Abstract:
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Purpose: To evaluate gadolinium enhanced MR imaging in athletes with chronic groin pain and correlate with clinical features.
Methods and Materials: MR examinations performed in 52 athletes (51 male, 1 female, median age 26) for chronic athletic groin pain were independently reviewed by two musculoskeletal radiologists blinded to clinical details. All imaging was performed on a 1.5T magnet using a protocol involving pre and post gadolinium sequences. Symptom duration (median 6 months) and clinical side of severity were recorded (right (n=16), left (n=9), right equal left (n=9), right greater than left (n=16), left greater than right (n=2)). Initially without post gadolinium sequences and then, three weeks later (median 29 days), the post gadolinium sequences only were scored for abnormality (normal, mildly abnormal or abnormal)in a number of anatomical areas and an overall assessment for side distribution of abnormality was made (using the same method as clinical side of severity). Specific areas assessed included the symphysis pubis, adductor group (muscles/tendons/enthesis), inguinal canals and abdominal wall muscles. Correlation between radiological and clinical abnormality was calculated by Spearman's correlation. Agreement for scoring abnormality and side distribution was assessed by Kappa analysis.
Results: Anterior pubis and enthesis enhancement significantly correlated with clinical side for both radiologists (both p=0.008). Anterior pubis, adductor longus enthesis and tendon edema significantly correlated with clinical side for one radiologist (p=0.009). All other features showed no significant correlation (p>0.05). For both radiologists assessment of side severity significantly correlated with clinical side for post gadolinium (p=0.048 and p=0.023) but not for non gadolinium sequences (p>0.05). Agreement for scoring individual sites was poor to moderate for non gadolinium (k=0.2-0.5) and fair to moderate for gadolinium sequences (k=0.22-0.51). When mildly abnormal changes were classified with normal this changed to fair to good for non gadolinium (k=0.28-0.67) and moderate to good for gadolinium sequences (k=0.44-0.67). Agreement for radiological side of severity was moderate (non gadolinium k=0.48, gadolinium k=0.41). This changed to good (non gadolinium k=0.75, gadolinium k=0.74) when agreement was allowed for plus or minus one level of side severity.
Conclusion: Anterior pubis and adductor longus enthesis abnormalities on MR imaging significantly correlate with athletes' symptoms.
Questions about this event email: p.robinson@leedsth.nhs.uk
Robinson MBChB, P,
Adductor related Groin Pain in Athletes: Correlation of MR Imaging Features with Clinical Findings. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3100228.html
