MR arthrography of acetabular cartilage delamination in femoroacetabular cam impingement
MR arthrography of acetabular cartilage delamination in femoroacetabular cam impingement
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DOI：
10.1148/radiol.2491080093
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发表时间：
2008-10-01
期刊：
影响因子：
19.7
通讯作者：
Hodler, Juerg
中科院分区：
文献类型：
--
作者：
Pfirrmann, Christian W. A.;Duc, Sylvain R.;Hodler, Juerg
目的：回顾性评价磁共振（MR）关节成像的频率和性能，以帮助诊断股髋臼撞击（FAI）患者髋臼软骨剥离。材料和方法：本回顾性研究放弃了机构审查委员会的批准和知情同意。连续纳入44例cam型FAI患者（平均年龄30.7岁，范围16-49岁），其中男性30例（平均年龄30.5岁，范围16-49岁），女性14例（平均年龄31.4岁，范围18-48岁）。纳入标准为无手术史，MR成像后3个月内手术，有髋臼软骨发现的详细手术报告。MR关节成像结果由两名盲读者独立评估。手术结果可作为参考标准。计算观察者间一致性的敏感性、特异性、准确性和K统计量。结果：手术中44例患者中有23例（52%）出现髋臼软骨剥离（髋臼缘软骨瓣平均大小7.6 mm，范围2 ~ 30 mm）。在MR中，软骨剥离下有液体信号强度的患者对读写器1的敏感性、特异性和准确性分别为22%、95%和57%，对读写器2的敏感性、特异性和准确性分别为30%、95%和61%。在矢状面三维水激发双回波稳态图像上，髋臼软骨的低峰线表现出中等的诊断性能（阅读器1的灵敏度、特异性和准确性分别为70%、57%和64%，阅读器2的灵敏度、特异性和准确性分别为70%、62%和66%）。在冠状面中等权重脂肪饱和图像上（阅读器1的灵敏度、特异性和准确性分别为52%、90%和70%，阅读器2的灵敏度、特异性和准确性分别为74%、90%和82%）和冠状面t1加权图像上（阅读器1的灵敏度、特异性和准确性分别为35%、90%和61%，阅读器2的灵敏度、特异性和准确性分别为61%、95%和77%），髋臼软骨的低信号区域都具有相当的特异性。结论：软骨剥离在FAI手术患者中很常见。软骨脱层下积液是一种特殊但罕见的发现。在中等加权脂肪饱和或t1加权图像上看到的髋臼软骨低信号区似乎是有用的诊断标准。(c) RSNA， 2008年。
Purpose: To retrospectively assess the frequency and performance of magnetic resonance (MR) arthrography to help diagnose acetabular cartilage delamination in femoroacetabular impingement (FAI).Materials and Methods: Institutional review board approval and informed consent were waived for this retrospective study. Forty-four consecutive patients with FAI of the cam type were included (mean age, 30.7 years; range, 16-49 years), including 30 men (mean age, 30.5 years; range, 16-49 years) and 14 women (mean age, 31.4 years; range, 18-48 years). The inclusion criteria were no previous surgery, surgery within 3 months after MR imaging, and availability of a detailed surgical report with acetabular cartilage findings. MR arthrographic findings were assessed independently by two blinded readers. Findings at surgery served as reference standard. Sensitivity, specificity, accuracy, and K statistics for interobserver agreement were calculated.Results: At surgery, acetabular cartilage delamination was seen in 23 (52%) of 44 patients (mean size of cartilage flap from acetabular rim, 7.6 mm; range, 2-30 mm). At MR, patients with fluid signal intensity under the cartilage delamination had a respective sensitivity, specificity, and accuracy of 22%, 95%, and 57% for reader 1 and 30%, 95%, and 61% for reader 2. A hypointense line in the acetabular cartilage on sagittal three-dimensional double-echo steadystate images with water excitation demonstrated moderate diagnostic performance (respective sensitivity, specificity, and accuracy were 70%, 57%, and 64% for reader 1 and 70%, 62%, and 66% for reader 2). Hypointense areas in the acetabular cartilage were quite specific on both coronal intermediate-weighted fat-saturated images (respective sensitivity, specificity, and accuracy were 52%, 90%, and 70% for reader 1 and 74%, 90%, and 82% for reader 2) and coronal T1-weighted images (respective sensitivity, specificity, and accuracy were 35%, 90%, and 61% for reader 1 and 61%, 95%, and 77% for reader 2).Conclusion: Cartilage delamination is common in patients undergoing surgery for FAI. Fluid under the cartilage delamination is a specific but rare finding. Hypointense areas in the acetabular cartilage seen on intermediate-weighted fat-saturated or T1-weighted images appear to be helpful diagnostic criteria. (c) RSNA, 2008.