The Dunn view was most sensitive (71%- 80%). The frog lateral showed the best specificity (91%- 100%). Substantial correlations (intraclass correlation coefficients, 0.64-0.75) between radiograph and radial oblique CT position were observed, including AP/12:00 (superior), Dunn/1:00 (anterolateral), frog/3:00 (anterior), and crosstable/3:00 (anterior). Conclusions: For diagnostic and treatment purposes, a three-view radiographic hip series (AP pelvis, 45° Dunn, and frog lateral) effectively characterizes femoral headneck junction malformations. Level of Evidence: Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
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