European Radiology

, Volume 27, Issue 4, pp 1486–1495 | Cite as

Reliability of MRI assessment of acute musculotendinous groin injuries in athletes

  • Andreas SernerEmail author
  • Frank W. Roemer
  • Per Hölmich
  • Kristian Thorborg
  • Jingbo Niu
  • Adam Weir
  • Johannes L. Tol
  • Ali Guermazi



To describe a multi-dimensional MRI assessment approach with a focus on acute musculotendinous groin lesions, and to evaluate scoring reproducibility.


Male athletes who participated in competitive sports and presented within 7 days of an acute onset of sports-related groin pain were included. All athletes underwent MRI (1.5 T) according to a standardized groin-centred protocol. From several calibration sessions, a system was developed assessing grade, location and extent of muscle strains, peri-lesional haematoma, as well as other non-acute findings commonly associated with long-standing groin pain. Kappa (K) statistics and intraclass correlation coefficients (ICCs) were used to describe intra- and inter-rater reproducibility.


Seventy-five athletes (mean age 26.6 ± 4.4 years) were included in the analyses, and 85 different acute lesions were observed. Adductor longus lesions were most common (42.7 %) followed by rectus femoris lesions (16.3 %). Kappa values ranged between 0.70 and 1.00 for almost all categorical features for acute lesions, with almost perfect intra- and inter-rater agreement (K = 0.89-1.00) for presence, number, location and grading of lesions. ICCs ranged between 0.77 and 1.00 for continuous measures of acute lesion extent.


A standardized MRI assessment approach of acute groin injuries was described and showed good intra- and inter-rater reproducibility.

Key Points

• A multidimensional MRI assessment approach for acute groin injuries was described.

• Standardized MRI assessment of acute musculotendinous groin injuries has high reproducibility.

• Injury location and injury extent can be scored reliably using 1.5 T MRI.


Muscle injury Adductor MSK imaging Radiology Reproducibility 

Abbreviations and acronyms


Cross-sectional area


Field of view


Intraclass correlation coefficient


Institutional Review Board


Magnetic resonance imaging




Echo time


Repetition time



The scientific guarantor of this publication is Andreas Serner. 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. The authors state that this work has not received any funding.

Outside this work, Dr. Guermazi has received consultancies, speaking fees and/or honoraria from Sanofi-Aventis, Merck Serono and TissuGene and is President and shareholder of Boston Imaging Core Lab (BICL), LLC a company providing image assessment services. Dr. Roemer is Chief Medical Officer and shareholder of BICL, LLC. None of the other authors have declared any competing interests. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study.

Some study subjects or cohorts have been previously reported in: Serner A, Tol JL, Jomaah N, et al. (2015) Diagnosis of Acute Groin Injuries: A Prospective Study of 110 Athletes. Am J Sports Med 0363546515585123. doi:  10.1177/0363546515585123. Methodology: prospective, cross-sectional study, performed at one institution.

Supplementary material

330_2016_4487_MOESM1_ESM.doc (39 kb)
ESM 1 (DOC 41 kb)
330_2016_4487_MOESM2_ESM.docx (21 kb)
ESM 2 (DOCX 25 kb)
330_2016_4487_MOESM3_ESM.docx (163 kb)
ESM 3 (DOCX 163 kb)


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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Andreas Serner
    • 1
    • 2
    Email author
  • Frank W. Roemer
    • 3
    • 4
  • Per Hölmich
    • 1
    • 2
  • Kristian Thorborg
    • 2
  • Jingbo Niu
    • 5
  • Adam Weir
    • 1
  • Johannes L. Tol
    • 1
    • 6
    • 7
  • Ali Guermazi
    • 4
  1. 1.Aspetar, Orthopaedic and Sports Medicine HospitalDohaQatar
  2. 2.Sports Orthopaedic Research Center–Copenhagen (SORC-C), Department of Orthopedic SurgeryCopenhagen University HospitalAmager-HvidovreDenmark
  3. 3.Department of RadiologyUniversity of Erlangen-NurembergErlangenGermany
  4. 4.Quantitative Imaging Center (QIC), Department of RadiologyBoston University School of MedicineBostonUSA
  5. 5.Clinical Epidemiology and Training Unit, Department of MedicineBoston University School of MedicineBostonUSA
  6. 6.The Sports Physician Group, Department of Sports MedicineOLVG WestAmsterdamThe Netherlands
  7. 7.Amsterdam Center of Evidence Based Sports MedicineAcademic Medical CenterAmsterdamThe Netherlands

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