Download Hip joint - O6U E

MRI HIP JOINT
BONY ANATOMY
• Femur
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Femoral Head
Femoral Neck
Greater Trochanter
Lesser Trochanter
Gluteal Tuberosity
Acetabulum
BONY ANATOMY
• Pelvic Girdle
• Acetabulum
• 3 bones fused together
• Ilium
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Lateral View
Iliac fossa
Iliac Crest
ASIS
AIIS
PSIS
PIIS
Gluteal Lines
Greater Sciatic Notch
BONY ANATOMY
• Ilium
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Medial View
Iliac fossa
Iliac Crest
Iliac Tuberosity
ASIS
AIIS
PSIS
PIIS
Gluteal Lines
ARTICULATIONS OF THE HIP AND PELVIS
• Pubic Symphysis
• Interpubic disk
• Some movement
ARTICULATIONS OF THE HIP AND PELVIS
• Pubic Symphysis
• Sacroiliac Joints
ARTICULATIONS OF THE HIP AND PELVIS
• Pubic Symphysis
• Sacroiliac Joints
• Hip Joints
LIGAMENTOUS AND CARTILOGENOUS
STRUCTURES FOR THE HIP AND PELVIC
GIRDLE
• Sacroiliac Joint
• Sacrotuberous
• Sacrospinous
• Function of these two
ligaments
• Iliolumbar
• Interosseous Sacroiliac
LIGAMENTOUS AND CARTILOGENOUS
STRUCTURES FOR THE HIP AND PELVIC GIRDLE
• Sacroiliac Joint
• Sacrotuberous
• Sacrospinous
• Function of these two
ligaments
• Iliolumbar
• Interosseous Sacroiliac
LIGAMENTOUS AND CARTILOGENOUS
STRUCTURES FOR THE HIP AND PELVIC GIRDLE
• Sacroiliac Joint
• Sacrotuberous
• Sacrospinous
• Function of these two
ligaments
• Iliolumbar
• Interosseous Sacroiliac
• Dorsal Sacroiliac
LIGAMENTOUS AND CARTILOGENOUS
STRUCTURES FOR THE HIP AND PELVIC GIRDLE
• Sacroiliac Joint
• Hip Joint
• Capsule
• Three thickenings of the
capsule
• Iliofemoral
• Pubofemoral
• Ishiofemoral
• Ligamentum Teres
• Inguinal
LIGAMENTOUS AND CARTILOGENOUS
STRUCTURES FOR THE HIP AND PELVIC GIRDLE
• Sacroiliac Joint
• Hip Joint
• Capsule
• Three thickenings of the
capsule
• Iliofemoral
• Pubofemoral
• Ishiofemoral
• Ligamentum Teres
• Inguinal
LIGAMENTOUS AND CARTILOGENOUS
STRUCTURES FOR THE HIP AND PELVIC GIRDLE
• Sacroiliac Joint
• Hip Joint
• Capsule
• Three thickenings of the
capsule
• Iliofemoral
• Pubofemoral
• Ishiofemoral
• Ligamentum Teres
• Inguinal
LIGAMENTOUS AND CARTILOGENOUS
STRUCTURES FOR THE HIP AND PELVIC GIRDLE
• Sacroiliac Joint
• Hip Joint
• Capsule
• Three thickenings of the
capsule
• Iliofemoral
• Pubofemoral
• Ishiofemoral
• Ligamentum Teres
• Inguinal
HIP MUSCLES
• Anterior
• Rectus Femoris
• Sartorius
• Iliopsoas Muscle Group
• Iliacus
• Psoas Major
HIP MUSCLES
• Anterior
• Rectus Femoris
• Sartorius
• Iliopsoas Muscle Group
• Iliacus
• Psoas Major
HIP MUSCLES
• Posterior
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Semimembranosus
Semitendinosus
Biceps Femoris
Gluteus Maximus
HIP MUSCLES
• Medial
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Adductor Brevis
Adductor Longus
Adductor Magnus
Pectineus
Gracilus
HIP MUSCLES
• Lateral
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Gluteus Medius
Gluteus Minimus
Tensor Fascia Lata
Six Intrinsic External Rotators
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Periformis
Quadratus Femoris
Obturator Internus
Obturator Externus
Gemellua Superior
Gemellus Inferior
HIP MUSCLES
• Lateral
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Gluteus Medius
