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Validation of scoring hip osteoarthritis with MRI (SHOMRI) scores using hip arthroscopy as a standard of reference

  • Jan Neumann
  • Alan L. Zhang
  • Benedikt J. Schwaiger
  • Michael A. Samaan
  • Richard Souza
  • Sarah C. Foreman
  • Gabby B. Joseph
  • Trevor Grace
  • Sharmila Majumdar
  • Thomas M. Link
Musculoskeletal

Abstract

Purpose

To validate SHOMRI gradings in preoperative hip magnetic resonance imaging (MRI) with intra-arthroscopic evaluation of intraarticular hip abnormalities.

Methods

Preoperative non-arthrographic 3.0-T MRIs of 40 hips in 39 patients (1 patient with bilateral hip surgery) with femoroacetabular impingement (FAI) syndrome (mean age, 34.7 years ± 9.0; n = 16 females), refractory to conservative measures, that underwent hip arthroscopy were retrospectively assessed by two radiologists for chondrolabral abnormalities and compared with intra-arthroscopic findings as the standard of reference. Arthroscopically accessible regions were compared with the corresponding SHOMRI subregions and assessed for the presence and grade of cartilaginous pathologies in the acetabulum and femoral head. The acetabular labrum was assessed for the presence or absence of labral tears. For the statistical analysis sensitivity and specificity as well as intraclass correlation (ICC) for interobserver agreement were calculated.

Results

Regarding chondral abnormalities, 58.8% of the surgical cases showed chondral defects. SHOMRI scoring showed a sensitivity of 95.7% and specificity of 84.8% in detecting cartilage lesions. Moreover, all cases with full-thickness defects (n = 9) were identified correctly, and in n = 6 cases (out of n = 36 with partial-thickness defects) the defective cartilage was identified but the actual depth overestimated. Labral tears were present in all cases and the MR readers identified 92.5% correctly. ICC showed a good interobserver agreement with 86.3% (95% CI 80.0, 90.6%)

Conclusion

Using arthroscopic correlation, SHOMRI grading of the hip proves to be a reliable and precise method to assess chondrolabral hip joint abnormalities.

Key Points

• Assessment of hip abnormalities using MRI with surgical correlation.

• Comparing surgery and MRI by creating a hybrid anatomic map that covers both modalities.

• Non-arthrographic use of 3.0-T MRI provides detailed information on cartilage and labral abnormalities in hip joints.

Keywords

Magnetic resonance imaging Evaluation studies Hip joint Arthroscopy Chondrolabral injuries 

Abbreviations

FAI

Femoroacetabular impingement

ICC

Intraclass correlation

MRI

Magnetic resonance imaging

NPV

Negative predictive value

OA

Osteoarthritis

PPV

Positive predictive value

SD

Standard deviation

SHOMRI

Scoring hip osteoarthritis with MRI

Notes

Funding

This study has received funding by the NIH/NIAMS (National Institute of Arthritis and Musculoskeletal and Skin Diseases) grants P50 AR060752, R01 AR069006 and F32 AR069458.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Prof. Thomas M. Link, MD, PhD, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• diagnostic study

• performed at one institution

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Jan Neumann
    • 1
  • Alan L. Zhang
    • 2
  • Benedikt J. Schwaiger
    • 1
    • 3
  • Michael A. Samaan
    • 1
  • Richard Souza
    • 1
    • 4
  • Sarah C. Foreman
    • 1
  • Gabby B. Joseph
    • 1
  • Trevor Grace
    • 2
  • Sharmila Majumdar
    • 1
  • Thomas M. Link
    • 1
  1. 1.Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical ImagingUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Department of Orthopedic SurgeryUniversity of CaliforniaSan FranciscoUSA
  3. 3.Department of Diagnostic and Interventional RadiologyTechnical University of MunichMunichGermany
  4. 4.Department of Physical Therapy & Rehabilitation ScienceUniversity of CaliforniaSan FranciscoUSA

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