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.
Highlights
The development of magnetic resonance (MR) imaging has allowed it to become the standard of reference in the work-up of bone and soft tissue abnormalities of the hip
Our routine protocol (Table 1) for MR arthrography of the hip at 1.5 T includes fat-saturated T1-weighted 3-mm slices in axial oblique, coronal and sagittal planes; fatsaturated T2-weighted 4-mm slices in the coronal plane; and fat-saturated three-dimensional (3D) gradient echo T1weighted 1-mm slices allowing for multiplanar and radial reconstructions, which could help in the detection of acetabular labrum lesions [12] and improve the analysis in its weight-bearing region [13]
In 1996, Czerny et al [33] proposed the following MR imaging classification of acetabular labrum lesions in increasing stages of severity: & Stage 0 corresponds to a normal labrum & Stage 1A corresponds to the presence of an intra-labral increased T2 signal not in continuity with the labral margin of a triangular labrum & Stage 2A corresponds to a partial labral tear with extension of contrast media into an undetached triangular labrum & Stage 3A corresponds to a complete labral tear through a triangular labrum & In Stages 1B, 2B and 3B, the labrum is thickened and a labral recess is not present
Summary
The development of magnetic resonance (MR) imaging has allowed it to become the standard of reference in the work-up of bone and soft tissue abnormalities of the hip. MR arthrography involves two steps: first, intra-articular injection under fluoroscopic guidance, MR imaging. Up to 4 ml may be injected, but subcutaneous anaesthesia is not absolutely necessary and would be discussed with the patient & Intra-articular access under fluoroscopic guidance with a 22-gauge spinal needle. & intra-articular injection under fluoroscopic guidance, 12 ml of iodinated contrast medium (Iodixanol Visipaque 270 mg I/ml, GE Healthcare) mixed with 0.06 ml gadolinium chelates (Gadopentetate Dimeglumine Magnevist 0.5 mmol/ml, Bayer) [1] or 10–15 ml from a prefilled syringe of gadolinium chelates (Gadoteric acid Artirem 0.0025 mmol/ml Guerbet). The cutaneous access location is found lateral to the femoral vessels and under the inguinal ligament It is chosen at the preference of the operator, generally at the superior or middle part of the femoral anatomical neck (Fig. 1). Imaging time and the specific absorption rate [7, 10] with, according Ryan et al [11], no discernible difference in image quality or SNR between images acquired with and without SENSE
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