髋关节MR造影检查对发育性髋关节发育不良病人髋臼盂唇损伤程度的评价

目的评价髋关节MR造影检查对发育性髋关节发育不良(DDH)病人髋臼盂唇损伤的诊断价值。方法选取2015年12月—2016年10月进行髋关节MR造影检查的DDH病人16例,其中男3例,女13例,年龄10~20岁,平均(14.88±2.60)岁。对每例病人的患侧髋臼行超声引导下髋关节MR造影检查,分别对前、外上及后盂唇进行观察,由2名影像诊断医师评价盂唇损伤的部位及程度,并以术中诊断结果作为金标准进行对比。采用Kappa检验计算髋关节MR造影检查与术中诊断的一致性。结果 16例病人共48处盂唇,无撕裂37处(0期32处,Ⅰ期损伤5处),髋臼实质部撕裂3处,髋臼盂唇-软骨连接区撕裂8处。术中所见无撕裂38处,髋臼实质部撕裂3处,髋臼盂唇-软骨连接区撕裂7处。髋关节MR造影诊断髋臼盂唇撕裂的敏感度为100%,特异度为97.37%,阳性预测值为90.91%,阴性预测值为100%。MR髋关节造影检查与术中诊断的一致性较好(Kappa=0.939,P0.001)。髋关节MR造影显示盂唇肥大、内翻2例,均为前盂唇,与术中所见相吻合。结论髋关节MR造影检查对DDH病人髋臼盂唇损伤诊断的敏感性和特异性均较高,可作为术前常规检查手段。     

髋关节撞击综合征的影像学表现

目的:探讨髋关节撞击综合征(femoroacetabular impingement,FAI)的影像特征。方法:对24例FAI的影像学资料进行回顾性分析,患者均行髋关节X线、CT及MRI检查。结果:FAI表现为股骨头颈解剖学异常,其中24例X线片示股骨头颈交界处骨性突起,呈"枪柄样"改变;5例有非圆形股骨头;3例髋臼后倾、髋臼过深,呈"8字征"改变;15例髋臼边缘软骨下囊性变;5例股骨头颈交界处皮质下囊性变。MRI显示24例髋臼盂唇、软骨损伤及关节骨质改变。CT示α角增大。结论:股骨头颈解剖学异常及髋臼形态异常是诊断FAI的主要征象,结合MRI显示髋臼盂唇及关节软骨损伤,综合评价可明确诊断FAI。     

单髋高分辨力磁共振成像对髋臼盂唇及关节软骨损伤的诊断价值

目的 分析单髋高分辨率磁共振成像（MRI）扫描诊断髋臼盂唇及关节软骨损伤的临床意义。方法 选取2018年2月至2021年2月我院骨科骨关节病区接纳的100例临床髋部疼痛患者，所有患者分别实施常规髋关节MRI扫描与单髋高分辨率MRI扫描，对图像髋臼盂唇损伤显示情况进行盲评法评分，比较2种检查方法对都髋臼盂唇及关节软骨损伤的检查灵敏度。结果 关节镜结果证实表明，100例髋部疼痛患者有76例出现髋臼盂唇及关节软骨损伤，单髋高分辨率MRI扫描检查灵敏度要高于常规髋关节MRI扫描，差异有统计学意义（P<0.05）；且单髋高分辨率髋关节MRI扫描在图像得分上要明显高于常规髋关节MRI扫描，差异有统计学意义（P<0.05）。结论 单髋高分辨率MRI扫描对髋臼盂唇及关节软骨损伤能够做出清晰显示且灵敏度较高，能够为临床疾病确诊和治疗提供准确依据，保证治疗效果，值得推广应用。     

髋关节撞击综合征16例X线表现

目的探讨髋关节撞击综合征（FAI）的X线表现。方法回顾性分析16例FAl患者的影像资料,16例患者均行髋关节正侧位X线检查,其中1例进行了髋关节CT检查。结果16例患者X线表现均出现股骨头颈交界处骨性突起,非圆形股骨头4例,股骨头颈交界处皮质下囊性变4例,髋臼边缘骨赘13例,髋臼边缘软骨下囊性变6例,髋臼后倾5例,髋臼过深2例。结论X线可以显示FAI患者股骨头颈交界处及髋臼解剖异常,有助于提高FAI的诊断准确性。     

髋关节撞击综合征的X线诊断

髋关节撞击综合征(femoroacetabular impingement,FAI)是指由于股骨近端和髋臼盂缘间解剖形态异常,在髋关节运动时股骨近端和髋臼盂缘之间发生异常接触或碰撞,引起髋臼盂唇和关节的软骨、骨的损伤和异常,如果不早期干预处理,最终会导致髋关节骨性关节炎[1,2].X线检查是确诊其解剖形态异常的重要而简易的手段.由于FAI是近些年才被认识的病变,骨科和影像医师对其认识不足,本文通过收集FAI患者的髋关节X线片进行分析和探讨,旨在加深对该病X线表现的认识,提高其影像诊断水平.     

