Zoga Adam C, Kavanagh Eoin C, Omar Imran M, Morrison William B, Koulouris George, Lopez Hector, Chaabra Avneesh, Domesek John, Meyers William C
Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, 10th Floor, Philadelphia, PA 19107, USA.
Radiology. 2008 Jun;247(3):797-807. doi: 10.1148/radiol.2473070049.
To retrospectively determine the sensitivity and specificity of magnetic resonance (MR) imaging findings in patients with clinical athletic pubalgia, with either surgical or physical examination findings as the reference standard.
Institutional review board approval was granted for this HIPAA-compliant study, and informed consent was waived. MR imaging studies in 141 patients (134 male patients, seven female patients; mean age, 30.1 years; range, 17-71 years) who had been referred to a subspecialist because of groin pain were reviewed for findings including hernia, pubic bone marrow edema, secondary cleft sign, and rectus abdominis and adductor tendon injury. MR imaging findings were compared with surgical findings for 102 patients, physical examination findings for all 141 patients, and MR imaging findings in an asymptomatic control group of 25 men (mean age, 29.8 years; range, 18-39 years). Sensitivity and specificity of MR imaging for rectus abdominis and adductor tendon injury were determined by using a chi(2) analysis, and significance of the findings was analyzed with an unpaired Student t test. Disease patterns seen at MR imaging were compared with those reported in the surgical and sports medicine literature.
One hundred thirty-eight (98%) of 141 patients had findings at MR imaging that could cause groin pain. Compared with surgery, MR imaging had a sensitivity and specificity, respectively, of 68% and 100% for rectus abdominis tendon injury and 86% and 89% for adductor tendon injury. Injury in each of these structures was significantly more common in the patient group than in the control group (P < .001). Only two patients had hernias at surgery. At MR imaging, injury or disease could be fit into distinct groups, including osteitis pubis, adductor compartment injury, rectus abdominis tendon injury, and injury or disease remote from the pubic symphysis. Patients with injury involving the rectus abdominis insertion were most likely to go on to surgical pelvic floor repair.
MR imaging depicts patterns of findings in patients with athletic pubalgia, including rectus abdominis insertional injury, thigh adductor injury, and articular diseases at the pubic symphysis (osteitis pubis).
以手术或体格检查结果作为参考标准，回顾性确定临床运动性耻骨痛患者磁共振（MR）成像表现的敏感性和特异性。
本符合健康保险流通与责任法案（HIPAA）的研究获得机构审查委员会批准，且无需知情同意。回顾了141例因腹股沟疼痛而被转诊至专科医生处的患者（134例男性患者，7例女性患者；平均年龄30.1岁；范围17 - 71岁）的MR成像研究结果，包括疝、耻骨骨髓水肿、继发裂隙征以及腹直肌和内收肌腱损伤。将MR成像结果与102例患者的手术结果、所有141例患者的体格检查结果以及25名男性无症状对照组（平均年龄29.8岁；范围18 - 39岁）的MR成像结果进行比较。采用卡方分析确定MR成像对腹直肌和内收肌腱损伤的敏感性和特异性，并使用非配对学生t检验分析结果的显著性。将MR成像所见的疾病模式与手术和运动医学文献中报道的模式进行比较。
141例患者中有138例（98%）在MR成像上有可导致腹股沟疼痛的表现。与手术相比，MR成像对腹直肌腱损伤的敏感性和特异性分别为68%和100%，对内收肌腱损伤的敏感性和特异性分别为86%和89%。这些结构中的每一个损伤在患者组中均显著比对照组更常见（P <.001）。手术中仅2例患者有疝。在MR成像上，损伤或疾病可分为不同组，包括耻骨炎、内收肌间隙损伤、腹直肌腱损伤以及远离耻骨联合的损伤或疾病。涉及腹直肌附着处损伤的患者最有可能接受手术盆底修复。
MR成像描绘了运动性耻骨痛患者的表现模式，包括腹直肌附着处损伤、大腿内收肌损伤以及耻骨联合处的关节疾病（耻骨炎）。
