MR and CT Arthrography of the Hip

 

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Abstract

CT arthrography (CTa) and MR arthrography (MRa) are useful tools for the investigation of intra-articular hip disease. They are minimally invasive techniques with a very low rate of complications and can be performed safely. CTa or MRa can be performed after an intra-articular injection of diluted contrast, but both techniques can also be performed after a single injection. As radiologists we should be able to address the surgeon's questions and work together to standardize terminology and classifications systems for accurate reporting. This update emphasizes radiological findings with a clinical perspective. CTa and MRa allow the precise diagnosis of labral tears, loose bodies, and intra-articular ligaments (capsular and ligamentum teres). The use of careful technique and a tailored protocol has improved our ability to detect and describe cartilage lesions. This is essential because knowledge of the status of the cartilage may dictate a specific surgical approach, and when cartilage lesions are extensive, they are a negative prognostic indicator for arthroscopic treatment.

• References

• 1 Safran MR, Hariri S. Hip arthroscopy assessment tools and outcomes. Oper Tech Orthop 2010; 20: 264-277
  CrossrefPubMedGoogle Scholar
• 2 Schenker ML, Martin R, Weiland DE, Philippon MJ. Current trends in hip arthroscopy: a review of injury diagnosis, techniques, and outcome scoring. Curr Opin Orthop 2005; 16: 89-94
  CrossrefPubMedGoogle Scholar
• 3 Bharam S. Labral tears, extra-articular injuries, and hip arthroscopy in the athlete. Clin Sports Med 2006; 25 (2) 279-292, ix
  CrossrefPubMedGoogle Scholar
• 4 Schulte-Altedorneburg G, Gebhard M, Wohlgemuth WA , et al. MR arthrography: pharmacology, efficacy and safety in clinical trials. Skeletal Radiol 2003; 32 (1) 1-12
  CrossrefPubMedGoogle Scholar
• 5 Brown RR, Clarke DW, Daffner RH. Is a mixture of gadolinium and iodinated contrast material safe during MR arthrography?. AJR Am J Roentgenol 2000; 175 (4) 1087-1090
  CrossrefPubMedGoogle Scholar
• 6 Perdikakis E, Karachalios T, Katonis P, Karantanas A. Comparison of MR-arthrography and MDCT-arthrography for detection of labral and articular cartilage hip pathology. Skeletal Radiol 2011; 40 (11) 1441-1447
  CrossrefPubMedGoogle Scholar
• 7 Andreisek G, Duc SR, Froehlich JM, Hodler J, Weishaupt D. MR arthrography of the shoulder, hip, and wrist: evaluation of contrast dynamics and image quality with increasing injection-to-imaging time. AJR Am J Roentgenol 2007; 188 (4) 1081-1088
  CrossrefPubMedGoogle Scholar
• 8 Duc SR, Hodler J, Schmid MR , et al. Prospective evaluation of two different injection techniques for MR arthrography of the hip. Eur Radiol 2006; 16 (2) 473-478
  CrossrefPubMedGoogle Scholar
• 9 Saupe N, Zanetti M, Pfirrmann CW, Wels T, Schwenke C, Hodler J. Pain and other side effects after MR arthrography: prospective evaluation in 1085 patients. Radiology 2009; 250 (3) 830-838
  CrossrefPubMedGoogle Scholar
• 10 Hodler J. Technical errors in MR arthrography. Skeletal Radiol 2008; 37 (1) 9-18
  PubMedGoogle Scholar
• 11 Christie-Large M, Tapp MJ, Theivendran K, James SL. The role of multidetector CT arthrography in the investigation of suspected intra-articular hip pathology. Br J Radiol 2010; 83 (994) 861-867
  CrossrefPubMedGoogle Scholar
• 12 Llopis E, Cerezal L, Kassarjian A, Higueras V, Fernandez E. Direct MR arthrography of the hip with leg traction: feasibility for assessing articular cartilage. AJR Am J Roentgenol 2008; 190 (4) 1124-1128
  CrossrefPubMedGoogle Scholar
• 13 Tannast M, Siebenrock KA, Anderson SE. Femoroacetabular impingement: radiographic diagnosis—what the radiologist should know. AJR Am J Roentgenol 2007; 188 (6) 1540-1552
  CrossrefPubMedGoogle Scholar
• 14 Lavigne M, Kalhor M, Beck M, Ganz R, Leunig M. Distribution of vascular foramina around the femoral head and neck junction: relevance for conservative intracapsular procedures of the hip. Orthop Clin North Am 2005; 36 (2) 171-176, viii
  CrossrefPubMedGoogle Scholar
• 15 Kassarjian A, Yoon LS, Belzile E, Connolly SA, Millis MB, Palmer WE. Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement. Radiology 2005; 236 (2) 588-592
  CrossrefPubMedGoogle Scholar
• 16 Lohan DG, Seeger LL, Motamedi K, Hame S, Sayre J. Cam-type femoral-acetabular impingement: is the alpha angle the best MR arthrography has to offer?. Skeletal Radiol 2009; 38 (9) 855-862
  CrossrefPubMedGoogle Scholar
• 17 Ilizaliturri Jr VM. Complications of arthroscopic femoroacetabular impingement treatment: a review. Clin Orthop Relat Res 2009; 467 (3) 760-768
  CrossrefPubMedGoogle Scholar
• 18 Dolan MM, Heyworth BE, Bedi A, Duke G, Kelly BT. CT reveals a high incidence of osseous abnormalities in hips with labral tears. Clin Orthop Relat Res 2011; 469 (3) 831-838
  CrossrefPubMedGoogle Scholar
• 19 Schmid MR, Nötzli HP, Zanetti M, Wyss TF, Hodler J. Cartilage lesions in the hip: diagnostic effectiveness of MR arthrography. Radiology 2003; 226 (2) 382-386
  CrossrefPubMedGoogle Scholar
• 20 Yoon LS, Palmer WE, Kassarjian A. Evaluation of radial-sequence imaging in detecting acetabular labral tears at hip MR arthrography. Skeletal Radiol 2007; 36 (11) 1029-1033
  CrossrefPubMedGoogle Scholar
• 21 Petersilge CA. MR arthrography for evaluation of the acetabular labrum. Skeletal Radiol 2001; 30 (8) 423-430
  CrossrefPubMedGoogle Scholar
• 22 Gdalevitch M, Smith K, Tanzer M. Delamination cysts: a predictor of acetabular cartilage delamination in hips with a labral tear. Clin Orthop Relat Res 2009; 467 (4) 985-991
  CrossrefPubMedGoogle Scholar
• 23 Vande Berg BC, Lecouvet FE, Maldague B, Malghem J. MR appearance of cartilage defects of the knee: preliminary results of a spiral CT arthrography-guided analysis. Eur Radiol 2004; 14 (2) 208-214
  CrossrefPubMedGoogle Scholar
• 24 Anderson LA, Peters CL, Park BB, Stoddard GJ, Erickson JA, Crim JR. Acetabular cartilage delamination in femoroacetabular impingement. Risk factors and magnetic resonance imaging diagnosis. J Bone Joint Surg Am 2009; 91 (2) 305-313
  CrossrefPubMedGoogle Scholar
• 25 Pfirrmann CWA, Duc SR, Zanetti M, Dora C, Hodler J. MR arthrography of acetabular cartilage delamination in femoroacetabular cam impingement. Radiology 2008; 249 (1) 236-241
  CrossrefPubMedGoogle Scholar
• 26 Cerezal L, Arnaiz J, Canga A , et al. Emerging topics on the hip: ligamentum teres and hip microinstability. Eur J Radiol 2011; ; June 30 (Epub ahead of print)
  PubMedGoogle Scholar
• 27 Cerezal L, Kassarjian A, Canga A , et al. Anatomy, biomechanics, imaging, and management of ligamentum teres injuries. Radiographics 2010; 30 (6) 1637-1651
  CrossrefPubMedGoogle Scholar
• 28 Bencardino JT, Kassarjian A, Vieira RL, Schwartz R, Mellado JM, Kocher M. Synovial plicae of the hip: evaluation using MR arthrography in patients with hip pain. Skeletal Radiol 2011; 40 (4) 415-421
  CrossrefPubMedGoogle Scholar
• 29 Katz LD, Haims A, Medvecky M, McCallum J. Symptomatic hip plica: MR arthrographic and arthroscopic correlation. Skeletal Radiol 2010; 39 (12) 1255-1258
  CrossrefPubMedGoogle Scholar
• 30 Neckers AC, Polster JM, Winalski CS, Krebs VE, Sundaram M. Comparison of MR arthrography with arthroscopy of the hip for the assessment of intra-articular loose bodies. Skeletal Radiol 2007; 36 (10) 963-967
  CrossrefPubMedGoogle Scholar