髋关节撞击综合征的影像表现

瑞士医生Ganz于1999年首先报道髋关节撞击综合征(femoroacetabular impingement,FAI)[1],并于2003年正式提出FAI的概念[2].FAI是由于股骨近端与髋臼盂缘的相对解剖关系异常,导致髋关节活动时两者之间不正常的接触、碰撞,损伤髋臼盂唇、关节软骨,从而引起腹股沟区慢性疼痛、髋关节活动受限等一系列临床症状[2].     

髋关节镜清理治疗髋臼盂唇损伤10例报告

目的:探讨髋关节镜在髋臼盂唇损伤中的诊疗价值.方法:对10例髋臼盂唇损伤的患者采用髋关节镜技术进行诊断和治疗,男性7例,女性3例.平均年龄43岁(17～63岁).左侧6例,右侧4例.髋臼发育不良4例,髋关节骨性关节炎3例,运动伤3例.关节镜检查髋臼盂唇放射瓣状损伤3例,退行性变3例,桶柄状损伤2例,横形裂2例.撕裂发生在前盂唇4例,后盂唇3例,上盂唇3例.射频气化清理增生肥厚的滑膜组织和软骨损伤的创面,切除并修整损伤的盂唇组织.结果:术后随访10例,平均11个月(6个月～31个月),髋关节症状完全解除7例,明显改善2例,1例因骨性关节炎较重于术后15个月行人工关节置换术.本组患者无血管神经损伤和感染病例.结论:髋关节镜对髋臼盂唇损伤具有重要的诊断和治疗价值,其疗效取决于关节软骨退变的程度和治疗时机.     

髋臼唇病变的影像学研究

髋臼唇同膝关节半月板一样,也是纤维软骨,它附着于髋臼边缘,具有加深髋臼更好的包容股骨头的生理作用。髋臼唇损伤是临床常见病多发病,也是导致髋关节骨性关节炎的主要潜在隐患之一,故日益引起临床的高度重视。以往对于髋臼唇病变的检查大多使用关节造影或关节镜等方法,由于上述两种方法均为有创检查,加上髋臼唇解剖形态结构复杂,髋关节腔狭窄,关节镜操作较困难,因此在应用中受到了很大的限制。随着MR检查技术的不断改进和提高,有关髋臼唇的研究也逐渐深入,无创的MRI扫描和MR关节造影为临床提供了越来越多的生理病理信息,使髋臼唇损伤和病变可以早期被发现并控制疾病的进一步发展。     

髋臼唇病损的影像学表现

髋关节由髋臼和股骨头组成,骨性髋臼内面覆盖透明软骨,髋臼周边有纤维软骨构成的盂唇,此称为髋臼唇（acetabular labrum）,它加大了髋臼的深度和容积。髋臼横韧带短而坚韧,和髋臼唇一起构成了髋臼。髋臼的关节软骨将髋臼唇与髋臼横韧带隔开,组织学可显示髋臼唇纤维软骨与髋臼软骨下骨之间的不规则移行带。正常髋臼唇近似三角形附着于髋臼的前上缘和后缘,下缘与髋臼横韧带融合,髋臼唇下缘的下份可与横韧带分离。髋臼唇分为前唇和后唇,前唇较薄,后唇较厚^[1-3]。正常髋臼唇呈倾斜走行。髋臼唇的形状和MR信号强度可随年龄而有所变化。显示髋臼唇的形状和病损以MR关节成像为最佳的方法。     

髋臼唇病损的影像学表现

髋关节由髋臼和股骨头组成,骨性髋臼内面覆盖透明软骨,髋臼周边有纤维软骨构成的盂唇,此称为髋臼唇（acetabular labrum）,它加大了髋臼的深度和容积。髋臼横韧带短而坚韧,和髋臼唇一起构成了髋臼。髋臼的关节软骨将髋臼唇与髋臼横韧带隔开,组织学可显示髋臼唇纤维软骨与髋臼软骨下骨之间的不规则移行带。正常髋臼唇近似三角形附着于髋臼的前上缘和后缘,下缘与髋臼横韧带融合,髋臼唇下缘的下份可与横韧带分离。髋臼唇分为前唇和后唇,前唇较薄,后唇较厚^[1-3]。正常髋臼唇呈倾斜走行。髋臼唇的形状和MR信号强度可随年龄而有所变化。显示髋臼唇的形状和病损以MR关节成像为最佳的方法。     

