Standing posterior-anterior (PA) radiographs from our clinical practice show that the concave and convex ilia are not always symmetrical in patients with adolescent idiopathic scoliosis (AIS).Transverse pelvic rotation may explain this observation, or pelvic asymmetry may be responsible.The present study investigated pelvic symmetry by examining the volume and linear measurements of the two hipbones in patients with AIS.Forty-two female patients with AIS were recruited for the study.Standing PA radiographs (covering the thoracic and lumbar spinal regions and the entire pelvis), CT scans and 3D reconstructions of the pelvis were obtained for all subjects.The concave/convex ratio of the inferior ilium at the sacroiliac joint medially (SI) and the anterior superior iliac spine laterally (ASIS) were measured on PA radiographs.Hipbone volumes and several distortion and abduction parameters were measured by post-processing software.The concave/convex ratio of SI-ASlS on PA radiographs was 0.97, which was significantly < 1 (P < 0.001).The concave and convex hipbone volumes were comparable in patients with AIS.The hipbone volumes were 257.3 ± 43.5 cm3 and 256.9 ± 42.6 cm3 at the concave and convex sides, respectively (P > 0.05).Furthermore, all distortion and abduction parameters were comparable between the convex and concave sides.Therefore, the present study showed that there was no pelvic asymmetry in patients with AIS, although the concave/convex ratio of SI-ASIS on PA radiographs was significantly < 1.The clinical phenomenon of asymmetrical concave and convex ilia in patients with AIS in preoperative standing PA radiographs may be caused by transverse pelvic rotation, but it is not due to developmental asymmetry or distortion of the pelvis.