Gluteus Minimus
Tensor Fascia Lata
Six Intrinsic External Rotators
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Periformis
Quadratus Femoris
Obturator Internus
Obturator Externus
Gemellua Superior
Gemellus Inferior
FEMORAL TRIANGLE
• Borders
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Superior
Lateral
Medial
Posterior
Anterior
• Structures
MOVEMENTS OF THE PELVIS
• Forward and Backward Tilt
• Left and right Lateral Tilt
• Left and Right Rotation
INDICATIONS
1. Avascular necrosis
2. Inflammatory arthritis
3. Osteoarthritis
4. Bursitis
5. Traumatic Fracture
6. Stress Fracture
7. Pathologic Fracture
8. Tendonitis
9. Muscle Injury
10. Acetabular Labral Tear
11. Degenerative Disk Disease
Patient Preparation
1. Have the patient go to the toilet before the
study
2. Explain the procedure to the patient
3. Offer the patient ear protectors or ear plugs
4. Have the patient undress except for
underwear
5. Ask the patient to remove anything containing
metal (hearing aids, hairpins, body jewelry,
etc.)
POSITIONING
1. Supine
2. Body array coil (body coil, wraparound coil)
3. Cushion the legs with a small roll under the knees
(do not elevate thethighs too much)
4. Have the patient cross the arms over the upper
abdomen
TECHNIQUE
1- Scout localizer
Coronal
plane
Axial
plane
2- Sequences (4)
1- coronalSTIR or T2
2-coronalT1
3- axial
T2
4- sagittalT1
Sequence 1 coronal across the femoral heads
(allow for an oblique presentation of the pelvis)
1-TIRM or STIR or T2-weighted, fat-saturated-or T1
• Plane:- parallel femoral heads. Scan from ischium through pubic
symphysis.
A.
B.
C.
D.
Slice thickness: 4mm T1 – 4-6 mm
Slice gap: 20% of slice thickness (!0.8mm or factor 1.2)
FOV: 350–380mm
Saturation slab: axial superior to the slices for saturation of the
vessels
1.5 and 1.0 T:
— TR = 6500
— TE = 30–60
— TI = 140
— Flip angle 180°
(1.0 and) 0.5 T:
— TR = 1800–2200
— TE = 30–60
— TI = 100–120
— Flip angle 90°
For T2-weighted - fat saturation
TSE, FS:
— TR = 2000–3500
— TE = 100–120
Sequence2 axial across the femoral heads and acetabula
(caudad to the lower aspect of the greater trochanter)
1- T2-weighted
•
A.
B.
C.
D.
Plane:- parallel line bisecting lesser trochanters and/or acetabular roofs. Scan
from iliac crests through lesser trochanter.
Slice thickness: 5–6mm
Slice gap: 20% of slice thickness (!1.0–1.2mm or factor 1.2)
FOV: approx. 350–380mm (possibly rectangular FOV), adjust
Saturation slab: axial (parallel) superior to the slices for saturation
of the vessels
For T2-weighted - fat saturation
TSE, FS:
— TR = 2000–4000
— TE = 100–130
Sequence 3 sagittal across both femoral heads
1- T1-–weighted
• Plane:- plane perpendicular to coronal plane. Scan from acetabulum
through greater trochanter.
A.
B.
C.
D.
Slice thickness: 5–6mm
Slice gap: 0–20% of slice thickness (! 0–1.2mm or factor 0–1.2)
FOV: approx. 380–400mm
Saturation slab: axial superior to the slices for saturation of the
vessels
T1
TR = 500–600
TE = 10–12
Tips & Tricks
Positioning aid:
• Center on anterior inferior iliac spine
If the coronal images show vascular artifacts due to the iliac
vessels, switching the phase encoding gradient to HF may help
(with oversampling in order to avoid fold over)