Femoroacetabular impingement: bone marrow oedema associated with fibrocystic change of the femoral head and neck junction

AIM: To describe the association of bone marrow oedema adjacent to areas of fibrocystic change at the femoral head and neck junction in patients with femoroacetabular impingement. MATERIALS AND METHODS: The clinical and imaging findings in six patients with bone marrow oedema adjacent to an area of fibrocystic change at the femoral head and neck junction are presented. There were five males and one female (age range 19-42 years, mean age 34.5 years). Three patients were referred with a clinical suspicion of femoroacetabular impingement, two with suspected osteoid osteoma and one with a clinical diagnosis of sciatica. The volume of bone marrow oedema (grade 1: 0-25%, grade 2: 26-50%, grade 3: 51-75% and grade 4: 76-100% of the femoral neck width), presence of labral and articular cartilage abnormality, joint effusion, and femoral head and neck morphology were recorded. RESULTS: Magnetic resonance imaging (MRI) identified fibrocystic change in the anterolateral aspect of the femoral head and neck junction in all cases (mean size 9 mm, range 5-14 mm, three multilocular and three unilocular cysts). The volume of oedema was variable (one grade 1, two grade 2, one grade 3 and two grade 4). All patients had abnormality of the anterosuperior labrum with five patients demonstrating chondral loss. An abnormal femoral head and neck junction was identified in five patients. CONCLUSION: The radiological finding of fibrocystic change at the anterosuperior femoral neck with or without bone marrow oedema should prompt the search for femoroacetabular impingement. Bone marrow oedema may rarely be identified adjacent to these areas of cystic change and should be considered in the differential diagnosis of bone marrow oedema in the femoral neck.     

Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients

PURPOSE: To retrospectively characterize magnetic resonance (MR) arthrographic findings in patients with cam femoroacetabular impingement (FAI) and in those with pincer FAI. MATERIALS AND METHODS: Institutional review board approval and informed consent were not required. MR arthrographic studies obtained in 50 consecutive patients (30 men, 20 women; mean age, 28.8 years) with FAI were analyzed for labral abnormalities, cartilage lesions, and osseous abnormalities of the acetabular rim. The nonspherical shape of the femoral head at the head-neck junction was measured in eight positions around the femoral head and neck and used to calculate the alpha angle. Acetabular depth was measured. Surgical diagnosis served as the reference standard. The Wilcoxon rank sum test was used for statistical analysis. RESULTS: At surgery, hips in 33 patients were classified as having cam FAI and hips in 17 patients were classified as having pincer FAI. In both groups, the mean age of patients was 28.8 years. There were significantly more men (n = 27) with cam FAI and more women (n = 14) with pincer FAI. The alpha angle was significantly larger in patients with cam FAI at the anterior and anterosuperior positions. The acetabulum was significantly deeper in patients with pincer FAI than in patients with cam FAI. Cartilage lesions at the anterosuperior and superior positions were significantly larger in patients with cam FAI than in patients with pincer FAI. Cartilage lesions at the posteroinferior position were significantly larger and labral lesions at the posterior and posteroinferior positions were more pronounced in patients with pincer FAI than in patients with cam FAI. Osseous abnormalities were not significantly different between the groups. Osseous bump formation at the femoral neck was significantly more common in patients with cam FAI than in patients with pincer FAI. CONCLUSION: Characteristic MR arthrographic findings of cam FAI include large alpha angles and cartilage lesions at the anterosuperior position and osseous bump formation at the femoral neck; characteristic findings of pincer FAI include a deep acetabulum and posteroinferior cartilage lesions.     

Magnetic resonance imaging of the hip

Standard magnetic resonance imaging (MRI) as well as MR arthrography (MRA) have been important diagnostic tools to assess for a spectrum of clinical presentations related to the hip. MRA has allowed the radiologist to closely examine intracapsular structures such as the acetabular labrum. In this article, we provide a general review of soft tissue and osseous anatomy of hips, especially focusing on the MR appearances of the acetabular labrum and the osseous morphology of the greater trochanter and ischial tuberosity with their muscle and tendon attachments. In addition, current topics in recent literature will be discussed such as femoroacetabular impingement (FAI) and rotator cuff tears of the hip.     

