The Copenhagen Standardised MRI protocol to assess the pubic symphysis and adductor regions of athletes: outline and intratester and intertester reliability

TY - JOUR

T1 - The Copenhagen Standardised MRI protocol to assess the pubic symphysis and adductor regions of athletes

T2 - outline and intratester and intertester reliability

AU - Branci, Sonia

AU - Thorborg, Kristian

AU - Bech, Birthe Højlund

AU - Boesen, Mikael

AU - Magnussen, Erland

AU - Court-Payen, Michel

AU - Nielsen, Michael Bachmann

AU - Hölmich, Per

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

PY - 2015/5/1

Y1 - 2015/5/1

N2 - BACKGROUND: There is currently no standardised MRI evaluation protocol for athletes who present with symptoms that may relate to the pubic symphysis, the pubic bones, and the adductor muscle insertions. We outline the protocol and reliability data.MATERIAL AND METHODS: Three musculoskeletal radiologists developed an 11-element MRI evaluation protocol defined according to precise criteria and illustrated in a pictorial atlas. Eighty-six male athletes (soccer players and non-soccer players) underwent standardised 3 Tesla MRI of the pelvis. Two external musculoskeletal radiologists were trained to use the protocol and pictorial atlas during two sessions of 2-4 h each. Each radiologist rated all 86 MRI independently. One radiologist evaluated the scans once, the other twice 2 months apart. Cohen κ statistics were used to determine intraobserver and interobserver agreement.RESULTS: The main findings were (1) substantial intraobserver (κ range 0.65-0.67) and moderate interobserver (κ range 0.45-0.52) agreement in rating pubic bone marrow oedema, (2) substantial to moderate intraobserver (κ range 0.49-0.72) and moderate-to-fair interobserver (κ range 0.21-0.52) agreement in rating most other MRI findings, (3) slight intraobserver and interobserver (κ range -0.06-0.05) agreement in rating adductor longus tendinopathy.CONCLUSIONS: The Copenhagen Standardised MRI protocol demonstrated moderate-to-substantial reliability in rating bone marrow oedema, and varied from fair-to-substantial agreement for the majority of MRI features, but showed only slight agreement in rating adductor longus tendinopathy. This rigorous investigation also confirms that while MRI evaluation seems to provide reasonable reliability in rating pubic bone marrow oedema, the evaluation of adductor tendinopathy in a clinical and research setting needs further resolution by continued development and testing of MRI acquisition protocols.

AB - BACKGROUND: There is currently no standardised MRI evaluation protocol for athletes who present with symptoms that may relate to the pubic symphysis, the pubic bones, and the adductor muscle insertions. We outline the protocol and reliability data.MATERIAL AND METHODS: Three musculoskeletal radiologists developed an 11-element MRI evaluation protocol defined according to precise criteria and illustrated in a pictorial atlas. Eighty-six male athletes (soccer players and non-soccer players) underwent standardised 3 Tesla MRI of the pelvis. Two external musculoskeletal radiologists were trained to use the protocol and pictorial atlas during two sessions of 2-4 h each. Each radiologist rated all 86 MRI independently. One radiologist evaluated the scans once, the other twice 2 months apart. Cohen κ statistics were used to determine intraobserver and interobserver agreement.RESULTS: The main findings were (1) substantial intraobserver (κ range 0.65-0.67) and moderate interobserver (κ range 0.45-0.52) agreement in rating pubic bone marrow oedema, (2) substantial to moderate intraobserver (κ range 0.49-0.72) and moderate-to-fair interobserver (κ range 0.21-0.52) agreement in rating most other MRI findings, (3) slight intraobserver and interobserver (κ range -0.06-0.05) agreement in rating adductor longus tendinopathy.CONCLUSIONS: The Copenhagen Standardised MRI protocol demonstrated moderate-to-substantial reliability in rating bone marrow oedema, and varied from fair-to-substantial agreement for the majority of MRI features, but showed only slight agreement in rating adductor longus tendinopathy. This rigorous investigation also confirms that while MRI evaluation seems to provide reasonable reliability in rating pubic bone marrow oedema, the evaluation of adductor tendinopathy in a clinical and research setting needs further resolution by continued development and testing of MRI acquisition protocols.

KW - Adolescent

KW - Adult

KW - Bone Marrow Diseases

KW - Clinical Protocols

KW - Edema

KW - Groin

KW - Hip

KW - Humans

KW - Joint Diseases

KW - Magnetic Resonance Imaging

KW - Male

KW - Musculoskeletal Pain

KW - Observer Variation

KW - Pubic Symphysis

KW - Soccer

KW - Sports Medicine

KW - Tendinopathy

KW - Young Adult

U2 - 10.1136/bjsports-2014-094239

DO - 10.1136/bjsports-2014-094239

M3 - Journal article

C2 - 25488954

SN - 0306-3674

VL - 49

SP - 692

EP - 699

JO - British Journal of Sports Medicine

JF - British Journal of Sports Medicine

IS - 10

ER -