FAI has been implicated in the progression of osteoarthritis (OA) and early detection may allow for treatment, which can slow or halt progression. FAI is a difficult condition to image and there is little objective evidence about imaging accuracy. We aim to measure the accuracy of five imaging modalities. Three blinded observers retrospectively reviewed five different modalities from two age and sex matched groups: A patient group referred to the outpatient clinic with a clinical diagnosis of FAI and a control group who had had CT scans of the pelvis for suspected trauma, where the Pelvic scan had been reported as showing no injuries. The imaging modalities were: Standard x-ray; Antero-Posterior, Lateral; Condition-specific x-ray projections; Dunn view, lateral internal rotation; Standard Computer Tomography (CT) multiplanar reconstruction (MPR); axial, sagittal and coronal; Condition-specific CT MPR; angled axial, angled coronal; 3D modelling; and surface rendered dynamic. We found marked variations in the sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictiive Value (NPV) for each of the following imaging modalities: Standard X-ray; Sensitivity 51.9; Specificity; 57.1; PPV; 40; NPV; 68.3 Special X-rays; Sensitivity; 66.7; Specificity; 57.1; PPV; 46.1; NPV; 75.7. Standard CT MPR; Sensitivity; 40.7; Specificity; 75.5; PPV; 47.8; NPV; 69.8 Special CT MPR; Sensitivity; 48.1; Specificity; 57.1; PPV; 46.4; NPV; 70.8 Dynamic 3D CT models; Sensitivity; 55.6; Specificity; 69.3; PPV; 42.8; and NPV; 71.8. The Dynamic 3D CT models (where the observer can manipulate the model in real time three dimension to control the perspective) proved to be the most accurate, closely followed by the special X-Ray views, which were also the most sensitive. The Standard CT MPRs were the most specific but had a low sensitivity. This is the first study to measure sensitivity, specificity and PPV and NPV for these imaging modalities in FAI. We recommend the use of condition-specific X-Ray views as well as 3D CT Models for optimal imaging accuracy in this condition. Standard X-Ray views and CTs proved less useful.
