Abstract
BackgroundSeveral types of Magnetic resonance imaging (MRI) are commonly used in imaging of femoroacetabular impingement (FAI), however till now there are no clear protocols and recommendations for each type. The aim of this meta-analysis is to detect the accuracy of conventional magnetic resonance imaging (cMRI), direct magnetic resonance arthrography (dMRA) and indirect magnetic resonance arthrography (iMRA) in the diagnosis of chondral and labral lesions in femoroacetabular impingement (FAI).MethodsA literature search was finalized on the 17th of May 2016 to collect all studies identifying the accuracy of cMRI, dMRA and iMRA in diagnosing chondral and labral lesions associated with FAI using surgical results (arthroscopic or open) as a reference test. Pooled sensitivity and specificity with 95% confidence intervals using a random-effects meta-analysis for MRI, dMRA and iMRA were calculated also area under receiver operating characteristic (ROC) curve (AUC) was retrieved whenever possible where AUC is equivocal to diagnostic accuracy.ResultsThe search yielded 192 publications which were reviewed according inclusion and exclusion criteria then 21 studies fulfilled the eligibility criteria for the qualitative analysis with a total number of 828 cases, lastly 12 studies were included in the quantitative meta-analysis.Meta-analysis showed that as regard labral lesions the pooled sensitivity, specificity and AUC for cMRI were 0.864, 0.833 and 0.88 and for dMRA were 0.91, 0.58 and 0.92. While in chondral lesions the pooled sensitivity, specificity and AUC for cMRI were 0.76, 0.72 and 0.75 and for dMRA were 0.75, 0.79 and 0.83, while for iMRA were sensitivity of 0.722 and specificity of 0.917.ConclusionsThe present meta-analysis showed that the diagnostic test accuracy was superior for dMRA when compared with cMRI for detection of labral and chondral lesions.The diagnostic test accuracy was superior for labral lesions when compared with chondral lesions in both cMRI and dMRA. Promising results are obtained concerning iMRA but further studies still needed to fully assess its diagnostic accuracy.
Highlights
Several types of Magnetic resonance imaging (MRI) are commonly used in imaging of femoroacetabular impingement (FAI), till there are no clear protocols and recommendations for each type
About 6 years ago Smith et al [18, 19] did their search for review metaanalysis; we reviewed the current evidence about the accuracy of conventional MRI, direct magnetic resonance arthrography (dMRA) and indirect magnetic resonance arthrography (iMRA) in the detection of chondral and labral lesions in FAI
To decrease heterogeneity of data, another 4 studies were excluded because it wasn’t suitable to pool their results with another studies, one study didn’t show the used magnetic resonance (MR) field-strength [17], another study used MR field-strength scanner 1 T [15] and two studies used MR field-strength scanner 3 T (Fig. 1)
Summary
Several types of Magnetic resonance imaging (MRI) are commonly used in imaging of femoroacetabular impingement (FAI), till there are no clear protocols and recommendations for each type. The condition shows pathological repetitive impingement of the surrounding soft tissue structures mostly in the labrum and the adjacent cartilage leading to their damage and appearance of pain. It has been associated both with specific morphotypes as well as with extreme/repetitive motion (e.g. kickboxing and soccer) [2–4]. The second is pincer type morphology which is characterized by anterior over coverage of the acetabulum (including coxa profunda, acetabular retroversion, and lateral rim lesions). Most symptomatic hips have been reported as mixed morphology and both femoral (cam) and acetabular (pincer) factors are present [1, 2, 5]
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