High resolution noncontrast MRI of the hip

Abstract

The relatively thin cartilage of the hip joint, as well as its complex geometry, poses challenges for standardized, reproducible assessment of cartilage and the acetabular labrum. With appropriate pulse sequence parameters, however, accurate, reproducible assessment of cartilage and the labrum is feasible. More detailed evaluation of cartilage biochemistry may be obtained with techniques aimed at noninvasively evaluating the integrity of collagen and/or proteoglycan components in the articular cartilage. One of the benefits of noncontrast techniques lie in the ability to visualize the native synovium, and thereby detect the presence of synovial proliferative disorders, the clinical symptoms of which may mimic a labral tear or traumatic cartilage injury. Standard cartilage evaluation allows for the detection of surface delamination and osteoarthritis in the setting of femoroacetabular impingement, as well as subtle areas of subchondral collapse and secondary delamination of cartilage in the setting of osteonecrosis. This preserves the use of hip arthroscopy as a therapeutic rather than a diagnostic tool.

Hip Arthroscopy Improves Symptoms Associated with FAI in Selected Adolescent Athletes

“…Chondral and labral disorders were evaluated using high-resolution, noncontrast MRI based on evidence from our institution regarding the equivalence or superiority to MR arthrograms for evaluation of labral disorders [50,60] ( Fig. 1), whereas bony pathoanatomy was assessed using plain radiographs and noncontrast CT scans with 3-D reconstruction reformatted images (Fig.…”

MRI of Hip Cartilage: Joint Morphology, Structure, and Composition

“…The phased-array torso coil is commonly used to image the hip, as it can increase the signal-to-noise ratio while maintaining visualization of both hips [27]. Moderate echo time fast spin echo (FSE) techniques with an effective echo time of 34 milliseconds at 1.5 T and 28 milliseconds at 3 T [24] yield optimal differential tissue contrast.…”

“…Axial oblique images oriented along the axis of the femoral neck are commonly utilized in the evaluation of FAI syndrome. Axial images of the distal femoral condyles are commonly obtained for hip version analysis [24]. Large-field-of-view fat-suppressed images of the entire pelvis are useful for identifying the presence of edema and fluid collections and for detecting intrapelvic pathology, such as tumors.…”

“…Traditional T1-weighted three-dimensional fatsuppressed gradient echo sequences allow for the differentiation between low-signal-intensity bone and highsignal-intensity cartilage but are less sensitive for partialthickness defects and result in substantial artifact in the postoperative setting. An intermediate-weighted twodimensional non-fat-suppressed FSE sequence is often favored, providing reduced scan time, accurate assessment of partial-thickness chondral defects, and good contrast between the bone, cartilage, and joint fluid [24]. MRI can demonstrate full-thickness cartilage defects, progressive degeneration, and fibrillation in the presence of preserved joint space on radiographs.…”

“…Surface fibrillation may also be noted, which is commonly seen before more substantial cartilage loss. Quantitative MR techniques are helpful for determining the degree of cartilage loss and can aid in identifying patients suitable for periacetabular osteotomy versus those who require arthroplasty [24]. Kim et al [16] showed dGEMRIC is a sensitive measure for the development of early osteoarthritis in patients with DDH.…”