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Does A Fluid-filled Cleft In The Anterosuperior Aspect Of The Acetabular Labrum Indicate The Age Of A Labral Tear?
Question: I had an OPEN MRI in August 2015 that showed minimal articular cartilage irregularity in my right hip. It also showed slight degenerative changes of the sacroiliac joints. In August of 2018, I had a 3T closed MRI that showed that there is a small fluid-filled cleft in the anterosuperior aspect of the acetabular labrum on the right side. There is no displacement present. The articular cartilage of the femoral head and acetabulum appears grossly unremarkable. There is no effusion present. No fracture or bone marrow edema in the proximal femur.The bony pelvis is intact. Normal SI joints.The iliopsoas, rectus femoris, hamstring and gluteal tendons are intact. I was told in 2015 that I had arthritis because of the articular cartilage irregularity. However, the 2018 MRI stated it was unremarkable. I am debating on having a hip arthroscopy to repair my torn labrum. However, I want to be cautious if I have arthritis present. So my questions are as follows:
1.) How did the irregularity not show up on the 2018 MRI and do I have arthritis?
2.) Will an X-RAY show arthritis better than a MRI because I go back to the Dr. at the end of the month and I do not believe he will order another MRI. Could my arthritis if I have it or cartilage damage increased since August 31, 2017. Also, does that small cleft give any indication of the size or age of the labral tear.
Thank you.
1.) How did the irregularity not show up on the 2018 MRI and do I have arthritis?
2.) Will an X-RAY show arthritis better than a MRI because I go back to the Dr. at the end of the month and I do not believe he will order another MRI. Could my arthritis if I have it or cartilage damage increased since August 31, 2017. Also, does that small cleft give any indication of the size or age of the labral tear.
Thank you.
Brief Answer:
The 3T MRI findings are more accurate than the open magnet
Detailed Answer:
Hi,
I have regularly seen images acquired using many different strengths of magnets starting from 0.2T, 0.35T, 0.5T, 1.0T, 1.5T and 3.0T. By open magnet I guess you are talking about a machine having a magnetic strength below 1.0T.
My answer to the first query:
There are differences in images which are acquired in smaller machines and there is a tendency to over report findings when in doubt. The surface of the cartilage can appear slightly hazy and therefore a comment of minimal cartilage irregularity mentioned in your report. Also at the same time small labral tear might go unnoticed in the open MRI images.
The 3T MRI images are of greater clarity and more reliable when it comes to making a comment of cartilage thinning and irregularity.
My answer to the second query:
A X-ray is a basic tool and shows many features like the margins and bone density and trabeculae in good detail.
Osteoarthritis is a clinical condition and different imaging modalities including MRI show variable sensitivity and specificity in picking up osteoarthitis. No imaging can be 100 percent accurate but getting scanned on a 3T MRI will give more accurate findings than the open magnet systems.
To my knowledge, there has been a review of the diagnostic performance of MRI in osteoarthritis from data collected from 16 research studies. This research makes an attempt to verify the performance utility of MRI when making a diagnosis of osteoarthritis. This study was done on individuals who had possible clinical features of arthritis in the hip, knee or hand areas.
The results of this research with reference to sensitivity and specificity of MRI to picking osteoarthritis is quoted as below
"With histology as the reference standard, sensitivity increased to 74% and specificity decreased to 76% compared with all reference standards combined. When arthroscopy was used as the reference standard, sensitivity increased to 69% and specificity to 93% compared with all reference standards combined."
So finally, we need to compare the outcome of the MRI scan with a histology or arthroscopy procedure and confirm a clinical diagnosis of osteoarthitis. Unless we do an invasive procedure, saying with 100 percent confidence is difficult.
The time duration from August 2017 till now is 6 months and progression of osteoarthritis is very slow in such time interval even if you have the condition. A new MRI might not show gross differences. However you can discuss with your doctors if they have done a T2 mapping MRI sequence for the hip joint cartilage previously or plan to do one this time. This is a more specialized sequence to study the cartilage changes.
A small cleft is likely referring to a partial thickness labral tear. The age of the tear is however not easy to guess.
Hope your queries are answered.
Regards,
Dr. Vivek Chail
Radiologist
The 3T MRI findings are more accurate than the open magnet
Detailed Answer:
Hi,
I have regularly seen images acquired using many different strengths of magnets starting from 0.2T, 0.35T, 0.5T, 1.0T, 1.5T and 3.0T. By open magnet I guess you are talking about a machine having a magnetic strength below 1.0T.
My answer to the first query:
There are differences in images which are acquired in smaller machines and there is a tendency to over report findings when in doubt. The surface of the cartilage can appear slightly hazy and therefore a comment of minimal cartilage irregularity mentioned in your report. Also at the same time small labral tear might go unnoticed in the open MRI images.
The 3T MRI images are of greater clarity and more reliable when it comes to making a comment of cartilage thinning and irregularity.
My answer to the second query:
A X-ray is a basic tool and shows many features like the margins and bone density and trabeculae in good detail.
Osteoarthritis is a clinical condition and different imaging modalities including MRI show variable sensitivity and specificity in picking up osteoarthitis. No imaging can be 100 percent accurate but getting scanned on a 3T MRI will give more accurate findings than the open magnet systems.
To my knowledge, there has been a review of the diagnostic performance of MRI in osteoarthritis from data collected from 16 research studies. This research makes an attempt to verify the performance utility of MRI when making a diagnosis of osteoarthritis. This study was done on individuals who had possible clinical features of arthritis in the hip, knee or hand areas.
The results of this research with reference to sensitivity and specificity of MRI to picking osteoarthritis is quoted as below
"With histology as the reference standard, sensitivity increased to 74% and specificity decreased to 76% compared with all reference standards combined. When arthroscopy was used as the reference standard, sensitivity increased to 69% and specificity to 93% compared with all reference standards combined."
So finally, we need to compare the outcome of the MRI scan with a histology or arthroscopy procedure and confirm a clinical diagnosis of osteoarthitis. Unless we do an invasive procedure, saying with 100 percent confidence is difficult.
The time duration from August 2017 till now is 6 months and progression of osteoarthritis is very slow in such time interval even if you have the condition. A new MRI might not show gross differences. However you can discuss with your doctors if they have done a T2 mapping MRI sequence for the hip joint cartilage previously or plan to do one this time. This is a more specialized sequence to study the cartilage changes.
A small cleft is likely referring to a partial thickness labral tear. The age of the tear is however not easy to guess.
Hope your queries are answered.
Regards,
Dr. Vivek Chail
Radiologist
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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