Magnetic resonance arthrography of the hip: technique and spectrum of findings in younger patients

Abstract

Magnetic resonance(MR) imaging is the reference imaging technique in the evaluation of hip abnormalities. However, in some pathological conditions—such as lesions of the labrum, cartilaginous lesions, femoroacetabular impingement, intra-articular foreign bodies, or in the pre-operative work-up of developmental dysplasia of the hip—intra-articular injection of a contrast medium is required to obtain a precise diagnosis. This article reviews the technical aspects, contraindications, normal appearance and potential pitfalls of MR arthrography, and illustrates the radiological appearance of commonly encountered conditions.

Kalcanin Manyetik Rezonans Artrografisi ve Femoroasetabular Sikisma

“…Kontrast madde enjeksiyonundan sonra, 45 dk. içinde-verilen ilacın sinovyal yüzeylerden absorbe olmadan-MR çekimi tamamlanmalıdır [9].…”

“…Bu düzeyde görü-lebilecek düzensizlikler, kleft görünümü yanlış olarak yırtık lehine yorumlanmamalıdır [9,22]. …”

Hip and Groin Pain in the Child Athlete

“…MR arthrography may be indirect, in which intravenous contrast is allowed to diffuse from the synovium into the hip joint, 18,19 or more commonly direct, in which contrast is injected directly into the joint. 6,7,[16][17][18][19][20][21][22][23] The advantages of the latter include joint distension, ability to control the volume of intra-articular contrast, and no need to incorporate an exercise regimen to promote contrast enhancement of the joint(s) of interest. A further advantage of direct MR arthrography is that a positive response to the intra-articular injection of anesthetic is predictive of intra-articular pathology with 90% reliability.…”

“…25,26 This information should be given as part of the consent process before performing MR arthrography 26 as well as obtaining consent for possible infection, allergic reaction, or bleeding. 20 For direct MR arthrography, the patient lies supine with toes together (hips internally rotated), and an aseptic technique is used to introduce local anesthetic (1% lignocaine) into the subcutaneous tissues via a 22G 3-inch spinal needle and short connecting tube. Then 1 mL water-soluble iodinated contrast (such as Omnipaque 240 (GE Healthcare, Chalfont St. Giles, United Kingdom)) is injected to allow confirmation of intra-articular position; contrast should flow away freely from the needle tip if the tip is within the joint.…”

“…It is advised that the scan is started within a maximum of 60 minutes following the injection and ideally within 45 minutes. 20 Although we do not practice it ourselves, the addition of 0.2 mL epinephrine at the time of intra-articular contrast injection leads to vasoconstriction and prolongs the presence of contrast in the joint if some delay is expected before the MRI. 6,21 We transfer the child to the MR suite in a wheelchair and begin the scan within 30 minutes of the injection.…”