HIP IMAGING SUMMARY OF HIP IMAGING Indications of Imaging : * Pain *Swelling * Trauma * Inflammation/Tumor SCAN PROTOCOL MRI Scout Axial "Both Hips" Axials T1 & T2 Coronal T1 - STIR Sagital T1 o T2 for disased If + Contrast Ax. – Sag. – Cor T1 Slice Thickness 5 mm FOV 30 -42 MANDATORY CORONAL STIR = LOOK FIRST TO CORONAL T1 , if abnormality seen  Look at CORONAL STIR Then search in other sequences ANATOMY * 95 % of Femoral Neck is intra-articular By A.M.Abodahab – Ass.Lecturer of Radiology - Sohag University

ITEMS TO BE EVALUATED 1. AVASCULAR NECROSIS SUMMARY OF HIP IMAGING 3 Muscles are important in Coronal scan  Obturator Internus &  '' '' Externous &  Adductor Brevis , …………… as injury is common ITEMS TO BE EVALUATED Avascular Necrosis "Commonest" Transient osteoporosis Perthes Disease Slipped capital Femoral Epiphysis Trauma & Muscle injury Others : Labral Tears - Loos Bodies Femoral Neck Anteversion - Bursitis 1. AVASCULAR NECROSIS Site : Femoral Head , Any site , – Anterolateral aspect is commonest Causes : - Steroids "commonest" - Radiation - Collagen Dis. Trauma Pancreatitis - Alcoholism -Sickle Cell By A.M.Abodahab – Ass.Lecturer of Radiology - Sohag University

SUMMARY OF HIP IMAGING Late - Collapse Early - Just Irregularities By A.M.Abodahab – Ass.Lecturer of Radiology - Sohag University

In AVN…… Acetabulum & Superior Joint space are not affected. SUMMARY OF HIP IMAGING MRI FINDING II NB. Stage I is not written in Report , but described as "Bone Marrow edema" When Advanced AVN is diagnosed By X-ray  No need of MRI Prognosis is related to : size of lesion < 25 % of head = Good prognosis Site : Medial Or central  better AVN Vs Osteoarthritis In AVN…… Acetabulum & Superior Joint space are not affected. By A.M.Abodahab – Ass.Lecturer of Radiology - Sohag University

SUMMARY OF HIP IMAGING STAGE IV X ray NORMAL By A.M.Abodahab – Ass.Lecturer of Radiology - Sohag University

Transient osteoporosis SUMMARY OF HIP IMAGING 2 TRANSIENT OSTEOPOROSIS"Migratory Osteoporosis" Key. IT AFFECT femoral HEAD & NECK , as seen in MRI & BONE SCAN Hot Uptake AVN Transient osteoporosis Extension Part of Head Head & Neck Side Frequent Bilateral Usually Unilateral Bone Scan NO UPTAKE "Avascular" HOT UPTAKE MRI STAGES EDEMA STEROID Causative Treatment When AVN Vs TOP is Equivocal  DO BONE SCAN To Differentiate NB. AFTER RESOLVING T.O.P. may  Line = Suggest That T.O.P is precursor of AVN By A.M.Abodahab – Ass.Lecturer of Radiology - Sohag University

3. SUBCHONDRAL FRACTURE SUMMARY OF HIP IMAGING Etiology : -In Young  Stress Fr. – In elder  Osteoporosis Finding : Line "of Fracture" + Bone Marrow Edema "Extensive" - Bone scan  Hot UPTAKE D.D. "AVN "  No Uptake in Bone scan" "TOP"  Hot Uptake Rapid Destructive Osteoarthritis By A.M.Abodahab – Ass.Lecturer of Radiology - Sohag University

+/- Metaphyseal reaction SUMMARY OF HIP IMAGING 4.PERTHES DISEASE Etiology : Unknown Pathology : Avascular Necrosis of femoral Epiphysis in Children M : F = 4 : 1 "4 : 9 y" NB. CHILD WITH KNEE PAIN MUST BE EXAMINED FOR HIP PATHOLOGY STAGES of Perthes Disease Site Stage Epiphysis Metaphysis I Ant. Aspect - II Metaphyseal reaction III All Epiphysis +/- Metaphyseal reaction IV FLATTENING & COLLAPSE Several Months or Years for Complete cure MRI : Can Give more details about signal changes , fissures But X – Ray is quite enough for diagnosis By A.M.Abodahab – Ass.Lecturer of Radiology - Sohag University

5.RAPIDLY DESTRUCTIVE OSTEOARTHERITIS SUMMARY OF HIP IMAGING 5.RAPIDLY DESTRUCTIVE OSTEOARTHERITIS Rare  Old women mainly Finding of Osteoartheritis but Rapid & destructive Usually Unilateral  Decrease J. Space  Sub articular sclerosis  Osteophytes  Psudocystic Changes By A.M.Abodahab – Ass.Lecturer of Radiology - Sohag University

