Comparison between dedicated MRI and symphyseal fluoroscopic guided contrast agent injection in the diagnosis of cleft sign in athletic groin pain and association with pelvic ring instability.
Eur Radiol
; 33(10): 7321-7329, 2023 Oct.
Article
in En
| MEDLINE
| ID: mdl-37145146
ABSTRACT
OBJECTIVE:
To compare dedicated MRI with targeted fluoroscopic guided symphyseal contrast agent injection regarding the assessment of symphyseal cleft signs in men with athletic groin pain and assessment of radiographic pelvic ring instability.METHODS:
Sixty-six athletic men were prospectively included after an initial clinical examination by an experienced surgeon using a standardized procedure. Diagnostic fluoroscopic symphyseal injection of a contrast agent was performed. Additionally, standing single-leg stance radiography and dedicated 3-Tesla MRI protocol were employed. The presence of cleft injuries (superior, secondary, combined, atypical) and osteitis pubis was recorded.RESULTS:
Symphyseal bone marrow edema (BME) was present in 50 patients, bilaterally in 41 patients and in 28 with an asymmetrical distribution. Comparison of MRI and symphysography was as followed no clefts 14 cases (MRI) vs. 24 cases (symphysography), isolated superior cleft sign 13 vs. 10, isolated secondary cleft sign 15 vs. 21 cases and combined injuries 18 vs. 11 cases. In 7 cases a combined cleft sign was observed in MRI but only an isolated secondary cleft sign was visible in symphysography. Anterior pelvic ring instability was observed in 25 patients and was linked to a cleft sign in 23 cases (7 superior cleft sign, 8 secondary cleft signs, 6 combined clefts, 2 atypical cleft injuries). Additional BME could be diagnosed in 18 of those 23.CONCLUSION:
Dedicated 3-Tesla MRI outmatches symphysography for purely diagnostic purposes of cleft injuries. Microtearing at the prepubic aponeurotic complex and the presence of BME is a prerequisite for the development of anterior pelvic ring instability. CLINICAL RELEVANCE STATEMENT For diagnostic of symphyseal cleft injuries dedicated 3-T MRI protocols outmatch fluoroscopic symphysography. Prior specific clinical examination is highly beneficial and additional flamingo view x-rays are recommended for assessment of pelvic ring instability in these patients. KEY POINTS ⢠Assessment of symphyseal cleft injuries is more accurate by use of dedicated MRI as compared to fluoroscopic symphysography. ⢠Additional fluoroscopy may be important for therapeutic injections. ⢠The presence of cleft injury might be a prerequisite for the development of pelvic ring instability.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Pubic Symphysis
/
Athletic Injuries
/
Sports
Type of study:
Diagnostic_studies
/
Guideline
/
Risk_factors_studies
Limits:
Humans
/
Male
Language:
En
Journal:
Eur Radiol
Journal subject:
RADIOLOGIA
Year:
2023
Document type:
Article
Affiliation country: