title: The role of pubic symphyseal CT arthrography in the imaging of athletic pubalgia.
abstract: OBJECTIVE
  The purpose of this article is to describe the results of pubic symphyseal CT arthrography compared with MRI in patients with suspected athletic pubalgia.
  
  
  METHODS
  In this study, two musculoskeletal radiologists retrospectively searched our department's PACS to identify patients who had undergone CT-guided injection with concurrent pubic symphyseal CT arthrography for evaluation and treatment of groin pain, sports hernia, or athletic pubalgia over a 5.5-year period (January 1, 2007-July 1, 2012). The MR and CT arthrography images and reports, clinical findings at presentation, pain response to injection, and operative findings were reviewed using the electronic medical record.
  
  
  RESULTS
  Twelve patients underwent CT-guided injection and pubic symphyseal CT arthrography at our institution during the 5.5-year study period. Nine of the 12 patients had undergone MRI before the procedure. In two of the three patients who had not undergone MRI, CT arthrography revealed secondary clefts. Three of four patients who had secondary clefts on MRI had contrast extravasation reproducing the cleft at CT. Three patients had MRI findings suggestive of athletic pubalgia without MRI evidence of a secondary cleft; in all three of these patients, CT arthrography showed a secondary cleft. In four patients, CT arthrography revealed tendon tears at the adductor origin that were not apparent on MRI. All 12 patients reported decreased groin pain after injection.
  
  
  CONCLUSIONS
  Pubic symphyseal CT arthrography is a useful technique for the diagnosis and short-term pain relief of athletic pubalgia. It can be used to identify secondary clefts and to detect tendon tears that can potentially be overlooked on MRI.
authors.affiliation: 1 Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 342, Birmingham, AL 35249-6830.
authors.forename: Tatum A
authors.initials: TA
authors.lastname: McArthur
authors.forename: Carl A
authors.initials: CA
authors.lastname: Narducci
authors.forename: Robert R
authors.initials: RR
authors.lastname: Lopez-Ben
mesh_terms: D000293:Adolescent; D000328:Adult; D001175:Arthrography / Q000379:methods; D001265:Athletic Injuries / Q000000981:diagnostic imaging*; D012090:Cumulative Trauma Disorders / Q000000981:diagnostic imaging*; D006801:Humans; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging* / Q000293:injuries*; D015588:Observer Variation; D011631:Pubic Symphysis / Q000000981:diagnostic imaging* / Q000293:injuries*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
keywords: CT arthrography; athletic pubalgia; pubic symphyseal CT arthrography; secondary cleft