Jardon Meghan, Burke Christopher, Li Zachary, Lin Charles, Li Xiaochun, Goldberg Judith D, Youm Thomas, Samim Mohammad
Department of Radiology, NYU Langone Health, 660 First Ave, 3rd Fl, New York, NY, 10016, USA.
Department of Orthopedic Surgery, NYU Langone Health, 333 East 38 th Street, New York, NY, 10016, USA.
Skeletal Radiol. 2025 May 1. doi: 10.1007/s00256-025-04939-w.
To assess the correlation of pre-operative symptoms, pre-operative diagnostic imaging for cartilage loss, and intra-operative cartilage findings in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome.
Three radiologists performed retrospective independent reviews of pre-operative MRIs in 96 hips for acetabular/femoral cartilage loss utilizing a simplified "high-low" classification and the International Cartilage Repair Society grading system. Severity of supra-foveal central femoral head cartilage loss was separately noted. Pre-operative radiographs were graded using the Tonnis and Kellgren-Lawrence systems and for central joint space narrowing. Pre-operative patient symptoms were prospectively gathered utilizing the Nonarthritic Hip Score and the modified Harris Hip Score. Intra-operatively, cartilage loss was recorded using the Outerbridge system.
A moderate-to-strong positive correlation between pre-operative radiographic and MR cartilage loss was observed (0.21 Τ 0.53, T = Kendall's tau) for all readers/scales. Weak-to-moderate positive correlation was found between intra-operative cartilage grading and radiographic grading (0.10 Τ 0.30). Weak-to-moderate positive correlation between MRI and intra-operative cartilage grading was found for all readers/grading systems (0.17 Τ 0.43). Cartilage defects were slightly under-reported on MRI, reaching statistical significance at the femoral head. There was moderate-to-strong positive correlation between radiographic central joint narrowing and MRI central femoral head cartilage loss (0.35 Τ 0.55) for all readers. Inter-reader reliability was fair-to-moderate for radiographs, but poor for MRI. Clinical scores demonstrated very weak negative to no correlation with radiographic/MR cartilage findings and weak positive correlation with intra-operative cartilage findings.
Despite MRI underestimation of cartilage loss, the very weak-to-weak correlation of clinical symptoms with pre-operative imaging and intra-operative findings emphasizes the importance of MRI in pre-operative evaluation.
评估因股骨髋臼撞击综合征接受髋关节镜手术患者的术前症状、术前软骨损伤诊断性影像学检查结果与术中软骨检查结果之间的相关性。
三位放射科医生对96例髋关节的术前MRI进行回顾性独立评估，采用简化的“高-低”分类法和国际软骨修复协会分级系统评估髋臼/股骨软骨损伤情况。分别记录中央股骨头凹上方软骨损伤的严重程度。术前X线片采用托尼斯（Tonnis）和凯尔格伦-劳伦斯（Kellgren-Lawrence）系统进行分级，并评估中央关节间隙变窄情况。术前患者症状采用非关节炎性髋关节评分和改良哈里斯髋关节评分进行前瞻性收集。术中采用奥尔特布里奇（Outerbridge）系统记录软骨损伤情况。
所有读者/评分标准下，术前X线片和MRI软骨损伤之间均观察到中度至强正相关（0.21 ≤ τ ≤ 0.53，τ = 肯德尔等级相关系数）。术中软骨分级与X线片分级之间存在弱至中度正相关（系数为0.10至0.30）；所有读者/分级系统下，MRI与术中软骨分级之间存在弱至中度正相关（0.17 ≤ τ ≤ 0.43）。MRI对软骨缺损的报告略有不足，在股骨头处具有统计学意义。所有读者中，X线片中央关节狭窄与MRI中央股骨头软骨损伤之间存在中度至强正相关（0.35 ≤ τ ≤ 0.55）。读者间对X线片的可靠性评估为中等，对MRI的评估较差。临床评分与X线片/MR软骨检查结果之间的相关性非常弱至无相关性，与术中软骨检查结果之间存在弱正相关。
尽管MRI对软骨损伤存在低估，但临床症状与术前影像学检查及术中检查结果之间的相关性非常弱至弱，这强调了MRI在术前评估中的重要性。
