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European Radiology

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01-04-2011 | Musculoskeletal

The diagnostic accuracy of acetabular labral tears using magnetic resonance imaging and magnetic resonance arthrography: a meta-analysis

Authors: Toby O. Smith, Gemma Hilton, Andoni P. Toms, Simon T. Donell, Caroline B. Hing

Published in: European Radiology | Issue 4/2011

Abstract

Objectives

Magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) have been advocated for the diagnosis of acetabular labral tears. The purpose of this study was to determine the sensitivity and specificity of MRI and MRA in diagnosing acetabular labral tears using meta-analysis.

Methods

Pertinent published and unpublished literature databases were reviewed. A two-by-two table was constructed to calculate the sensitivity and specificity of MRI or MRA investigations against surgical outcomes. Pooled sensitivity and specificity and Receiver Operating Characteristic curve (ROC) evaluations were performed. Methodological quality of each study was assessed using the QUADAS (Quality Assessment of Diagnostic Accuracy Studies) tool.

Results

Nineteen papers assessing 881 hips were reviewed. Conventional MRI was assessed in 13 studies and MRA was assessed in 16 studies. Whilst both MRI (0.5–3T) and MRA (0.5–3T) presented with a moderate sensitivity and specificity (sensitivity 66%, 87%; specificity 79%, 64%), diagnostic accuracy of MRA appeared to be superior to MRI in detecting acetabular labral tears on ROC curve interpretation. The literature poorly described population characteristics, assessor blinding, with limited sample sizes.

Conclusions

MRI and MRA may be useful adjuncts in the diagnosis of acetabular labral tears in adults. MRA appears to be superior to conventional MRI.

Drake RL, Vogl AW, Mitchell AWM (2010) Gray’s anatomy for students, 2nd edn. Elsevier/Churchill Livingstone, Philadelphia

Groh M, Herrera J (2009) A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med 2:105–117PubMedCrossRef

Petersen W, Petersen F, Tillmann B (2003) Structure and vascularization of the acetabular labrum with regard to the pathogenesis and healing of labral lesions. Arch Orthop Trauma Surg 11:403–408

Seldes RM, Tan V, Hunt J, Katz M, Winiarsky R, Fitzgerald RH Jr (2001) Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Relat Res 382:232–240PubMedCrossRef

Bharam S (2006) Labral tears, extra-articular injuries, and hip arthroscopy in the athlete. Clin Sports Med 25:279–292PubMedCrossRef

Keene GS, Villar RN (1994) Arthroscopic anatomy of the hip: an in vitro study. Arthroscopy 10:392–399PubMedCrossRef

Petersilge CA, Haque MA, Petersilge WJ, Lewin JS, Lieberman JM, Buly R (1996) Acetabular labral tears: evaluation with MR arthrography. Radiology 2000:231–235

Tan V, Seldes RM, Katz MA, Freedhand AM, Klimkiewicz JJ, Fitzgerald RH Jr (2001) Contribution of acetabular labrum to articulating surface area and femoral head coverage in adult hip joints: an anatomic study in cadavera. Am J Orthop 30:809–812PubMed

Hunt D, Clohisy J, Prather H (2007) Acetabular tears of the hip in women. Phys Med Rehabil Clin N Am 18:497–520PubMed

10.

Ferguson SJ, Bryant JT, Ganz R, Ito K (2000) The acetabular labrum seal: a poroelastic finite element model. Clin Biomech 15:463–468CrossRef

11.

Hlavacek M (2002) The influence of the acetabular labrum seal, intact articular superficial zone and synovial fluid thixotropy on squeeze-fill lubrication of a spherical synovial joint. J Biomech 35:1325–1335PubMedCrossRef

12.

Byers PD, Contepomis CA, Farkas TA (1970) A post mortem study of the hip joint. Ann Rheum Dis 29:15–31PubMedCrossRef

13.

Byrd JW (1996) Labral lesions: an elusive source of hip pain case reports and literature review. Arthroscopy 12:603–612PubMedCrossRef

14.

Ferguson SJ, Bryant JT, Ganz R, Ito K (2000) The influence of the acetabular labrum on hip joint cartilage consolidation: a poroelastic finite element model. J Biomech 33:953–960PubMedCrossRef

15.

Kelly BT, Weiland DE, Schenker ML, Philippon MJ (2005) Arthroscopic labral repair in the hip: surgical technique and review of the literature. Arthroscopy 21:1496–1504PubMedCrossRef

16.

Philippon MJ, Martin RR, Kelly BT (1995) A classification system for labral tears of the hip. Arthroscopy 21(Suppl):e36

17.

Ikeda T, Awaya G, Suzuki S, Okada Y, Tada H (1988) Torn acetabular labrum in young patients. J Bone Joint Surg 70-B:13–16

18.

Dameron TB (1959) Bucket handle tear of acetabular labrum accompanying posterior dislocation of the hip. J Bone Joint Surg 41-A:131–134PubMed

19.

