Institute of Diagnostic and Interventional Radiology, Paediatric and Neuroradiology, University Medicine Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
Department of Orthopaedics, Rostock University Medical Center, Doberanerstr. 142, 18057, Rostock, Germany.
Eur Radiol. 2023 Oct;33(10):7321-7329. doi: 10.1007/s00330-023-09666-1. Epub 2023 May 5.
To compare dedicated MRI with targeted fluoroscopic guided symphyseal contrast agent injection regarding the assessment of symphyseal cleft signs in men with athletic groin pain and assessment of radiographic pelvic ring instability.
Sixty-six athletic men were prospectively included after an initial clinical examination by an experienced surgeon using a standardized procedure. Diagnostic fluoroscopic symphyseal injection of a contrast agent was performed. Additionally, standing single-leg stance radiography and dedicated 3-Tesla MRI protocol were employed. The presence of cleft injuries (superior, secondary, combined, atypical) and osteitis pubis was recorded.
Symphyseal bone marrow edema (BME) was present in 50 patients, bilaterally in 41 patients and in 28 with an asymmetrical distribution. Comparison of MRI and symphysography was as followed: no clefts: 14 cases (MRI) vs. 24 cases (symphysography), isolated superior cleft sign: 13 vs. 10, isolated secondary cleft sign: 15 vs. 21 cases and combined injuries: 18 vs. 11 cases. In 7 cases a combined cleft sign was observed in MRI but only an isolated secondary cleft sign was visible in symphysography. Anterior pelvic ring instability was observed in 25 patients and was linked to a cleft sign in 23 cases (7 superior cleft sign, 8 secondary cleft signs, 6 combined clefts, 2 atypical cleft injuries). Additional BME could be diagnosed in 18 of those 23.
Dedicated 3-Tesla MRI outmatches symphysography for purely diagnostic purposes of cleft injuries. Microtearing at the prepubic aponeurotic complex and the presence of BME is a prerequisite for the development of anterior pelvic ring instability.
For diagnostic of symphyseal cleft injuries dedicated 3-T MRI protocols outmatch fluoroscopic symphysography. Prior specific clinical examination is highly beneficial and additional flamingo view x-rays are recommended for assessment of pelvic ring instability in these patients.
• Assessment of symphyseal cleft injuries is more accurate by use of dedicated MRI as compared to fluoroscopic symphysography. • Additional fluoroscopy may be important for therapeutic injections. • The presence of cleft injury might be a prerequisite for the development of pelvic ring instability.
比较专用 MRI 与靶向荧光引导耻骨联合对比剂注射在评估运动性腹股沟疼痛男性的耻骨联合裂隙征和评估放射性骨盆环不稳定方面的作用。
66 名运动男性患者在经验丰富的外科医生进行初始临床检查后，采用标准化程序前瞻性纳入研究。进行诊断性荧光耻骨联合对比剂注射。此外，还进行了站立单腿位 X 线摄影和专用 3-Tesla MRI 检查。记录裂隙损伤（上型、二级、混合型、非典型型）和耻骨炎的存在情况。
50 例患者存在耻骨骨髓水肿（BME），41 例患者双侧存在，28 例患者存在不对称分布。MRI 和耻骨造影的比较结果如下：无裂隙：14 例（MRI）与 24 例（耻骨造影），孤立的上型裂隙征：13 例与 10 例，孤立的二级裂隙征：15 例与 21 例，混合型损伤：18 例与 11 例。7 例患者在 MRI 中观察到混合型裂隙征，但在耻骨造影中仅观察到孤立的二级裂隙征。25 例患者存在前骨盆环不稳定，其中 23 例与裂隙征相关（7 例上型裂隙征，8 例二级裂隙征，6 例混合型裂隙征，2 例非典型裂隙损伤）。在这 23 例中，18 例还可诊断出额外的 BME。
专用 3-Tesla MRI 在纯粹的诊断目的上优于荧光耻骨造影，耻骨前腱膜复合结构的微撕裂和 BME 的存在是前骨盆环不稳定发展的前提。
对于耻骨联合裂隙损伤的诊断，专用 3-T MRI 方案优于荧光耻骨造影。在这些患者中，进行特定的临床检查非常有益，并建议加做 Flamingo 位 X 线片以评估骨盆环的稳定性。
与荧光耻骨造影相比，专用 MRI 评估耻骨联合裂隙损伤更准确。
额外的荧光透视可能对治疗性注射很重要。
裂隙损伤的存在可能是骨盆环不稳定发展的前提。