Comparative reliability and diagnostic performance of conventional 3T magnetic resonance imaging and 1.5T magnetic resonance arthrography for the evaluation of internal derangement of the hip

Objective

To compare the diagnostic accuracy of conventional 3T MRI against 1.5T MR arthrography (MRA) in patients with clinical femoroacetabular impingement (FAI).

Methods

Sixty-eight consecutive patients with clinical FAI underwent both 1.5T MRA and 3T MRI. Imaging was prospectively analysed by two musculoskeletal radiologists, blinded to patient outcomes and scored for internal derangement including labral and cartilage abnormality. Interobserver variation was assessed by kappa analysis. Thirty-nine patients subsequently underwent hip arthroscopy and surgical results and radiology findings were analysed.

Results

Both readers had higher sensitivities for detecting labral tears with 3T MRI compared to 1.5T MRA (not statistically significant p=0.07). For acetabular cartilage defect both readers had higher statistically significant sensitivities using 3T MRI compared to 1.5T MRA (p=0.02). Both readers had a slightly higher sensitivity for detecting delamination with 1.5T MRA compared to 3T MRI, but these differences were not statistically significant (p=0.66). Interobserver agreement was substantial to perfect agreement for all parameters except the identification of delamination (3T MRI showed moderate agreement and 1.5T MRA substantial agreement).

Conclusion

Conventional 3T MRI may be at least equivalent to 1.5T MRA in detecting acetabular labrum and possibly superior to 1.5T MRA in detecting cartilage defects in patients with suspected FAI.

Key Points

? Conventional 3T MRI is equivalent to 1.5T MRA for diagnosing labral tears. ? Conventional 3T MRI is superior to 1.5T MRA for diagnosing acetabular cartilage defect. ? Conventional 3T MRI is equivalent to 1.5T MRA for diagnosing cartilage delamination. ? Symptom severity score was significantly higher (p<0.05) in group proceeding to surgery.

     

The diagnostic performance of non-contrast 3-Tesla magnetic resonance imaging (3-T MRI) versus 1.5-Tesla magnetic resonance arthrography (1.5-T MRA) in femoro-acetabular impingement

ObjectiveThe aim of this study was to evaluate the diagnostic accuracy of 3-T non-contrast MRI versus 1.5-T MRA for assessing labrum and articular cartilage lesions in patients with clinical suspicion of femoro-acetabular impingement (FAI).Subjects and methodsFifty patients (thirty men and twenty women, mean age 42.5 years) underwent 1.5-T MRA, 3-T MRI and arthroscopy on the same hip. An optimized high-resolution proton density spin echo pulse sequence was included in the 3-T non-contrast MRI protocol.ResultsThe 3-T non-contrast MRI identified forty-two of the forty-three arthroscopically proven tears at the labral-chondral transitional zone (sensitivity, 97.7%; specificity, 100%; positive predictive value (PPV), 100%; negative predictive value (NPV), 87.5%; accuracy 98%). With 1.5-T MRA, forty-four tears were diagnosed. However, there was one false positive (sensitivity, 100%; specificity, 85.7%; PPV, 97.7%; NPV, 100%; accuracy 98%).Agreement between arthroscopy and MRI, whether 3-T non-contrast MRI or 1.5-T MRA, as to the degree of chondral lesion in the acetabulum was reached in half of the patients and in the femur in 76% of patients.ConclusionNon-invasive assessment of the hip is possible with 3-T MR magnet. 3-T non-contrast MRI could replace MRA as the workhorse technique for assessing hip internal damage. MRA would then be reserved for young adults with a strong clinical suspicion of FAI but normal findings on 3-T non-contrast MRI.When compared with 1.5-T MRA, optimized sequences with 3-T non-contrast MRI help in detecting normal variants and in diagnosing articular cartilage lesions.     

Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement

PURPOSE: To retrospectively analyze magnetic resonance (MR) arthrographic findings in patients with clinical cam-type femoroacetabular impingement. MATERIALS AND METHODS: This study was approved by the institutional review board, and informed consent was waived. Study was compliant with the Health Insurance Portability and Accountability Act. Forty-two MR arthrograms obtained in 40 patients with clinical femoroacetabular impingement were analyzed retrospectively by two radiologists. Quantitative analysis by using alpha angle measurement was performed to assess anterosuperior femoral head-neck morphology. Presence of labral tears, articular cartilage lesions, paralabral cysts, os acetabuli, and synovial herniation pits was recorded. Presence of the typical triad of anterosuperior labral tear, anterosuperior cartilage lesion, and abnormal alpha angle was recorded. Surgical comparison was available for 11 patients. RESULTS: At imaging, in 40 patients (22 male, 18 female) with a mean age of 36.5 years, 39 of 42 hips (93%) had an abnormal alpha angle, with a mean angle of 69.7 degrees ; 40 of 42 (95%) had an anterosuperior cartilage abnormality; and 42 of 42 (100%) had an anterosuperior labral tear. Thirty-seven of 42 hips (88%) had the triad. Six had paralabral cysts, 17 had an os acetabuli, and two had synovial herniation pits. Surgical comparison for 11 hips led to confirmation of all labral and cartilage abnormalities seen at imaging. CONCLUSION: MR arthrography demonstrated a triad of abnormal head-neck morphology, anterosuperior cartilage abnormality, and anterosuperior labral abnormality in 37 of 42 patients with cam-type femoroacetabular impingement.     