Robertson WJ, Kadrmas WR, Kelly BT (2007) Arthroscopic management of labral tears in the hip: a systematic review. Clin Orthop Relat Res 455:88–92PubMedCrossRef

20.

McCarthy JC, Nobel PC, Schuck MR, Wright J, Lee J (2001) The watershed labral lesion: its relationship to early arthritis of the hip. J Arthroplasty 16(Suppl 1):81–87PubMedCrossRef

21.

Lewis CL, Sahrmann SA (2006) Acetabular labral tears. Phys Ther 86:110–121PubMed

22.

McCarthy JC, Busconi B (1995) The role of hip arthroscopy in the diagnosis and treatment of hip disease. Orthopedics 18:753–756PubMed

23.

Narvani AA, Tsiridis E, Kendall S, Chaudhuri R, Thomas P (2003) A preliminary report on prevalence of acetabular labrum tears in sports patients with groin pain. Knee Surg Sports Traumatol Arthrosc 11:403–408PubMedCrossRef

24.

Burnett RS, Della Rocca GJ, Prather H, Curry M, Maloney WJ, Clohisy JC (2006) Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg 88-A:1448–1457CrossRef

25.

Fitzgerald RH (1995) Actebular labrum tears: diagnosis and treatment. Clin Orthop 311:60–68PubMed

26.

Hase T, Uei T (1999) Acetabular labral tear: arthroscopic diagnosis and treatment. Arthroscopy 15:138–141PubMedCrossRef

27.

Klaue K, Durnin CW, Ganz R (1991) The acetabular rim syndrome. A clinical presentation of dysplasia of the hip. J Bone Joint Surg 73-B:423–429

28.

Philippon MJ (2006) New frontiers in hip arthroscopy: the role of arthroscopic hip labral repair and capsulorrhaphy in the treatment of hip disorders. Instr Course Lect 55:309–316PubMed

29.

Philippon MJ, Stubbs AJ, Schenker ML, Maxwell RB, Ganz R, Leunig M (2007) Arthroscopic management of FAI: osteoplasty technique and literature review. Am J Sports Med 35:1571–1580PubMedCrossRef

30.

Czerny C, Hofmann S, Neuhold A, Tschauner C, Engel A, Recht MP, Kramer J (1996) Lesions of the acetabular labrum: accuracy of MR imaging and MR arthrography in detection and staging. Radiology 200:225–230PubMed

31.

Chandnani VP, Yeager TD, DeBerardino T, Christensen K, Gagliardi JA, Heitz DR, Baird DE, Hansen MF (1993) Glenoid labral tears: prospective evaluation with MRI imaging, MR arthrography, and CT arthrography. AJR Am J Roentgenol 161:1229–1235PubMed

32.

Hayes CW, Conway WF (1992) Evaluation of articular cartilage: radiographic and cross-sectional imaging techniques. Radiographics 12:409–428PubMed

33.

McCauley TR, Pope CF, Jokl P (1992) Normal and abnormal glenoid labrum: assessment with multiplanar gradient-echo MR imaging. Radiology 183:35–37PubMed

34.

Kramer J, Hofmann S, Imhof H (1994) The non-traumatic femur head necrosis in the adult. II: radiologic diagnosis and staging. Radiologe 34:11–20PubMed

35.

Engel A (1990) Magnetic resonance knee arthrography. Enhanced contrast by gadolinium complex in the rabbit and in humans. Acta Orthop Scand Suppl 240:1–57PubMed

36.

Whiting P, Rutjes AW, Dinnes J, Reitsma J, Bossuyt PM, Kleijnen J (2004) Development and validation of methods for assessing the quality of diagnostic accuracy studies. Health Technol Assess 8:1–234

37.

Whiting PF, Weswood ME, Rutjes AW, Reitsma JB, Bossuyt PN, Kleijnen J (2006) Evaluation of QUADAS, a tool for the quality assessment of diagnostic accuracy studies. BMC Med Res Methodol 6:9PubMedCrossRef

38.

Littenberg B, Moses LE (1993) Estimating diagnostic accuracy from multiple conflicting reports: a new analytic method. Med Decis Making 13:313–321PubMedCrossRef

39.

Deeks JJ (2001) Systematic reviews of evaluations of diagnostic and screening tests. In: Egger M, Davey Smith G, Altman DG (eds) Systematic reviews in healthcare: meta-analysis in context. BMJ Publishing Groups, London, pp 248–284

40.

Edwards DJ, Lomas D, Villar RN (1995) Diagnosis of the painful hip by magnetic resonance imaging and arthroscopy. J Bone Joint Surg 77-B:374–376

41.

Nishii T, Nakanishi K, Sugano N, Naito H, Tamura S, Ochi T (1996) Acetabular labral tears: contrast-enhanced MR imaging under continuous leg traction. Skeletal Radiol 25:349–356PubMedCrossRef

42.

