Weber Marc-André
Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland.
Radiologie (Heidelb). 2023 Apr;63(4):268-274. doi: 10.1007/s00117-023-01117-8. Epub 2023 Jan 30.
CLINICAL/METHODICAL ISSUE: Groin pain in athletes can have various causes. Radiologically, osteitis pubis and clefts with affection of the interpubic disc as well as muscle and tendon tears near the pubic bone can be clearly identified.
Magnetic resonance imaging (MRI) is the imaging modality of choice, as well as single-leg stand imaging (flamingo view radiographs), and where appropriate symphysography.
Optimized MRI sequence protocol with oblique (axial oblique) slices parallel to the linea arcuata of the iliac bone is recommended. High-resolution MRI sequences and symphysography can detect superior and secondary cleft formation. Instabilities of the pubic symphysis can be diagnosed using flamingo view radiographs.
The MRI findings of osteitis pubis and clinical symptoms correlate. The presence of parasymphyseal bone marrow edema is the earliest morphological sign of acute osteitis pubis on MR imaging. Edema in the periosteal tissue and isolated muscle lesions next to the symphysis are generally associated with more severe clinical symptoms.
Close communication between radiologists and the referring physicians is indispensable when planning an adequate imaging protocol, and precise knowledge of the clinical symptoms in the case of clinical suspicion of osteitis pubis allows for a reliable diagnosis and provides important prognostic information.
临床/方法学问题：运动员腹股沟疼痛可能有多种原因。在放射学上，耻骨炎、累及耻骨间盘的耻骨联合分离以及耻骨附近的肌肉和肌腱撕裂均可清晰识别。
磁共振成像（MRI）是首选的成像方式，还有单腿站立成像（“火烈鸟”位X线片），以及在适当情况下的耻骨联合造影。
建议采用优化的MRI序列方案，即使用与髂骨弓状线平行的斜（轴向斜）层面。高分辨率MRI序列和耻骨联合造影可检测耻骨联合上方及继发性分离的形成情况。耻骨联合不稳定可通过“火烈鸟”位X线片诊断。
耻骨炎的MRI表现与临床症状相关。耻骨联合旁骨髓水肿是急性耻骨炎在磁共振成像上最早的形态学表现。耻骨联合周围骨膜组织水肿和孤立的肌肉损伤通常与更严重的临床症状相关。
在制定合适的成像方案时，放射科医生与转诊医生之间的密切沟通必不可少，而且在临床怀疑耻骨炎时，对临床症状的精确了解有助于做出可靠诊断并提供重要的预后信息。
