1 Department of Radiology, Orthopedic University Hospital Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland.
AJR Am J Roentgenol. 2014 Jan;202(1):160-9. doi: 10.2214/AJR.12.10266.
The objective of our study was to prospectively compare the diagnostic performance of MR arthrography and conventional MRI with surgical correlation in the same patient for detecting labrum and articular cartilage defects.
Twenty-eight patients (mean age, 31.8 years) underwent MR arthrography, conventional MRI, and subsequent hip surgery, which served as the reference standard. Labrum and cartilage defects were evaluated at MRI by two independent readers. A McNemar test and kappa statistics were used for statistical analysis.
At surgery, 31 labral tears were identified. MR arthrography had an advantage over conventional MRI for detecting labral tears at the anterosuperior quadrant (sensitivity of MR arthrography, 81% and 69% for readers 1 and 2, respectively; sensitivity of conventional MRI, 50% for both readers); this difference in performance between MR arthrography and conventional MRI was statistically significant for reader 1 (p = 0.02) but not for reader 2 (p = 0.2). Interobserver agreement for labral tears was higher for MR arthrography (κ = 0.81) than for conventional MRI (κ = 0.63). Surgery showed 31 acetabular cartilage defects and nine femoral cartilage defects. MR arthrography had an advantage over conventional MRI for detecting acetabular cartilage defects (sensitivity of MR arthrography, 71% and 92% for readers 1 and 2, respectively; sensitivity of conventional MRI, 58% and 83%), whereas there was no advantage to using MR arthrography for detecting femoral cartilage defects with statistically significant difference for the acetabular cartilage or femoral cartilage. Interobserver agreement was slightly higher for MR arthrography (κ = 0.50) than for conventional MRI (κ = 0.40) for assessing the acetabular cartilage and was almost identical for the femoral cartilage (κ = 0.62 and 0.63, respectively).
MR arthrography was superior to conventional MRI for detecting labral tears and acetabular cartilage defects and showed a higher interobserver agreement. For femoral cartilage lesions, both modalities yielded comparable results.
本研究旨在前瞻性比较 MRI 关节造影和常规 MRI 与手术结果的相关性，以检测盂唇和关节软骨损伤。
28 例患者（平均年龄 31.8 岁）分别接受 MRI 关节造影、常规 MRI 及后续髋关节手术，手术结果作为参考标准。由两位独立的阅片者评估 MRI 中的盂唇和软骨损伤。采用 McNemar 检验和 Kappa 统计进行统计学分析。
术中发现 31 例盂唇撕裂。MRI 关节造影在检测前上象限盂唇撕裂方面优于常规 MRI（两位阅片者的 MRI 关节造影的敏感性分别为 81%和 69%，常规 MRI 的敏感性均为 50%）；MRI 关节造影和常规 MRI 的性能差异在第一位阅片者（p = 0.02）中具有统计学意义，但在第二位阅片者（p = 0.2）中无统计学意义。MRI 关节造影对盂唇撕裂的观察者间一致性（κ = 0.81）高于常规 MRI（κ = 0.63）。手术发现 31 例髋臼软骨损伤和 9 例股骨软骨损伤。MRI 关节造影在检测髋臼软骨损伤方面优于常规 MRI（两位阅片者的 MRI 关节造影的敏感性分别为 71%和 92%，常规 MRI 的敏感性分别为 58%和 83%），但在检测股骨软骨损伤方面，MRI 关节造影并无优势。髋臼软骨和股骨软骨的差异均无统计学意义。MRI 关节造影对髋臼软骨的观察者间一致性（κ = 0.50）略高于常规 MRI（κ = 0.40），对股骨软骨的观察者间一致性则几乎相同（κ = 0.62 和 0.63）。
与常规 MRI 相比，MRI 关节造影在检测盂唇撕裂和髋臼软骨损伤方面具有更高的诊断性能和观察者间一致性。对于股骨软骨病变，两种方法的结果相当。