Freedman BA, Potter BK, Dinauer PA, Giuliani JR, Kuklo TR, Murphy KP (2006) Prognostic value of magnetic resonance arthrography for Czerny stage II and III acetabular labral tears. Arthroscopy 22:742–747PubMedCrossRef

43.

Leunig M, Werlen S, Ungersböck A, Ito K, Ganz R (1997) Evaluation of the acetabular labrum by MR arthrography. J Bone Joint Surg 79-B:230–234CrossRef

44.

Hodler J, Yu JS, Steinert HC, Resnick D (1995) MR imaging versus alternative imaging techniques. Magn Reson Imaging Clin N Am 3:591–608PubMed

45.

Sundberg TP, Toomayan GA, Major NM (2006) Evaluation of the acetabular labrum at 3.0-T MR imaging compared with 1.5-T MR arthrography: preliminary experience. Radiology 238:706–711PubMedCrossRef

46.

Toomayan GA, Holman WR, Major NM, Kozlowicz SM, Vail TP (2006) Sensitivity of MR arthrography in the evaluation of acetabular labral tears. AJR Am J Roentgenol 186:449–453PubMedCrossRef

47.

Ziegert AJ, Blankenbaker DG, De Smet AA, Keene JS, Shinki K, Fine JP (2009) Comparison of standard hip MR arthrographic imaging planes and sequences for detection of arthroscopically proven labral tear. AJR Am J Roentgenol 192:1397–1400PubMedCrossRef

48.

Czerny C, Hofmann S, Urban M, Tschauner C, Neuhold A, Pretterklieber M, Recht MP, Kramer J (1999) MR arthrography of the adult acetabular capsular-labral complex: correlation with surgery and anatomy. AJR Am J Roentgenol 173:345–359PubMed

49.

Zlathin MB, Pevsner D, Sanders TG, Hancock CR, Ceballos CE, Herrera MF (2010) Acetabular labral tears and cartilage lesions of the hip: Indirect MR arthrographic correlation with arthroscopy-A preliminary study. AJR Am J Roentgenol 194:709–714CrossRef

50.

Petersilge CA (1997) Current concepts of MR arthrography if the hip. Semin Ultrasound CT MR 18:291–301PubMedCrossRef

51.

Dinauer PA, Murphy KP, Carroll JF (2004) Sublabral sulcus at the posteroinferior acetabulum: a potential pitfall in MR arthrography diagnosis of acetabular labral tears. AJR Am J Roentgenol 183:1745–1753PubMed

52.

McCarthy JC, Lee JA (2002) Acetabular dysplasia: a paradigm of arthroscopic examination of chondral injuries. Clin Orthop Relat Res 405:122–128PubMedCrossRef

53.

Chan Y-S, Lien L-C, Hsu H-L, Wan Y-L, Lee MSS, Hsu K-Y, Shih C-H (2005) Evaluating hip labral tears using magnetic resonance arthrography: A prospective study comparing hip arthroscopy and magnetic resonance arthrography diagnosis. Arthroscopy 21:1250, e.1-8PubMedCrossRef

54.

Byrd JW, Jones KS (2004) Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography, and intra-articular injection in hip arthroscopy patients. Am J Sports Med 32:1668–1674PubMedCrossRef

55.

James SL, Ali K, Malara F, Young D, O’Donnell J, Connell DA (2006) MRI findings of femoroacetabular impingement. AJR Am J Roentgenol 187:1412–1419PubMedCrossRef

56.

Schmid MR, Nötzli HP, Zanetti M, Wyss TF, Hodler J (2002) Cartilage lesions in the hip: diagnostic effectiveness of MR arthrography. Radiology 226:382–386CrossRef

57.

Mintz DN, Hooper T, Connell D, Buly R, Padgett DE, Potter HG (2005) Magnetic resonance imaging of the hip: detection of labral and chondral abnormalities using noncontrast imaging. Arthroscopy 21:385–393PubMedCrossRef

58.

Studler U, Kalberer F, Leunig M, Zanetti M, Hodler J, Dora C, Pfirrmann CW (2008) MR arthrography of the hip: differentiation between an anterior sublabral recess as a normal variant and a labral tear. Radiology 249:947–954PubMedCrossRef

59.

Keeney JA, Peelle MW, Jackson J, Rubin D, Maloney WJ, Clohisy JC (2004) Magnetic resonance arthrography versus arthroscopy in the evaluation of articular hip pathology. Clin Orthop Relat Res 429:163–169PubMedCrossRef

Title: The diagnostic accuracy of acetabular labral tears using magnetic resonance imaging and magnetic resonance arthrography: a meta-analysis
Authors: Toby O. Smith
Gemma Hilton
Andoni P. Toms
Simon T. Donell
Caroline B. Hing
Publication date: 01-04-2011
Publisher: Springer-Verlag
Published in: European Radiology / Issue 4/2011
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-010-1956-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The diagnostic accuracy of acetabular labral tears using magnetic resonance imaging and magnetic resonance arthrography: a meta-analysis

Abstract

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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