Accuracy of magnetic resonance studies in the detection of chondral and labral lesions in femoroacetabular impingement: systematic review and meta-analysis

Abstract

BackgroundSeveral types of Magnetic resonance imaging (MRI) are commonly used in imaging of femoroacetabular impingement (FAI), however till now there are no clear protocols and recommendations for each type. The aim of this meta-analysis is to detect the accuracy of conventional magnetic resonance imaging (cMRI), direct magnetic resonance arthrography (dMRA) and indirect magnetic resonance arthrography (iMRA) in the diagnosis of chondral and labral lesions in femoroacetabular impingement (FAI).MethodsA literature search was finalized on the 17th of May 2016 to collect all studies identifying the accuracy of cMRI, dMRA and iMRA in diagnosing chondral and labral lesions associated with FAI using surgical results (arthroscopic or open) as a reference test. Pooled sensitivity and specificity with 95% confidence intervals using a random-effects meta-analysis for MRI, dMRA and iMRA were calculated also area under receiver operating characteristic (ROC) curve (AUC) was retrieved whenever possible where AUC is equivocal to diagnostic accuracy.ResultsThe search yielded 192 publications which were reviewed according inclusion and exclusion criteria then 21 studies fulfilled the eligibility criteria for the qualitative analysis with a total number of 828 cases, lastly 12 studies were included in the quantitative meta-analysis.Meta-analysis showed that as regard labral lesions the pooled sensitivity, specificity and AUC for cMRI were 0.864, 0.833 and 0.88 and for dMRA were 0.91, 0.58 and 0.92. While in chondral lesions the pooled sensitivity, specificity and AUC for cMRI were 0.76, 0.72 and 0.75 and for dMRA were 0.75, 0.79 and 0.83, while for iMRA were sensitivity of 0.722 and specificity of 0.917.ConclusionsThe present meta-analysis showed that the diagnostic test accuracy was superior for dMRA when compared with cMRI for detection of labral and chondral lesions.The diagnostic test accuracy was superior for labral lesions when compared with chondral lesions in both cMRI and dMRA. Promising results are obtained concerning iMRA but further studies still needed to fully assess its diagnostic accuracy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1443-2) contains supplementary material, which is available to authorized users.

Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018

“…Incidental intra-articular findings are common in asymptomatic individuals and should be managed with the appropriate clinical sensitivity 1 43 44. Again, caution is suggested as the clinical utility of diagnostic imaging can have only small shifts in post-test probability as a result of either positive or negative findings 45–47. As such, a comprehensive clinical examination, including screening for other conditions that might present with hip-related pain (eg, of the spine and pelvis), is required, and the diagnosis of the cause of hip-related pain should never be made on imaging alone 22 23…”

Results of arthroscopic treatment of femroacetabular impingement (FAI)

“…The sensitivity of MRA was 46.67%, its specificity was 84.0%, its positive predictive value was 63.64%, its negative predictive value was 72.41%, and its accuracy was 70.0% in detecting cartilage injury. Saied et al 6 in their meta-analysis of magnetic resonance studies in detecting intra-articular pathology in cases of FAI reported that arthrography improves the accuracy of detection of both labral tears and chondral damage. The accuracy was superior for detection of labral tears than for chondral lesions.…”

Conventional and Arthrographic Magnetic Resonance Techniques for Hip Evaluation: What the Radiologist Should Know

“…Direct MR arthrography is currently considered the diagnostic gold standard for detection of intra-articular lesions and provides a diagnostic benefit over noncontrast imaging according to systematic reviews. [105][106][107] Intra-articular injection distends the joint capsule and leads to an improved differentiation of the peripheral aspect of the labrum. Contrast extending into the labrum or its base facilitates the diagnosis of labrum tears, and contrast accumulation between the femoroacetabular interface indicates cartilage thinning or defects.…”