MRI in chronic groin pain: sequence diagnostic reliability compared to systematic surical assessment

Chronic groin pain (CGP) is a common issue affecting mainly high-performance athletes. The leading diagnostic imaging tools for CGP are ultrasounds (US) and magnetic resonance imaging (MRI). Until now, no study has previously focused on the reliability of each MRI sequence compared to surgical assessment. Therefore, the present study revealed that MRI has 77.78% accuracy, 100.00% sensitivity, 69.23% specificity, 55.56% positive predictive value (PPV) and 100.00% negative prospective value (NPV) in evaluating CGP.

The study aimed to assess the magnetic resonance imaging (MRI) sequences' diagnostic reliability in chronic groin pain (CGP) than surgery and attempt to suggest a favourable MRI protocol.  

A total of 43 consecutive patients with resistant clinical CGP went through a pre-surgical pelvis MRI. Study involved a total of eight MRI sequences: coronal PDFS, coronal FSE T1 FSGE, axial fast spin-echo T1-weighted (FSE T1), axial FSE T1 with fat saturation and gadolinium enhancement (FSGE), coronal FSE T1, axial FSE T1 with Valsalva maneuver (VM), axial-oblique (in symphysis plane) proton density weighted with fat saturation (PDFS), and sagittal PDFS. An examination of these sequences was done for adductor longus (AL) tendon, abdominal wall (AW) injuries and pubic symphysis assessment. One surgeon treated all the patients (26 AL and 49 AW). Specificity (Sp), sensitivity (Se), negative prospective value (NPV), accuracy, and positive predictive value (PPV) of every sequence and combinations for AL or AW injuries were measured in comparison to surgical outcomes.

A total of 192 sequences were retrieved. The most reliable sequences noticed were axial T1 VM and coronal T1 FSGE with 83.33% accuracy in AW and 91.67% in AL. The axial PDFS, sagittal PDFS, coronal T1, and axial T1 VM was noticed as the best sequence combination.  

MRI exhibits 100.00% sensitivity, 55.56% PPV, 77.78% accuracy, 100.00% NPV, and 69.23% specificity in determining CGP, with coronal T1-axial PDFS-sagittal PDFS-axial T1 VM as the suitable protocol regarding diagnostic performance within a reasonable scan time. The surgery used as reference standard to examine the diagnostic performance of MRI in the determination of CGP.