Sabah Hasan Shindakh
Radiologist, Head of Radiation Protection Center, Ministry of Health and Environment, Baghdad, Iraq
Fernando Ruiz Santiago
2Head of Radiology Department, Hospital of Traumatology, Carretera de Jaen SN, 18014 Granada, Spain
Ali Falah Zbalah
Rheumatologist, Al-Kindy College of Medicine, University of Baghdad, Iraq
Thair Wali Ali
Pathologist, College of Medicine, Al-Qadisiyah University, Iraq
Mustafa Karam Alfawadi
Medical Physicist, Private International Medical Center, Baghdad, Iraq
Haydar Raheem Hmoud
Department of Family and Community Medicine, Al-Kindy College of Medicine, University of Baghdad, Iraq
Objective: In patients with hip osteoarthritis (OA), this study sought to assess and contrast the diagnostic efficacy of magnetic resonance imaging (MRI), the gold standard, with conventional radiography (X-ray) and ultrasound (US). Methods: A mean age of 52.8 ± 7.6 years was obtained from 63 patients (126 hip joints). The participants were all subjected to X-ray, US, and MRI of the hip. The OA presence characteristics (joint space narrowing (JSN) and bony changes on X-ray and joint effusion and soft tissue examination on US) were compared with the related MRI results. The sensitivity, specificity, positive and negative predictive values (PPV, NPV), accuracy and Kappa statistics were used to evaluate diagnostic performance. ROC analysis, association, using Phi coefficient (?) and agreement by the Bland-Altman analysis were conducted. Results: X-ray showed high levels of specificity (94.3%) but moderate levels of sensitivity (64.3%) to detect JSN compared to MRI (Kappa=0.62). US had moderate sensitivity (65.9%), and specificity (63.6%) values compared to MRI (Kappa=0.27). Analysis of ROC indicated that X-ray had a moderate diagnostic performance in the detection of JSN (AUC=0.728) and US in the detection of bone effusion (AUC=0.748). The correlation between OA diagnoses between modalities was moderate in all cases (X-ray vs. MRI ? =0.329; US vs. MRI ? =0.386; X-ray vs. US ? =0.320). According to the Bland-Altman analysis, there was a systematic bias and broad limits of agreement between the conventional imaging and MRI and there is no interchangeability of the two methods in individual patient measurements. Conclusion: MRI is the most multifunctional modality in the evaluation of hip OA; nevertheless, X-ray and US may play an important and complementary role. X-ray is very specific in bony changes and US with regard to visualization of the soft-tissue pathology. A combined X-ray and US methodology can offer a feasible and efficient diagnostic plan to hip osteoarthritis first screening and treatment in a resource-constrained environment, including remote communities or hospitals with no MRI services.
