REVIEW PAPER
Magnetic resonance imaging of the hip: anatomy and pathology
,
 
 
 
 
More details
Hide details
1
Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, UK
 
 
Submission date: 2020-06-06
 
 
Final revision date: 2020-07-21
 
 
Acceptance date: 2020-07-22
 
 
Publication date: 2020-09-04
 
 
Pol J Radiol, 2020; 85: 489-508
 
KEYWORDS
TOPICS
ABSTRACT
The aim of this review is to outline the normal anatomy of the hip and to discuss common painful conditions of the hip that affect the general adult population. Hip pain is a common complaint with many different etiologies. In this review, hip pathologies are divided by location into osseous, intra-articular and extra-articular lesions. Magnetic resonance imaging (MRI) is the modality of choice for investigating painful hip conditions due to its multiplanar capability and high contrast resolution. This review focuses on the characteristic MRI features of common traumatic and pathologic conditions of the hip.
 
REFERENCES (69)
1.
Omoumi P, Vande Berg B. Hip imaging: normal variants and asymptomatic findings. Semin Musculoskelet Radiol 2017; 21: 507-517.
 
2.
Hegazi TM, Belair JA, McCarthy EJ, et al. Sports injuries about the hip: what the radiologist should know. Radiographics 2016; 36: 1717-1745.
 
3.
Chang CY, Huang AJ. MR imaging of normal hip anatomy. Magn Reson Imaging Clin N Am 2013; 21: 1-19.
 
4.
Ladd LM, Blankenbaker DG, Davis KW, et al. MRI of the hip: important injuries of the adult athlete. Curr Radiol Rep 2014; 2: 51123.
 
5.
Blankenbaker DG, Tuite MJ. The painful hip: new concepts. Skeletal Radiol 2006; 35: 352-370.
 
6.
Teh J. Imaging the hip. Imaging 2007; 19: 234-248.
 
7.
Schmaranzer F, Todorski IAS, Lerch TD, et al. Intra-articular lesions: imaging and surgical correlation. Semin Musculoskelet Radiol 2017; 21: 487-506.
 
8.
Agten CA, Sutter R, Buck FM, et al. Hip imaging in athletes: sports imaging series. Radiology 2016; 280: 351-369.
 
9.
Ilizaliturri VM, Byrd JWT, Sampson TG, et al. A geographic zone method to describe intra-articular pathology in hip arthroscopy: cadaveric study and preliminary report. Arthroscopy 2008; 24: 534-539.
 
10.
Naraghi A, White LM. MRI of labral and chondral lesions of the hip. Am J Roentgenol 2015; 205: 479-490.
 
11.
Sutter R, Zubler V, Hoffmann A, et al. Hip MRI: how useful is intraarticular contrast material for evaluating surgically proven lesions of the labrum and articular cartilage? Am J Roentgenol 2014; 202: 160-169.
 
12.
Magee T. Comparison of 3.0-T MR vs. 3.0-T MR arthrography of the hip for detection of acetabular labral tears and chondral defects in the same patient population. Br J Radiol 2015; 88: 1-7.
 
13.
Llopis E, Cerezal L, Kassarjian A, et al. Direct MR arthrography of the hip with leg traction: feasibility for assessing articular cartilage. Am J Roentgenol 2008; 190: 1124-1128.
 
14.
Schmaranzer F, Klauser A, Kogler M, et al. Diagnostic performance of direct traction MR arthrography of the hip: detection of chondral and labral lesions with arthroscopic comparison. Eur Radiol 2015; 25: 1721-1730.
 
15.
Vilanova JC, Ribes R. Learning diagnostic imaging. In: Musculoskeletal imaging. Berlin, Heildelberg: Springer; 2008; 127-151.
 
16.
Cerezal L, Kassarjian A, Canga A, et al. Anatomy, biomechanics, imaging, and management of ligamentum teres injuries. Radiographics 2010; 30: 1637-1651.
 
17.
Blankenbaker DG, de Smet AA, Keene JS, et al. Imaging appearance of the normal and partially torn ligamentum teres on hip MR arthrography. Am J Roentgenol 2012; 199: 1093-1098.
 
18.
Wagner F V, Negrão JR, Campos J, et al. Capsular ligaments of the hip: anatomic, histologic, and positional study in cadaveric specimens with MR arthrography. Radiology 2012; 263: 189-198.
 
19.
Robinson P, White LM, Agur A, et al. Obturator externus bursa: anatomic origin and MR imaging features of pathologic involvement. Radiology 2003; 228: 230-234.
 
20.
Pfirrmann CWA, Chung CB, Theumann NH, et al. Greater trochanter of the hip: Attachment of the abductor mechanism and a complex of three bursae – MR imaging and MR bursography in cadavers and MR imaging in asymptomatic volunteers. Radiology 2001; 221: 469-477.
 
