BROOKLYN 3 MRI USER GROUP Gareth LEEPER Sat 31 st Aug 2013 Session 2 / Talk 2 10:55 – 11:06 ABSTRACT Magnetic Resonance Imaging of the Hip under traction. One of the more difficult aspects of diagnosing causes of hip pain on MRI is to clearly identify early degenerative change in the cartilage. The application of traction to the limb being imaged allows for expansion of the joint and excellent delineation of cartilage margins of both the femoral head and acetabulum. It will only work once the joint has been decompressed following an arthrographic procedure. We have been performing Hip arthrograms using this technique for 3 months with some success. It is dependent on patient co-operation and good staff technique. The resultant images in successful cases are excellent

Fatal A Traction Fatal A Traction Gareth Leeper Manager of MRI Services Christchurch Radiology Group Femoral !!!

Initial setup

Attaching leg traction device

At CRG we have been applying traction to our Hip Arthrograms with some success 20cm FOV 288x288 4mm 20cm FOV 288x288 3mm

Imaging performed in addition  Measuring Femoral rotation:

Schematic diagrams of the right femur and acetabulum show how abnormal femoral antetorsion might contribute to the development of FAI. Left: Markedly reduced femoral antetorsion with smaller amplitude at internal rotation, which may lead to an increased mec... Sutter R et al. Radiology doi: /radiol ©2012 by Radiological Society of North America

 3D Modelling of the upper femur to determine Femoral Acetabular Impingement

T2 mapping Multi echoes allow demonstration of T2 variations in cartilage Healthy cartilage highly structured matrix low T2 signal As collagen fibres degenerate water molecules less restricted higher T2 signal

Future possibilities  Delayed gadolinium enhanced MRI of cartilage (dGEMRIC) Glycosaminoglycans (GAGs) in normal cartilage Glycosaminoglycans (GAGs) in normal cartilage Negatively charged repel Gadolinium ions T1 map multi inversion technique GAG GAG

Diary Date 2014 Please make a note in your diaries / phones today NZ MR User Group study day Saturday March ??? 2014 Auckland ?? Cardiovascular focus ?? These will be run biannually in Auckland and Christchurch initially but will consider running them in other centres if demand is high enough