Sonia Branci1, Kristian Thorborg2, Birthe Højlund Bech3, Mikael Boesen4, Erland Magnussen5, Michel Court-Payen6, Michael Bachmann Nielsen3, Per Hölmich7. 1. Department of Orthopaedic Surgery, Sports Orthopaedic Research Center-Copenhagen, Arthroscopic Center Amager, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. 2. Department of Orthopaedic Surgery, Sports Orthopaedic Research Center-Copenhagen, Arthroscopic Center Amager, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark. 3. Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. 4. Department of Radiology, Frederiksberg Hospital and Parker Institute, University of Copenhagen, Copenhagen, Denmark. 5. Department of Radiology, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark. 6. Department of Musculoskeletal Imaging, Gildhøj Private Hospital, Copenhagen, Denmark. 7. Department of Orthopaedic Surgery, Sports Orthopaedic Research Center-Copenhagen, Arthroscopic Center Amager, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark Sports Groin Pain Center, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
Abstract
BACKGROUND: There is currently no standardised MRI evaluation protocol for athletes who present with symptoms that may relate to the pubic symphysis, the pubic bones, and the adductor muscle insertions. We outline the protocol and reliability data. MATERIAL AND METHODS: Three musculoskeletal radiologists developed an 11-element MRI evaluation protocol defined according to precise criteria and illustrated in a pictorial atlas. Eighty-six male athletes (soccer players and non-soccer players) underwent standardised 3 Tesla MRI of the pelvis. Two external musculoskeletal radiologists were trained to use the protocol and pictorial atlas during two sessions of 2-4 h each. Each radiologist rated all 86 MRI independently. One radiologist evaluated the scans once, the other twice 2 months apart. Cohen κ statistics were used to determine intraobserver and interobserver agreement. RESULTS: The main findings were (1) substantial intraobserver (κ range 0.65-0.67) and moderate interobserver (κ range 0.45-0.52) agreement in rating pubic bone marrow oedema, (2) substantial to moderate intraobserver (κ range 0.49-0.72) and moderate-to-fair interobserver (κ range 0.21-0.52) agreement in rating most other MRI findings, (3) slight intraobserver and interobserver (κ range -0.06-0.05) agreement in rating adductor longus tendinopathy. CONCLUSIONS: The Copenhagen Standardised MRI protocol demonstrated moderate-to-substantial reliability in rating bone marrow oedema, and varied from fair-to-substantial agreement for the majority of MRI features, but showed only slight agreement in rating adductor longus tendinopathy. This rigorous investigation also confirms that while MRI evaluation seems to provide reasonable reliability in rating pubic bone marrow oedema, the evaluation of adductor tendinopathy in a clinical and research setting needs further resolution by continued development and testing of MRI acquisition protocols. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
BACKGROUND: There is currently no standardised MRI evaluation protocol for athletes who present with symptoms that may relate to the pubic symphysis, the pubic bones, and the adductor muscle insertions. We outline the protocol and reliability data. MATERIAL AND METHODS: Three musculoskeletal radiologists developed an 11-element MRI evaluation protocol defined according to precise criteria and illustrated in a pictorial atlas. Eighty-six male athletes (soccer players and non-soccer players) underwent standardised 3 Tesla MRI of the pelvis. Two external musculoskeletal radiologists were trained to use the protocol and pictorial atlas during two sessions of 2-4 h each. Each radiologist rated all 86 MRI independently. One radiologist evaluated the scans once, the other twice 2 months apart. Cohen κ statistics were used to determine intraobserver and interobserver agreement. RESULTS: The main findings were (1) substantial intraobserver (κ range 0.65-0.67) and moderate interobserver (κ range 0.45-0.52) agreement in rating pubic bone marrow oedema, (2) substantial to moderate intraobserver (κ range 0.49-0.72) and moderate-to-fair interobserver (κ range 0.21-0.52) agreement in rating most other MRI findings, (3) slight intraobserver and interobserver (κ range -0.06-0.05) agreement in rating adductor longus tendinopathy. CONCLUSIONS: The Copenhagen Standardised MRI protocol demonstrated moderate-to-substantial reliability in rating bone marrow oedema, and varied from fair-to-substantial agreement for the majority of MRI features, but showed only slight agreement in rating adductor longus tendinopathy. This rigorous investigation also confirms that while MRI evaluation seems to provide reasonable reliability in rating pubic bone marrow oedema, the evaluation of adductor tendinopathy in a clinical and research setting needs further resolution by continued development and testing of MRI acquisition protocols. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Andreas Serner; Frank W Roemer; Per Hölmich; Kristian Thorborg; Jingbo Niu; Adam Weir; Johannes L Tol; Ali Guermazi Journal: Eur Radiol Date: 2016-07-06 Impact factor: 5.315