Magnetic Resonance Imaging of Hip Neuropathies: Beyond the Sciatica: A Practical Approach

Abstract

Neural entrapments in the hip area represent a challenging diagnosis due to the complexity, deep location, and variable distribution of pelvic nerves. This paper aims to perform an anatomic and pathologic review of neural entrapment syndromes involving the pudendal, obturator, lateral cutaneous femoral, and femoral nerves at the pelvis. Among the etiologies for pelvic neuropathies, besides idiopathic and expansive processes, extrinsic compression by normal anatomical structures is also frequent, which relights the importance of the critic constriction points on nerves pathway. High-field 3-Tesla (3-T) magnetic resonance neurography is considered the best image method for such imaging investigation. At MR imaging neural disease may be appreciated by alterations in nerve signal intensity, size, and morphology. For such evaluation, three-dimensional images with isotropic volumetric data acquisition both on T1 and STIR sequences should be performed, enabling post-processing imaging on workstations, which improves the diagnostic sensibility an enables early therapeutic procedures.