Radiäre MRT des Hüftgelenks zur Abklärung präarthrotischer Veränderungen im jungen Erwachsenenalter: ein Vergleich verschiedener Sequenzen

Abstract

Femoroacetabular impingement has been shown to be an important cause for the development of osteoarthritis of the hip joint. Radial MRI of the hip has proven to be the diagnostic procedure of choice to differentiate which patient to operate. While examinations after instillation of contrast agents have been described, new papers have shown high accuracy without contrast medium. Since instillation of contrast medium is considered painful and poses the risk of infection, it is not performed for MRI evaluation of the hip at our institution. However, the question as to which sequence to use has not been settled yet. Therefore, four frequently used sequences using the same resolution were compared. A retrospective analysis of T (1)-weighted (T (1)), T (2)-weighted (T (2)) and proton density sequences (the latter with and without fat saturation [PDfs and PD]) of 50 hips in 48 patients with femoro-acetabular impingement and developmental dysplasia of the hip was performed by two raters blinded to the clinical information. The different sequences were rated separately. Evaluated criteria were subjective imaging quality, power to differentiate acetabular from femoral cartilage as well as the labrum from the joint capsule, and localisation and characterisation of pathological changes in joint cartilage, the labrum and at the femoral head-neck junction. Subjective imaging quality was assessed to be similar for T (1), PDfs and PD, whereas it was significantly worse for T (2). In discriminating specific intraarticular structures, however, only PDfs and PD were superior. The differentiation of acetabular from femoral cartilage was possible in only 44% and 40% of T (1) and T (2) images, but in 79% and 76% of PDfs and PD images. Similar results were found for the differentiation of the acetabular labrum from its vicinity, especially the joint capsule (36%, 35%, 77% and 74%, respectively). Intralabral pathology was seen in a comparable extent in all sequences. An intramedullary oedema at the head-neck junction, however, was significantly more frequent in PDfs only (67% vs. 0%, 17% and 10% for PDfs vs. T (1), T (2) and PD). Despite their good subjective quality, T (1)- and T (2-)weighted sequences could not depict the acetabular labrum as efficiently as PD-weighted sequences. Concluding from our data, a PDfs sequence (possibly combined with a conventional PD sequence) is advantageous over T (1) and T (2) sequences. Intraarticular administration of contrast medium seems to be superfluous.