Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
Pathologic Laboratory Dr. Obrist, Dr. Brunhuber OG, Zams, Austria.
Acad Radiol. 2019 Sep;26(9):e252-e259. doi: 10.1016/j.acra.2018.10.008. Epub 2018 Nov 19.
Although intra-articular bodies are a classic indication for MR arthrography and surgical removal, diagnostic studies are currently sparse. To assess the diagnostic performance of MR arthrography with and without leg traction in detection of intra-articular bodies in the hip joint.
The institutional hip arthroscopy data base (2009-2016: 631 hips) was retrospectively reviewed. Inclusion criteria were hips with and without intra-articular bodies and direct MR arthrography performed with and without leg traction. Twenty-one hips with intra-articular bodies constituted the "disease-positive" group. Seventy-nine randomly selected hips without intra-articular bodies constituted the "disease-negative" group. Images were reviewed independently for presence of intra-articular bodies by two blinded readers. Overall diagnosis and location of intra-articular bodies was recorded (peripheral or central). Arthroscopy served as goldstandard for diagnosis and location of intra-articular bodies. Diagnostic performance and kappa statistics of traction MR arthrography with and without traction were calculated.
For both readers sensitivity/specificity of traction MR arthrography was 86%-95% respectively 90%-91% for overall diagnosis of intra-articular bodies and was 81%-86% respectively 90%-92%for MR arthrogrpahy without traction. For central intra-articular bodies sensitivity was higher for both readers with traction (79%-89%) than without traction (74% each).
MR arthrography with and without traction of the hip is highly accurate in identifying central and peripheral intra-articular bodies. Application of traction was further useful for visualization of centrally located intra-articular bodies.
虽然关节内体是磁共振关节造影和手术切除的经典适应证，但目前诊断研究较为匮乏。本研究旨在评估髋关节磁共振关节造影（MRA）联合和不联合下肢牵引在诊断髋关节内体中的应用价值。
回顾性分析 2009 年至 2016 年的机构髋关节镜检查数据库（631 髋）。纳入标准为：髋关节内存在或不存在体和直接 MRA 联合或不联合下肢牵引。21 髋存在关节内体，构成“疾病阳性”组。79 髋随机选择无关节内体，构成“疾病阴性”组。由两位盲法阅片者独立评估关节内体的存在。记录关节内体的总体诊断和位置（外周或中央）。关节镜检查作为关节内体诊断和位置的金标准。计算牵引 MRA 与非牵引 MRA 的诊断性能和kappa 统计值。
两位阅片者的诊断性能分别为：牵引 MRA 对髋关节内体的总体诊断的敏感度/特异度分别为 86%-95%和 90%-91%；非牵引 MRA 对髋关节内体的总体诊断的敏感度/特异度分别为 81%-86%和 90%-92%。对于中央关节内体，两位阅片者的敏感度均以牵引时较高（分别为 79%-89%），而非牵引时则较低（各为 74%）。
髋关节 MRA 联合和不联合下肢牵引对诊断中央和外周关节内体均具有较高的准确性。应用牵引有助于观察中央关节内体。
