Roles of radiograph, magnetic resonance imaging, threedimensional computed tomography in early diagnosis of femoro-acetabular impingement in 17 cases

Objective: To evaluate the roles of radiograph, magnetic resonance imaging (MRI), three-dimensional computed tomography (3-D CT) in early diagnosis of femoro-acetabular impingement (FAI) in 17 cases. Methods: Plain radiographs of the pelvis, 3-D CT, and MRI of the hip were made on 17 patients with groin pain, which was worse with prolonged sitting (i.e. hip flexion). There was no history of trauma or childhood hip disorders in the patients who did not complain of any other joint problems or neurologic symptoms. All patients had positive anterior or posterior impingement test. Plain radiographs included an antero-posterior (AP) view of the hip and a cross table lateral view with slight internal rotation of the hip. CT scan was performed with the Lightspeed 16 row spiral (General Electric Company, USA) at 1.25 mm slice reconstruction. MRI scan was performed on the Siemens Avanto (Siemens Company, Germany)1.5T supraconducfion magnetic resonance meter. The CT and MRI scans were taken from 1 cm above the acetabulum to the lesser trochanter in 5 series. Results: The plain radiographs of the pelvis showed that among the 17 patients, 12 (70.59%) had "Cam" change of the femoral head, 6 (35.29%) had positive "cross-over" sign, and 17 (100%) had positive "Pincer" change of the acetabulum. The 16 row spiral CT noncontrast enhanced scan and 3-D reconstruction could discover minus femoral offset and ossification and osteophyte of the acetabulum labrum in all the 17 cases (100%). The MRI noncontrast enhanced scan could discover more fluid in the hip joint in 15 cases (88.33%), subchondral ossification in 3 cases (17.6%), and labium tears in 3 cases (17.6%). Conclusions: Plain radiographs can provide the initial mainstay for the diagnosis of FAI, 3-D CT can tell us the femoral offset, while MRI can show labrum tears in the very early stage of FAI. Basically, X-ray examination is enough for the early diagnosis of FAI, but 3-D CT and MRI may be useful for the treatment.