Şirolu Sabri, Hamid Rauf, Arman Gökçe Merve, Karagöz Seyfullah Halit, Salt Vefa, Alçiçek Merve Nur, Akgün Kenan, Kalyoncu Uçar Ayşe, Adaletli İbrahim
University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Radiology Clinic, Istanbul, Turkey.
Radiology Department, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Medicine (Baltimore). 2024 Dec 13;103(50):e38622. doi: 10.1097/MD.0000000000038622.
Greater trochanteric pain syndrome (GTPS) is a common cause of hip pain and is often associated with chronic lower back pain and lower extremity osteoarthritis. Its diagnosis is clinical; however, imaging has been shown to aid in the differential diagnosis of challenging cases. Superb microvascular imaging (SMI) is a new technique that may be more effective than power Doppler ultrasonography (PDUS) in the detection of inflammation-related vascularity in patients. In this study, we aimed to compare the diagnostic accuracies of SMI and PDUS in patients with GTPS and evaluate the usefulness of these techniques in clinical practice. We recruited 37 GTPS patients and 15 healthy volunteers for participation in this study. PDUS and SMI examinations were performed and we retrospectively reviewed the magnetic resonance imaging scans for tendinosis, tears, and edema. The PDUS and SMI were positive in 19 and 31 hips, respectively. Both techniques had low sensitivity but high specificity and positive predictive values, with SMI being slightly better. PDUS and SMI had accuracies of 75% and 82.7%, respectively, with a grade 1 vascularization threshold. Moreover, magnetic resonance imaging detected peritendinous edema with an accuracy of 60.5%, including tendinosis and partial tears but not complete tendon tears. Our study showed that PDUS is an underutilized modality in the diagnosis of GTPS and that SMI may further improve diagnostic accuracy. However, the low sensitivity of both techniques suggests that a clinical diagnosis remains essential.
大转子疼痛综合征（GTPS）是髋部疼痛的常见原因，常与慢性下背痛和下肢骨关节炎相关。其诊断依靠临床症状；然而，影像学检查已被证明有助于疑难病例的鉴别诊断。超微血管成像（SMI）是一种新技术，在检测患者炎症相关血管方面可能比能量多普勒超声（PDUS）更有效。在本研究中，我们旨在比较SMI和PDUS对GTPS患者的诊断准确性，并评估这些技术在临床实践中的实用性。我们招募了37例GTPS患者和15名健康志愿者参与本研究。进行了PDUS和SMI检查，并回顾性分析了磁共振成像扫描结果，以评估肌腱病、撕裂和水肿情况。PDUS和SMI检查分别在19个和31个髋关节中呈阳性。两种技术的敏感性均较低，但特异性和阳性预测值较高，SMI略优。在设定1级血管化阈值时，PDUS和SMI的诊断准确率分别为75%和82.7%。此外，磁共振成像检测肌腱周围水肿的准确率为60.5%，包括肌腱病和部分撕裂，但不包括完全性肌腱撕裂。我们的研究表明，PDUS在GTPS诊断中未得到充分利用，而SMI可能进一步提高诊断准确性。然而，两种技术的低敏感性表明临床诊断仍然至关重要。
