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

• Published in: Skeletal radiology 2020-04, Vol.49 (4), p.555-561
• Main Authors: Kheterpal, Arvin B., Bunnell, Katherine M., Husseini, Jad S., Chang, Connie Y., Martin, Scott D., Zoga, Adam C., Bredella, Miriam A.
• Format: Article
• Language: English
• Subjects: Adult; Anesthetics, Local - administration & dosage; Anesthetics, Local - therapeutic use; Arthrography - methods; Care and treatment; Cartilage Diseases - diagnostic imaging; Cartilage Diseases - pathology; Corticosteroids; Diagnosis, Differential; Female; Fluoroscopy; Hip; Hip Joint - diagnostic imaging; Hip Joint - pathology; Humans; Imaging; Injection; Injections, Intra-Articular; Joint Diseases - diagnostic imaging; Joint Diseases - pathology; Knee; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical records; Medicine; Medicine & Public Health; Middle Aged; Nuclear Medicine; Orthopedics; Pain; Pain - drug therapy; Pathology; Physical Examination - methods; Privacy, Right of; Radiography, Interventional; Radiology; Range of Motion, Articular; Retrospective Studies; Scientific Article; Tendon Injuries - diagnostic imaging; Tendon Injuries - pathology
• ISSN: 0364-2348; 1432-2161
• DOI: 10.1007/s00256-019-03323-9

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.