From the Departments of Radiology (M.S., W.W., S.G.) and Orthopedic Surgery (L.P., T.Y.), NYU Langone Orthopedic Hospital, 301 E 17th St, Room 600, New York, NY 10003.
Radiology. 2019 Nov;293(2):412-421. doi: 10.1148/radiol.2019190581. Epub 2019 Sep 24.
Background The MRI manifestations of subspine impingement (SSI) other than morphologic features of anterior inferior iliac spine (AIIS) have not been extensively explored and validated. Purpose To determine the MRI findings associated with SSI, including AIIS morphologic features, femoral distal cam, and associated soft-tissue injuries. Materials and Methods This is a retrospective study of symptomatic patients who underwent arthroscopic treatment for femoroacetabular impingement between December 2014 and March 2017, with preoperative MRI within 6 months before surgery. The SSI group included patients with clinical and intraoperative findings of SSI; the remaining patients comprised the non-SSI group. Preoperative MRI findings were independently assessed by two radiologists who were blinded to clinical information. Interreader agreement was assessed, and multivariable logistic regression was also used. Results A total of 62 patients (mean age ± standard deviation, 42.1 years ± 11.9; 38 women) were included. SSI was diagnosed in 20 of the 62 patients (32%) (mean age, 43 years ± 12); 42 patients (68%) did not have SSI (mean age, 41 years ± 10). Reader 1 detected distal cam in 16 of the 20 patients with SSI (80%) and eight of the 42 patients without SSI (19%), and reader 2 detected distal cam in 15 of the 20 patients with SSI (75%) and eight of the 42 patients without SSI (19%) ( < .001 for both). Reader 1 detected signs of impingement on the distal femoral neck (IDFN) in 18 of the 20 patients with SSI (90%) and seven of the 42 patients without SSI (16%), and reader 2 detected signs of IDFN in 13 of the 20 patients with SSI (65%) and nine of the 42 patients without SSI (21%) ( < .001 and = .001, respectively). Reader 1 detected superior capsular edema in 15 of 20 patients with SSI (75%) and three of 42 patients without SSI (7%), and reader 2 detected superior capsular edema in 17 of 20 patients with SSI (85%) and 22 of 42 patients without SSI (52%) ( < .001 and = .02, respectively). Distal cam was a predictor of SSI after adjustment for IDFN. Interreader agreement was substantial for distal cam (κ = 0.80) and moderate for IDFN (κ = 0.50). Conclusion Soft-tissue injuries and osseous findings other than morphologic features of the anterior inferior iliac spine were associated with subspine impingement. © RSNA, 2019 See also the editorial by Guermazi in this issue.
背景 除了前下髂嵴（AIIS）的形态特征外，亚棘突撞击（SSI）的 MRI 表现尚未得到广泛探讨和验证。目的 确定与 SSI 相关的 MRI 表现，包括 AIIS 形态特征、股骨远端凸轮和相关的软组织损伤。材料与方法 这是一项回顾性研究，纳入了 2014 年 12 月至 2017 年 3 月期间因髋关节撞击综合征而行关节镜治疗的有症状患者，所有患者均在术前 6 个月内行 MRI 检查。SSI 组包括临床和术中发现有 SSI 的患者；其余患者为非 SSI 组。两名放射科医生对术前 MRI 结果进行独立评估，评估过程中他们对临床信息不知情。评估了两位读者之间的一致性，并进行了多变量逻辑回归分析。结果 共纳入 62 例患者（平均年龄±标准差，42.1 岁±11.9；38 例女性）。62 例患者中，20 例（32%）诊断为 SSI（平均年龄，43 岁±12）；42 例（68%）无 SSI（平均年龄，41 岁±10）。读者 1 在 20 例 SSI 患者中检测到 16 例（80%）和 42 例非 SSI 患者中的 8 例（19%）有远端凸轮，读者 2 在 20 例 SSI 患者中检测到 15 例（75%）和 42 例非 SSI 患者中的 8 例（19%）有远端凸轮（均<.001）。读者 1 在 20 例 SSI 患者中检测到 18 例（90%）和 42 例非 SSI 患者中的 7 例（16%）有股骨颈远端撞击征（IDFN）的征象，读者 2 在 20 例 SSI 患者中检测到 13 例（65%）和 42 例非 SSI 患者中的 9 例（21%）有 IDFN 的征象（均<.001 和 =.001）。读者 1 在 20 例 SSI 患者中检测到 15 例（75%）有上囊水肿，而在 42 例非 SSI 患者中检测到 3 例（7%），读者 2 在 20 例 SSI 患者中检测到 17 例（85%）和 42 例非 SSI 患者中的 22 例（52%）有上囊水肿（均<.001 和 =.02）。调整 IDFN 后，远端凸轮是 SSI 的预测因素。读者之间在远端凸轮（κ=0.80）和 IDFN（κ=0.50）的一致性为高度一致。结论 除了前下髂嵴的形态特征外，亚棘突撞击还与软组织损伤和骨病变有关。