6. SLIPPED CAPITAL FEMORAL EPIPHYSIS SUMMARY OF HIP IMAGING 6. SLIPPED CAPITAL FEMORAL EPIPHYSIS Etiology : Unknown …May Trauma, Obesity Pathology : Femoral epiphysis displacement  Posterior & Inferior Lead to AVN in 15 % Side : 20 : 25 % Bilateral = CT is the best For diagnosis, Can diagnosed by X-ray "Lines are non reliable" = MRI Less sensitive than CT , but important if AVN is suspected Normal Slipped BEST SEEN BY CT By A.M.Abodahab – Ass.Lecturer of Radiology - Sohag University

7 . MUSCLES INJURY SUMMARY OF HIP IMAGING STAGES OF MUSCLES & INJURU Lesion Muscle Morphology I Edema + Preserved Morphology Preserved II Up to 50 % of Fibers replaced by Hematoma III Complete Ms. Tear Retraction or Atrophy By A.M.Abodahab – Ass.Lecturer of Radiology - Sohag University

So Donot Rash To Diagnose Mets. Or Biopsy SUMMARY OF HIP IMAGING HIP FRACTURES (Best evaluated By CT)….Easily Missed in X ray = You need to determine while fracture is : Intra-capsular Extra-capsular Acetabular Femoral Head Subcapital Trans-cervical inter-trochanteric Subtrochanteric Ant Column Quadrilateral Plate Post. Column Retained -/+Fragments -/+Retained Fragments = Associated AVN is evaluated by MRI. = Stress Fracture of the neck is best seen by MRI "Edema = Line" , it may not seen By CT. NB. ANY BONE MARROW EDEMA IS ENHANCING WITH CONTRAST So Donot Rash To Diagnose Mets. Or Biopsy Complaint in one side , can be due to pathology in other side Subtle Finding in X-ray or CT , May = Grave Finding in MRI, So Donot ignore complaint or finding By A.M.Abodahab – Ass.Lecturer of Radiology - Sohag University

MR ARTHROGRAM SUMMARY OF HIP IMAGING INDICATIONs: L O L By A.M.Abodahab – Ass.Lecturer of Radiology - Sohag University

LABRUM DEGENERATION & TEARS SUMMARY OF HIP IMAGING LABRUM DEGENERATION & TEARS Abnormal Intermediate signal = Degeneration Fluid signal or Cyst = Tear SNAPPING HIP SYNDROME Pain & Click on Hip Motion. Etiology : Snapping of Muscle over bone +/- Loss bodies Internal Causes External Cause Better seen by Dynamic MRI By Conventinal MRI  You can seen Bursitis Bursitis Bursa: Sac of synovial tissue  prevent friction of bone & soft tissue. Around Hip , 15 – 20 bursa Ilio-psoas is the largest allover the body , Located medial to ilio-psoas ms. By A.M.Abodahab – Ass.Lecturer of Radiology - Sohag University

FEMRO-ACCETABULAR IMPINGMENT SUMMARY OF HIP IMAGING Bursitis = Effusion in bursa +/- enhancing margins Large Effusion due to RA may decompressed in bursa FEMRO-ACCETABULAR IMPINGMENT 2 types Cam & Pincer….. or Combined By A.M.Abodahab – Ass.Lecturer of Radiology - Sohag University

SUMMARY OF HIP IMAGING Seen by X-ray or CT If cartilaginous , BY MR & MR Arthrogram Pain + click = Snap By A.M.Abodahab – Ass.Lecturer of Radiology - Sohag University

FEMRAL NECK ANTEVERSION ANGLE SUMMARY OF HIP IMAGING Pathology : synovial metaplasia  cartilaginous bodies M 2 : 1 F - 40 th - Any Joint (Knee > Hip > Elbow) Finding : Wide joint space Loss bodies Bone erosion 2ndry OA FEMRAL NECK ANTEVERSION ANGLE Angle between Line of Neck & Line of femoral condyles By A.M.Abodahab – Ass.Lecturer of Radiology - Sohag University

DEVELOPMENTAL DYSPLASIA OF THE HIP SUMMARY OF HIP IMAGING DEVELOPMENTAL DYSPLASIA OF THE HIP Def: Abnormal relation of femoral head to accetabulum Etiology : - Lax ligaments - Abnormal fetus position - Oligohydramnios Incidence : 2 : 20 / 1000 Diagnosis : confirmed by US Fate : Resolve spontaineously in 6 – 8 wweks Finding: Smaller size of Epiph. - Abnormal Location M8 : 1F Normal capital Femoral Epiph. Is seen at lower medial quadrant of this lines By A.M.Abodahab – Ass.Lecturer of Radiology - Sohag University

Donot Forget Angle of Over Coverage SUMMARY OF HIP IMAGING Donot Forget Angle of Over Coverage By A.M.Abodahab – Ass.Lecturer of Radiology - Sohag University