Department of Orthopaedics, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
J Bone Joint Surg Am. 2012 Sep 19;94(18):1643-8. doi: 10.2106/JBJS.K.01342.
Arthroscopic surgery of the hip is being increasingly used to diagnose and treat various abnormalities, including acetabular labral tears. Magnetic resonance arthrography has been suggested as the imaging test of choice for the evaluation of the acetabular labrum. There is substantial variability in the previously reported accuracy of magnetic resonance arthrography for diagnosing labral lesions. Interobserver reliability has not been established previously. The purpose of this study was to establish the interobserver reliability and the validity of magnetic resonance arthrography for detecting lesions of the acetabular labrum in a retrospective case series.
Two radiologists independently assessed the acetabular labrum on magnetic resonance arthrograms of ninety-five hips in ninety-three patients who underwent hip arthroscopy for a suspected acetabular labral lesion. Magnetic resonance arthrography findings were compared with the gold standard, which was defined as the assessment of the labrum during the hip arthroscopy.
At arthroscopy, ninety-one labral lesions were identified in the ninety-five hips. The interobserver reliability of detecting labral lesions with magnetic resonance arthrography was fair (kappa=0.268). Magnetic resonance arthrography, as interpreted by observers A and B, showed a sensitivity of 86% and 86%, specificity of 75% and 50%, negative predictive value of 19% and 13%, and positive predictive value of 99% and 98%, respectively.
Because of its limited reliability and the high prevalence of labral lesions, magnetic resonance arthrography provides a limited complementary benefit in the detection of labral lesions in patients with a high clinical suspicion of labral pathology. When there is a high clinical suspicion of a labral lesion, magnetic resonance arthrography has a poor negative predictive value and cannot be used to rule out a labral lesion. Physicians should critically consider whether the findings on a magnetic resonance arthrogram will alter the treatment strategy for an individual patient with a clinical suspicion of labral pathology.
髋关节镜手术越来越多地用于诊断和治疗各种异常，包括髋臼唇撕裂。磁共振关节造影术已被认为是评估髋臼唇的首选影像学检查方法。先前报道的磁共振关节造影术诊断唇裂病变的准确性存在很大差异。以前没有建立过观察者间可靠性。本研究的目的是在回顾性病例系列中建立磁共振关节造影术检测髋臼唇病变的观察者间可靠性和有效性。
两名放射科医生独立评估了 93 名接受髋关节镜检查的疑似髋臼唇撕裂患者的 95 髋磁共振关节造影的髋臼唇。将磁共振关节造影的结果与金标准进行比较，金标准定义为髋关节镜检查时对唇的评估。
在髋关节镜检查中，95 髋中有 91 个唇裂病变。磁共振关节造影术检测唇裂病变的观察者间可靠性为中等（kappa=0.268）。观察者 A 和 B 解读的磁共振关节造影术的敏感性分别为 86%和 86%，特异性分别为 75%和 50%，阴性预测值分别为 19%和 13%，阳性预测值分别为 99%和 98%。
由于可靠性有限，且唇裂病变的患病率较高，磁共振关节造影术在检测有高临床怀疑有唇裂病变的患者的唇裂病变方面提供的补充效益有限。当有高临床怀疑有唇裂病变时，磁共振关节造影术的阴性预测值较差，不能用于排除唇裂病变。对于有临床怀疑有唇裂病变的患者，医生应仔细考虑磁共振关节造影的结果是否会改变对个别患者的治疗策略。
