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Image quality of hip MR arthrography with intra-articular injection of hyaluronic acid versus gadolinium-based contrast agent in patients with femoroacetabular impingement

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Abstract

Objective

To compare image quality of magnetic resonance arthrography (MRA) of the hip with intra-articular injection of high-viscosity hyaluronic acid (HA-MRA) versus Gd-based contrast agent (Gd-MRA) in patients with femoroacetabular impingement (FAI).

Materials and methods

Design: single-centre, observational, retrospective, inter-individual, and cross-sectional. FAI patients who underwent HA-MRA (3 mL of high-viscosity HA plus 17 mL of saline) were compared with 37 age- and sex-matched FAI patients who underwent Gd-MRA (20 mL of 2 mmol/L solution of gadopentetate dimeglumine). Two independent blinded radiologists assessed image quality for all sequences (two-dimensional proton density, non-fat-sat axial, fat-sat coronal and sagittal; three-dimensional dual-echo steady state), using a 5-point Likert scale considering separately labrum, cartilage, round ligament, transverse ligament, and capsule. Pearson χ2 and Cohen κ were used.

Results

The HA-MRA group was composed of 37 patients (23 males, 14 females; median age 38 years), the Gd-MRA group of 37 patients (21 males, 16 females; median age 38 years), without significant difference for age (p = 0.937) and sex (p = 0.636). Image quality did not differ between the two readers for any structure: labrum (p ≥ 0.340), cartilage (p ≥ 0.198), round ligament (p ≥ 0.255), transverse ligament (p ≥ 0.806), and capsule (p ≥ 0.314). Inter-reader agreement (κ) ranged from 0.785 to 1.000.

Conclusions

HA-MRA provided an image quality not significantly different from that of Gd-MRA. This may open the possibility of combining MRA and viscosupplementation in one single procedure.

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Author notes

  1. Filippo Randelli and Elisabetta Antonia Nocerino contributed equally to this work.

Authors and Affiliations

  1. Hip Department and Trauma, I.R.C.C.S. Policlinico San Donato, Milan, Italy

    Filippo Randelli

  2. Unit of Radiology, IRCCS Policlinico San Donato, Milan, Italy

    Elisabetta Antonia Nocerino & Francesco Sardanelli

  3. Breast Radiology Unit, European Institute of Oncology, Milan, Italy

    Luca Nicosia

  4. Unit of Diagnostic Imaging and Stereotactic Radiosurgery, Centro Diagnostico Italiano, Milan, Italy

    Marco Alì

  5. Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy

    Caterina Beatrice Monti & Francesco Sardanelli

  6. Unit of Radiology, Clinical Institutes Zucchi, Monza, Monza Brianza, Italy

    Alberto Aliprandi

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Correspondence to Luca Nicosia.

Ethics declarations

The local Ethics Committee approved this observational retrospective cross-sectional single-centre study (Ethics Committee of Ospedale San Raffaele; protocol code ArtroRetro; approved on May 11, 2017). There was no overlap with subjects from previous research performed at our institution. This research received no specific grant from any funding body in the public, commercial, or non-profit sectors. Due to the retrospective nature of this study, informed consent was waived.

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Randelli, F., Nocerino, E.A., Nicosia, L. et al. Image quality of hip MR arthrography with intra-articular injection of hyaluronic acid versus gadolinium-based contrast agent in patients with femoroacetabular impingement. Skeletal Radiol 49, 937–944 (2020). https://doi.org/10.1007/s00256-019-03366-y

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