SUMMARY OF HIP IMAGING Indications of Imaging Pain

SUMMARY OF HIP IMAGING Indications of Imaging : * Pain *Swelling * Trauma * Inflammation/Tumor SCAN PROTOCOL MRI Axial "Both Hips" Scout T 1 & T 2 Axials T 1 - STIR Coronal T 1 o T 2 for disased Sagital If + Contrast Ax. – Sag. – Cor T 1 Slice Thickness 5 mm FOV 30 -42 MANDATORY CORONAL STIR = LOOK FIRST TO CORONAL T 1 , 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

SUMMARY OF HIP IMAGING 3 Muscles are important in Coronal scan Obturator Internus & '' '' Externous & Adductor Brevis , …………… as injury is common ITEMS TO BE EVALUATED o o o 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 - Alcoholism - Pancreatitis -Sickle Cell By A. M. Abodahab – Ass. Lecturer of Radiology - Sohag University

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

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 : o size of lesion < 25 % of head = Good prognosis o 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

SUMMARY OF HIP IMAGING 2 TRANSIENT OSTEOPOROSIS"Migratory Osteoporosis" Key. IT AFFECT femoral HEAD & NECK , Hot Uptake as seen in MRI & BONE SCAN Extension Side Bone Scan MRI AVN Part of Head Frequent Bilateral NO UPTAKE "Avascular" STAGES Transient osteoporosis Head & Neck Usually Unilateral HOT UPTAKE 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

SUMMARY OF HIP IMAGING 3. SUBCHONDRAL FRACTURE 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

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 I II IV Epiphysis Metaphysis Ant. Aspect Metaphyseal reaction All Epiphysis +/- Metaphyseal reaction 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

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

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

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

SUMMARY OF HIP IMAGING HIP FRACTURES (Best evaluated By CT)…. Easily Missed in X ray = You need to determine while fracture is : Intra-capsular Femoral Head Subcapital Trans-cervical Extra-capsular inter-trochanteric Subtrochanteric Acetabular Ant Column Quadrilateral Plate Post. Column Retained -/+Fragments = Associated AVN is evaluated by MRI. -/+Retained Fragments = 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

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

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 o Internal Causes o External Cause Better seen by Dynamic MRI By Conventinal MRI You can seen Bursitis o Bursa: Sac of synovial tissue prevent friction of bone & soft tissue. o Around Hip , 15 – 20 bursa o Ilio-psoas is the largest allover the body , Located medial to ilio-psoas ms. By A. M. Abodahab – Ass. Lecturer of Radiology - Sohag University

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

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

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 : 20 / 1000 M 8 : 1 F Diagnosis : confirmed by US Fate : Resolve spontaineously in 6 – 8 wweks Finding: Smaller size of Epiph. - Abnormal Location Normal capital Femoral Epiph. Is seen at lower medial quadrant of this lines By A. M. Abodahab – Ass. Lecturer of Radiology - Sohag University

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