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This Article Full Text Full Text (PDF) All Versions of this Article: 32/7/1668    most recent 0363546504266480v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (29) Citing Articles via Google Scholar Google Scholar Articles by Byrd, J. W. T. Articles by Jones, K. S. Search for Related Content PubMed PubMed Citation Articles by Byrd, J. W. T. Articles by Jones, K. S. Related Collections Imaging Studies Hip/groin

Diagnostic Accuracy of Clinical Assessment, Magnetic Resonance Imaging, Magnetic Resonance Arthrography, and Intra-articular Injection in Hip Arthroscopy Patients

From the Nashville Sports Medicine & Orthopaedic Center, Nashville, Tennessee

^* Address correspondence to J. W. Thomas Byrd, MD, Nashville Sports Medicine & Orthopaedic Center, 2011 Church Street, Suite 100, Nashville, TN 37203 (e-mail: info{at}nsmoc.com).

Background: Hip arthroscopy has defined elusive causes of hip pain.

Hypothesis/Purpose: It is postulated that the reliability of various investigative methods is inconsistent. The purpose of this study is to evaluate the diagnostic accuracy of these methods.

Study Design: Retrospective review of prospectively collected data.

Methods: Five parameters were assessed in 40 patients: clinical assessment, high-resolution magnetic resonance imaging, magnetic resonance imaging with gadolinium arthrography, intra-articular bupivacaine injection, and arthroscopy. Using arthroscopy as the definitive diagnosis, the other parameters were evaluated for reliability.

Results: Hip abnormality was clinically suspected in all cases with 98% accuracy (1 false positive). However, the nature of the abnormality was identified in only 13 cases with 92% accuracy. Magnetic resonance imaging variously demonstrated direct or indirect evidence of abnormality but overall demonstrated a 42% false-negative and a 10% false-positive interpretation. Magnetic resonance arthrography demonstrated an 8% false-negative and 20% false-positive interpretation. Response to the intra-articular injection of anesthetic was 90% accurate (3 false-negative and 1 false-positive responses) for detecting the presence of intra-articular abnormality.

Conclusions: In this series, clinical assessment accurately determined the existence of intra-articular abnormality but was poor at defining its nature. Magnetic resonance arthrography was much more sensitive than magnetic resonance imaging at detecting various lesions but had twice as many false-positive interpretations. Response to an intra-articular injection of anesthetic was a 90% reliable indicator of intra-articular abnormality.

Key Words: hip arthroscopy • evaluation • magnetic resonance imaging (MRI) • magnetic resonance arthrography • hip pathology

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