Clin Orthop Surg.  2019 Mar;11(1):21-27. 10.4055/cios.2019.11.1.21.

Accuracy of Magnetic Resonance Imaging and Computed Tomography Arthrography in Diagnosing Acetabular Labral Tears and Chondral Lesions

• Lee GY
• Kim S
• Baek SH
• Jang EC
• Ha YC

• KMID: 2438330
• DOI: http://doi.org/10.4055/cios.2019.11.1.21

Abstract

BACKGROUND
We investigated sensitivity, specificity, and accuracy of magnetic resonance imaging (MRI) and computed tomography arthrography (CTA), on the basis of arthroscopic findings, to diagnose acetabular labral tears and chondral lesions.
METHODS
We retrospectively reviewed the results of MRI and subsequent CTA in 36 hips that underwent arthroscopic surgery (33 patients; 17 males [17 hips] and 16 females [19 hips]; average age, 35 years). All patients had positive impingement test results and groin pain. We analyzed sensitivity, specificity, and accuracy of MRI and CTA by comparing with the arthroscopic findings. Interobserver agreement and intraobserver reproducibility of the presence of tears and cartilage lesions on MRI and CTA were calculated using Kappa coefficients.
RESULTS
The sensitivity, specificity, and accuracy of MRI for detection of acetabular labral tears by two observers were 60%, 80%, and 64%, respectively, and 65%, 70%, and 69%, respectively. The sensitivity, specificity, and accuracy of CTA for detection of labral tears by both observers were 85%, 90%, and 86%, respectively, and 92%, 80%, and 89%, respectively. However, the sensitivity and specificity of MRI for detection of acetabular chondral lesions by both observers were 36% and 84%, respectively, and 46% and 88%, respectively. The sensitivity and specificity of CTA for detecting acetabular cartilage lesions by both observers were 46% and 72%, respectively, and 64% and 72%, respectively. Intraobserver reproducibility for detection of labral tears and chondral lesions by using MRI was substantial (κ = 0.756 and κ = 0.693, respectively). Interobserver reliability for detection of labral tears and chondral lesions by using MRI was substantial (κ = 0.700 and κ = 0.875, respectively). Intraobserver reproducibility for detection of labral tears and chondral lesions by using CTA was substantial (κ = 0.832 and κ = 0.774, respectively). Interobserver reliability for detection of labral tears and chondral lesions by using CTA was high (κ = 0.886 and κ = 0.596, respectively).
CONCLUSIONS
This study demonstrated that the accuracy of MRI to detect an acetabular labral tear and a chondral lesion of the hip joint was not sufficient. CTA was reliable in the diagnosis of acetabular labral tears. However, both CTA and MRI were also of limited value to detect chondral lesions.

Keyword

Hip; Magnetic resonance imaging; Computed tomography arthrography; Acetabular labrum; Chondral lesion

MeSH Terms

Acetabulum*
Arthrography*
Arthroscopy
Cartilage
Diagnosis
Female
Groin
Hip
Hip Joint
Humans
Magnetic Resonance Imaging*
Male
Retrospective Studies
Sensitivity and Specificity
Tears*

Figure

• 

  Fig. 1 Proton density magnetic resonance imaging (MRI): the coronal (A) and sagittal (B) views showed a cartilage defect (arrows) on the right acetabulum. The defective cartilage lesion was also seen in computed tomography arthrography (CTA): coronal (C) and sagittal (D) views (arrows). Adjacent subchondral cyst of the acetabulum just above this chondral defect was observed in MRI and CTA. (E) Labral tear. (F) This lesion could be confirmed in arthroscopic examination after labral repair.

• 

  Fig. 2 On T2-weighted magnetic resonance imaging coronal (A) and sagittal (B) views, a definite labral tear was not identified, whereas the lesion was observed in computed tomography coronal (C) and sagittal (D) views. (E) This lesion was confirmed in arthroscopic examination.

• 

  Fig. 3 There was no abnormal finding on the cartilage of the acetabulum in magnetic resonance imaging (A, B) nor in computer tomography arthrography (C, D). But in arthroscopic examination, we could find a floating lesion of the cartilage (E), called “carpet lesion (F).”

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