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Value of response to anesthetic injection during hip MR arthrography to differentiate between intra- and extra-articular pathology

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Abstract

Purpose

To determine the value of anesthetic injection during hip MR arthrography (anesthetic MRA) to differentiate between intra- and extra-articular pathology in patients with hip pain.

Materials and methods

This retrospective study was IRB-approved and HIPAA-compliant. We included 75 consecutive adult patients (46 women, mean age 38 ± 13 years) who were referred for MRA. All patients underwent a focused hip examination including active flexion, passive flexion, and passive flexion with internal and external rotation, immediately prior to injection. Anesthetic MRA was performed following fluoroscopically guided intra-articular injection of contrast mixed with anesthetic. Following the injection, the hip examination was repeated, and the pain response was recorded. Clinical records, including response to corticosteroid injections, physical therapy notes, and operative reports were reviewed for verification of intra- and extra-articular pathology as the source of hip pain (gold standard). The positive (PPV) and negative predictive values (NPP) of anesthetic MRA to differentiate between intra- and extra-articular pathology were calculated.

Results

On MRI, 41 patients had only intra-articular and 5 patients only extra-articular pathology, while 29 patients had both, intra- and extra-articular pathology. Forty-three patients had pain relief and 32 patients had no pain relief after anesthetic injection. PPV of anesthetic MRA to detect intra-articular pathology was 91% and NPV was 67%.

Conclusion

Anesthetic MRA can be used as an adjunct to define the origin of hip pain. A positive response suggests intra-articular pathology which can be helpful to localize the source of pain in equivocal cases where both intra- and extra-articular pathology are evident on MRI.

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Funding

This study was supported by NIH grant K24 DK-109940.

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Authors and Affiliations

  1. Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA

    Arvin B. Kheterpal, Katherine M. Bunnell, Jad S. Husseini, Connie Y. Chang & Miriam A. Bredella

  2. Sports Medicine, Department of Orthopedic Surgery, Massachusetts General Hospital and Harvard Medical School, 175 Cambridge Street, Boston, MA, 02114, USA

    Scott D. Martin

  3. Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Thomas Jefferson University Hospitals, Sidney Kimmel Medical College at Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA, 19107, USA

    Adam C. Zoga

Authors
  1. Arvin B. Kheterpal
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  2. Katherine M. Bunnell
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  3. Jad S. Husseini
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  4. Connie Y. Chang
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  5. Scott D. Martin
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  6. Adam C. Zoga
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  7. Miriam A. Bredella
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Corresponding author

Correspondence to Miriam A. Bredella.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was waived for this retrospective study.

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This study [Bredella M, Zoga A, Vicentini JT, Torriani M, Kheterpal A. Value of response to anesthetic injection during hip MR arthrography to differentiate between intra- and extra-articular pathology. Skelet Radiol. 2019 Mar;48(3):488] was presented at the Annual Meeting of the Society of Skeletal Radiology in Scottsdale, AZ.

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Kheterpal, A.B., Bunnell, K.M., Husseini, J.S. et al. Value of response to anesthetic injection during hip MR arthrography to differentiate between intra- and extra-articular pathology. Skeletal Radiol 49, 555–561 (2020). https://doi.org/10.1007/s00256-019-03323-9

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  • DOI: https://doi.org/10.1007/s00256-019-03323-9

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