Fibrocystic changes at anterosuperior femoral neck: prevalence in hips with femoroacetabular impingement

PURPOSE: To retrospectively evaluate if there is an association between juxta-articular fibrocystic changes at the anterosuperior femoral neck and femoroacetabular impingement (FAI). MATERIALS AND METHODS: The institutional review board approved this study and did not require informed patient consent. An orthopedic surgeon and a radiologist in consensus retrospectively reviewed the anteroposterior (AP) pelvic radiographs of 117 hips with FAI and compared these images with the AP radiographs of a control group of 132 hips with developmental dysplasia (DD) to determine the prevalence of juxta-articular fibrocystic changes at the anterosuperior femoral neck. Criteria for juxta-articular fibrocystic changes at the anterosuperior femoral neck were location close to the physis and a diameter (of the fibrocystic change) of greater than 3 mm. The sensitivity and specificity of AP pelvic radiography in the detection of these fibrocystic changes were calculated by using an additional 61 hips with FAI and on the basis of findings at magnetic resonance (MR) arthrography, which was routinely performed for assessment of FAI. In 24 patients who underwent joint-preserving surgery for FAI, the fibrocystic changes were localized intraoperatively and the spatial relation of the region of these changes to the area of FAI was identified. Joint-preserving surgery consisted of anterior surgical dislocation of the hip with osteochondroplasty of the proximal femur and/or the acetabular rim to improve the impingement-free range of hip motion. For statistical comparisons, nonparametric tests were performed. RESULTS: Fibrocystic changes were identified on the AP radiographs of 39 (33%) of the 117 FAI-affected hips and on none of the radiographs of the 132 DD-affected hips. According to MR arthrogram findings, the sensitivity, specificity, and positive and negative predictive values of AP pelvic radiography were 64%, 93%, 91%, and 71%, respectively. The mean diameter of the juxta-articular fibrocystic changes was 5 mm (range, 3-15 mm); smaller lesions were more prevalent. Dynamic MR imaging with the hip flexed and intraoperative observations revealed a close spatial relationship between the region of the fibrocystic changes at the anterosuperior femoral neck and the acetabular rim. CONCLUSION: The high prevalence of juxta-articular fibrocystic changes at the anterosuperior femoral neck and their spatial relation to the impingement site suggest an association and possible causal relationship between these alterations and FAI.     

MRI of the Hip for the evaluation of femoroacetabular impingement; past,present, and future

The concept of femoroacetabular impingement (FAI) has, in a relatively short time, come to the forefront of orthopedic imaging. In just a few short years MRI findings that were in the past ascribed to degenerative change, normal variation, or other pathologies must now be described and included in radiology reports, as they have been shown, or are suspected to be related to, FAI. Crucial questions have come up in this time, including: what is the relationship of bony morphology to subsequent cartilage and labral damage, and most importantly, how is this morphology related to the development of osteoarthritis? In this review, we attempt to place a historical perspective on the controversy, provide guidelines for interpretation of MRI examinations of patients with suspected FAI, and offer a glimpse into the future of MRI of this complex condition. J. Magn. Reson. Imaging 2015;41:558–572. © 2014 Wiley Periodicals, Inc.     

Hip MR arthrography and femoroacetabular impingement

Hip pain is a common complaint among athletes of all ages. Advances in imaging and treatment are changing the paradigm of evaluation and management of hip pain. The role of abnormal femoral and acetabular morphology and lesions of the acetabular labrum and cartilage is increasingly recognized as being crucial in the development of degenerative change. In addition, femoroacetabular impingement is increasingly recognized as an etiologic factor in hip pain. This article discusses techniques of hip magnetic resonance (MR) arthrography, normal anatomy seen at hip MR arthrography, common intra-articular pathologies in patients with hip pain, and imaging findings of femoroacetabular impingement.