Emmanuel Ducouret1, Gilles Reboul2, François Dalmay3, Christina Iosif4,5, Charbel Mounayer6, Lionel Pesquer7, Benjamin Dallaudiere7,8,9. 1. Département de Radiologie, Centre Hospitalier Universitaire Dupuytren, 2 Avenue Martin Luther King, 87042, Limoges, France. emmanuel.ducouret@hotmail.com. 2. Service de Chirurgie Pariétale, Clinique du Sport de Bordeaux-Mérignac, 2 rue Georges Négrevergne, 33700, Mérignac, France. 3. CEBIMER, Centre Hospitalier Universitaire Dupuytren, 2 Avenue Martin Luther King, 87042, Limoges, France. 4. CHU Jean Minjoz, Besançon, France. 5. BioEM, CNRS, UMR 7252, Université de Limoges, Limoges, France. 6. Département de Neuroradiologie Interventionnelle, Centre Hospitalier Universitaire Dupuytren, 2 Avenue Martin Luther King, 87042, Limoges, France. 7. Centre d'imagerie ostéoarticulaire, Clinique du Sport, Bordeaux Mérignac, 2, rue Georges-Négrevergne, 33700, Mérignac, France. 8. Service de Radiologie, Département d'imagerie Musculo-Squelettique, Centre Hospitalier Universitaire Pellegrin, place Amélie-Léon-Rabat, 33000, Bordeaux, France. 9. Centre de Résonance Magnétique des Systèmes Biologiques, UMR 5536, CNRS, Université de Bordeaux, 146 rue Léo Saignat, 33076, Bordeaux, France.
Abstract
OBJECTIVE: To determine the diagnostic reliability of magnetic resonance imaging (MRI) sequences in chronic groin pain (CGP) compared to surgery and try to propose a suitable MRI protocol. MATERIALS AND METHODS: Forty-three consecutive patients with resistant clinical CGP underwent a pre-surgical pelvis MRI. Eight MRI sequences were acquired: axial fast spin-echo T1-weighted (FSE T1), coronal FSE T1, axial-oblique (in symphysis plane) proton density weighted with fat saturation (PDFS), coronal PDFS, sagittal PDFS, axial FSE T1 with fat saturation and gadolinium enhancement (FSGE), coronal FSE T1 FSGE and axial FSE T1 with Valsalva maneuver (VM). These sequences were reviewed for pubic symphysis assessment, adductor longus (AL) tendon and abdominal wall (AW) injuries. The same surgeon operated on all of these patients (26 AL and 49 AW). Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative prospective value (NPV) and accuracy of each sequence and combinations for AL or AW injuries were calculated in comparison to surgical findings. RESULTS: One hundred ninety-two sequences were obtained. Coronal T1 FSGE and axial T1 VM proved to be the most reliable sequences (accuracy: 91.67% in AL and 83.33% in AW). The best sequence combination was coronal T1, axial PDFS, sagittal PDFS and axial T1 VM (accuracy: 77.78%; Se: 100.00%, Sp: 69.23%, PPV: 55.56%, NPV: 100.00%). CONCLUSION: MRI has 77.78% accuracy, 100.00% sensitivity, 69.23% specificity, 55.56% PPV and 100.00% NPV in evaluating CGP, with coronal T1-axial PDFS-sagittal PDFS-axial T1 VM as the optimal protocol in terms of diagnostic performance within a reasonable scan time. Diagnostic performance of MRI was examined in the evaluation of CGP using surgery as reference standard.
OBJECTIVE: To determine the diagnostic reliability of magnetic resonance imaging (MRI) sequences in chronic groin pain (CGP) compared to surgery and try to propose a suitable MRI protocol. MATERIALS AND METHODS: Forty-three consecutive patients with resistant clinical CGP underwent a pre-surgical pelvis MRI. Eight MRI sequences were acquired: axial fast spin-echo T1-weighted (FSE T1), coronal FSE T1, axial-oblique (in symphysis plane) proton density weighted with fat saturation (PDFS), coronal PDFS, sagittal PDFS, axial FSE T1 with fat saturation and gadolinium enhancement (FSGE), coronal FSE T1 FSGE and axial FSE T1 with Valsalva maneuver (VM). These sequences were reviewed for pubic symphysis assessment, adductor longus (AL) tendon and abdominal wall (AW) injuries. The same surgeon operated on all of these patients (26 AL and 49 AW). Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative prospective value (NPV) and accuracy of each sequence and combinations for AL or AW injuries were calculated in comparison to surgical findings. RESULTS: One hundred ninety-two sequences were obtained. Coronal T1 FSGE and axial T1 VM proved to be the most reliable sequences (accuracy: 91.67% in AL and 83.33% in AW). The best sequence combination was coronal T1, axial PDFS, sagittal PDFS and axial T1 VM (accuracy: 77.78%; Se: 100.00%, Sp: 69.23%, PPV: 55.56%, NPV: 100.00%). CONCLUSION: MRI has 77.78% accuracy, 100.00% sensitivity, 69.23% specificity, 55.56% PPV and 100.00% NPV in evaluating CGP, with coronal T1-axial PDFS-sagittal PDFS-axial T1 VM as the optimal protocol in terms of diagnostic performance within a reasonable scan time. Diagnostic performance of MRI was examined in the evaluation of CGP using surgery as reference standard.
Entities:
Keywords:
Chronic; Groin pain; MRI; Protocol; Reliability; Sequences; Surgery
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