From the Guidelines
MRA without contrast is not the most appropriate initial imaging choice for a patient with chronic groin pain, and an MRI of the pelvis or hip without contrast is generally preferred. For patients with chronic groin pain, the initial imaging recommendation would usually be an MRI of the pelvis or hip rather than an MRA, as MRA specifically focuses on blood vessels which are rarely the primary cause of chronic groin pain 1. According to the ACR Appropriateness Criteria, radiographs of the pelvis and hip should be the first test ordered for the evaluation of patients with chronic hip pain, and MRI hip without IV contrast is appropriate in patients with chronic hip pain when radiographs are negative, equivocal, or nondiagnostic and there is a suspicion for an extra-articular noninfectious soft tissue abnormality such as tendonitis 1.
Some key points to consider when evaluating chronic groin pain include:
- The patient's clinical presentation and physical examination findings
- The suspected underlying cause of the groin pain
- The use of initial screening tools such as ultrasound or X-rays, followed by MRI if needed
- The effectiveness of MRI without contrast in evaluating soft tissue structures like muscles, tendons, ligaments, and labral tears that commonly cause groin pain
- The potential need for MRA if vascular pathology is suspected, but this would typically be determined after initial evaluation suggests a vascular cause 1.
It's also important to note that contrast-enhanced MRA provides better vessel visualization, though non-contrast techniques can be used for patients with kidney problems or contrast allergies. Ultimately, the imaging choice should be guided by the patient's individual needs and the suspected underlying cause of the groin pain, with a focus on minimizing morbidity, mortality, and improving quality of life 1.
From the Research
MRA without Contrast for Chronic Groin Pain
- MRA (Magnetic Resonance Angiography) without contrast may be considered for patients with chronic groin pain, as it can provide valuable information about the anatomy and potential causes of pain in the groin area 2.
- A study published in European Radiology in 2000 found that MRI without contrast medium can depict the anatomy in the groins well and reveal other causes of groin pain, such as inflammatory changes in the symphysis region 2.
- However, the primary diagnostic tool for diagnosing hernias is herniography, and if the herniogram is normal, MRI may be used to reveal other causes of groin pain and better visualize related structures in the groin 2.
Comparison with Other Imaging Modalities
- MRI is frequently used as the primary imaging modality for athletic groin pain, but ultrasound is the best image modality for dynamic assessment of soft tissue abnormality and for guided intervention 3.
- A study published in Seminars in Musculoskeletal Radiology in 2011 found that comprehensive evaluation of all anatomical locations prone to injury, including the hip joint, sacrum, ilium, and proximal femora, is required to diagnose the cause of groin pain, and MRI provides superb soft tissue contrast resolution, multiplanar capabilities, and a wide field of view to evaluate many potential causes of groin pain 4.
Diagnostic Considerations
- The diagnosis of groin pain can be difficult to establish due to the complex interconnected anatomy at the pubic symphysis and surrounding structures, and diagnostic imaging is crucial in reaching the correct diagnosis 5.
- A study published in European Radiology in 1996 found that MRI is a valuable method for evaluating discrete and ambiguous pelvic pain in athletes, particularly for identifying concomitant changes in the superior ramus, which may give rise to long-standing pain localized laterally in the groin 6.