Advances in FAI Imaging: a Focused Review

Abstract

Purpose of Review Femoroacetabular impingement (FAI) is one of the main causes of hip pain in young adults and poses clinical challenges which have placed it at the forefront of imaging and orthopedics. Diagnostic hip imaging has dramatically changed in the past years, with the arrival of new imaging techniques and the development of magnetic resonance imaging (MRI). This article reviews the current state-of-the-art clinical routine of individuals with suspected FAI, limitations, and future directions that show promise in the field of musculoskeletal research and are likely to reshape hip imaging in the coming years. Recent Findings The largely unknown natural disease course, especially in hips with FAI syndrome and those with asymptomatic abnormal morphologies, continues to be a problem as far as diagnosis, treatment, and prognosis are concerned. There has been a paradigm shift in recent years from bone and soft tissue morphological analysis towards the tentative development of quantitative approaches, biochemical cartilage evaluation, dynamic assessment techniques and, finally, integration of artificial intelligence (AI)/deep learning systems. Summary Imaging, AI, and hip preserving care will continue to evolve with new problems and greater challenges. The increasing number of analytic parameters describing the hip joint, as well as new sophisticated MRI and imaging analysis, have carried practitioners beyond simplistic classifications. Reliable evidence-based guidelines, beyond differentiation into pure instability or impingement, are paramount to refine the diagnostic algorithm and define treatment indications and prognosis. Nevertheless, the boundaries of morphological, functional, and AI-aided hip assessment are gradually being pushed to new frontiers as the role of musculoskeletal imaging is rapidly evolving.

Femoral acetabular impingement labral pathology on MRI is correlated with greater hip flexion and decreased abduction in collegiate water polo players: A pilot study

“…A radial MR or Dunn lateral x-rays would be an ideal addition to assess for deformity in other planes. 21 We also did not assess femoral version in this MR series, and we understand that changes to femoral version can alter the location of impingement lesions. 22 Similarly, the CEA is usually measured using plain radiographs of the pelvis.…”

Best practice guidelines for clinical and radiological assessment of patients with femoroacetabular impingement. Results from the ISHA International Delphi Consensus Project—Phase 2

“…It allows direct evaluation of articular cartilage and labral pathology, and can assist in optimizing indications as well as patients’ selection for different surgical strategies [ 44 ]. Advanced diagnostic imaging has been recommended as a necessary component of a comprehensive approach to the diagnosis of FAIS, achieving >80% consensus in both CT and MRI evaluations [ 45 ].…”

Inteligencia artificial y radiología: la disrupción tecnológica en la transformación de un paradigma

“…El aprendizaje profundo corresponde a un conjunto de algoritmos de redes neuronales artificiales que intentan modelar abstracciones de alto nivel en datos (11). De esta forma, estos algoritmos conforman diversas capas de aprendizaje con la capacidad de reconocer objetos particulares en imágenes según características definidas (12).…”