Toslak Iclal Erdem, Cekic Bulent, Turk Aysen, Eraslan Ali, Parlak A Eda
Department of Radiology, Antalya Training and Research Hospital.
Department of Sports Medicine, Antalya Training and Research Hospital.
Magn Reson Med Sci. 2017 Oct 10;16(4):317-324. doi: 10.2463/mrms.mp.2016-0104. Epub 2017 Feb 13.
Our aims were to determine the feasibility of diffusion-weighted magnetic resonance imaging (DWI) in the detection of bone marrow edema (BME) and explore the apparent diffusion coefficient (ADC) alterations in patients with osteitis pubis (OP).
42 consecutive patients clinically suspected to have athletic pubalgia and 31 control subjects were enrolled in the study. All subjects underwent diagnostic focused magnetic resonance imaging (MRI) and DWI at b values of 0 and 600 s/mm. Two radiologists reviewed the images for the presence of active OP. The presence of subchondral BME and contrast enhancement were considered to indicate active OP. ADC values were measured from public bodies of both groups. DWI results were correlated with routine MRI findings. Receiver-operating-characteristic curves were formed. Cut-off values for ADC, sensitivity and specificity values were measured.
36/42 (85%) of the cases had BME/enhancement on routine MRIs and identified as active OP. ADC measurements of the patients were greater than the controls (P < 0.05). For the optimal cut-off values DWI showed sensitivity and specificity values of 97.3%, and 90.3%, for the right, and 97.1%, and 96.7% for the left side, respectively (Area under the curve 0.965 and 0.973). Intra-and inter-rater reliability for readers were substantial-perfect for all sessions.
DWI is fast, accurate, and highly reproducible technique for the detection of BME in patients with active OP. It allows distinct bone marrow contrast without the use of gadolinium contrast, increases visual perception of active lesions, gives objective information by quantifying the diffusion coefficients, thus increase diagnostic confidence. We suggest the use of DWI as a cost-effective adjunctive tool for the diagnosis of active OP particularly in early cases and inconclusive diagnostic MRI. Future studies are necessary to determine the utility of DWI to evaluate severity of the disease and treatment response before returning athletes to play.
我们的目的是确定扩散加权磁共振成像（DWI）在检测骨髓水肿（BME）中的可行性，并探讨耻骨炎（OP）患者的表观扩散系数（ADC）变化。
本研究纳入了42例临床怀疑患有运动性耻骨痛的连续患者和31例对照受试者。所有受试者均接受了聚焦诊断磁共振成像（MRI）和b值为0和600 s/mm²的DWI检查。两名放射科医生对图像进行了检查，以确定是否存在活动性OP。软骨下BME的存在和对比增强被认为提示活动性OP。测量了两组耻骨部位的ADC值。DWI结果与常规MRI表现进行了相关性分析。绘制了受试者操作特征曲线。测量了ADC的截断值、敏感性和特异性值。
42例患者中有36例（85%）在常规MRI上出现BME/强化，并被确定为活动性OP。患者的ADC测量值高于对照组（P < 0.05）。对于最佳截断值，DWI显示右侧的敏感性和特异性值分别为97.3%和90.3%，左侧为97.1%和96.7%（曲线下面积分别为0.965和0.973）。阅片者的组内和组间可靠性在所有检查中均为高度一致。
DWI是一种快速、准确且高度可重复的技术，用于检测活动性OP患者的BME。它无需使用钆对比剂即可产生明显的骨髓对比，增强了对活动性病变的视觉感知，通过量化扩散系数提供客观信息，从而提高诊断信心。我们建议将DWI作为一种经济有效的辅助工具用于诊断活动性OP，特别是在早期病例和诊断性MRI结果不明确的情况下。未来有必要进行研究以确定DWI在评估疾病严重程度和治疗反应方面的效用，以便运动员能够安全重返赛场。