21.
Hirschmann A, Falkowski AL, Kovacs B. Greater trochanteric pain syndrome: abductors, external rotators. Semin Musculoskelet Radiol 2017; 21: 539-546.
 
22.
Kassarjian A, Fritz B, Afonso PD, et al. Guidelines for MR. Imaging of the hip region. 2016. Available at: https://essr.org/content-essr/....
 
23.
Sheehan SE, Shyu JY, Weaver MJ, et al. Proximal femoral fractures: what the orthopedic surgeon wants to know. Radiographics 2015; 35: 1563-1584.
 
24.
Long MM, Stetts DM. Stress fractures of the femoral neck. Orthop Nurs 1985; 4: 70-72.
 
25.
Kim SJ, Ahn J, Kim HK, et al. Is magnetic resonance imaging necessary in isolated greater trochanter fracture? A systemic review and pooled analysis. BMC Musculoskelet Disord 2015; 16: 395.
 
26.
Ikemura S, Yamamoto T, Motomura G, et al. MRI evaluation of collapsed femoral heads in patients 60 years old or older: Differentiation of subchondral insufficiency fracture from osteonecrosis of the femoral head. Am J Roentgenol 2010; 195: W63-68.
 
27.
Schueller-Weidekamm C, Teh J. Inflammatory conditions of the hip. Semin Musculoskelet Radiol 2017; 21: 589-603.
 
28.
Murphey MD, Foreman KL, Klassen-Fischer MK, et al. From the radiologic pathology archives: imaging of osteonecrosis: radiologic-pathologic correlation. Radiographics 2014; 34: 1003-1028.
 
29.
Mitchell DG, Steinberg ME, Dalinka MK, et al. Magnetic resonance imaging of the ischemic hip. Alterations within the osteonecrotic, viable, and reactive zones. Clin Orthop Relat Res 1989; 244: 60-77.
 
30.
Jawad MU, Haleem AA, Scully SP. In brief: Ficat classification: avascular necrosis of the femoral head. Clin Orthop Relat Res 2012; 470: 2636-2639.
 
31.
Lee GC, Khoury V, Steinberg D, et al. How do radiologists evaluate osteonecrosis? Skeletal Radiol 2014; 43: 607-614.
 
32.
Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br 1985; 67: 3-9.
 
33.
Lamer S, Dorgeret S, Khairouni A, et al. Femoral head vascularisation in Legg-Calvé-Perthes disease: Comparison of dynamic gadolinium-enhanced subtraction MRI with bone scintigraphy. Pediatr Radiol 2002; 32: 580-585.
 
34.
Ducou le Pointe H, Haddad S, Silberman B, et al. Legg-Perthes-Calvé disease: staging by MRI using gadolinium. Pediatr Radiol 1994; 24: 88-91.
 
35.
Merlini L, Combescure C, de Rosa V, et al. Diffusion-weighted imaging findings in Perthes disease with dynamic gadolinium-enhanced subtracted (DGS) MR correlation: a preliminary study. Pediatr Radiol 2010; 40: 318-325.
 
36.
De Rosa V, Laurent M, Canavese F, et al. A simple, precocious, and reliable way to assess future clinical outcome in children with Perthes disease and mild femoral head involvement: correlation between MRI with diffusion-weighted and dynamic gadolinium-enhanced subtraction and Catterall and Herring classifications. Eur J Orthop Surg Traumatol 2018; 28: 1283-1290.
 
37.
Szwedowski D, Nitek Z, Walecki J. Evaluation of transient osteoporosis of the hip in magnetic resonance imaging. Polish J Radiol 2014; 79: 36-38.
 
38.
Balakrishnan A, Schemitsch EH, Pearce D, et al. Distinguishing transient osteoporosis of the hip from avascular necrosis. Can J Surg 2003; 46: 187-192.
 
39.
Gray AJR, Villar RN. The ligamentum teres of the hip: an arthroscopic classification of its pathology. Arthroscopy 1997; 13: 575-578.
 
40.
McCarthy JC, Noble PC, Schuck MR, et al. The role of labral lesions to development of early degenerative hip disease. Clin Orthop Relat Res 2001; 393: 25-37.
 
41.
Blankenbaker DG, de Smet AA, Keene JS, et al. Classification and localization of acetabular labral tears. Skeletal Radiol 2007; 36: 391-397.
 
42.
Freedman BA, Potter BK, Dinauer PA, et al. Prognostic value of magnetic resonance arthrography for czerny stage II and III acetabular labral tears. Arthroscopy 2006; 22: 742-747.
 
43.
Czerny C, Hofmann S, Urban M, et al. MR arthrography of the adult acetabular capsular-labral complex: Correlation with surgery and anatomy. Am J Roentgenol 1999; 173: 345-349.
 
44.
Neumann G, Mendicuti AD, Zou KH, et al. Prevalence of labral tears and cartilage loss in patients with mechanical symptoms of the hip: evaluation using MR arthrography. Osteoarthr Cartil 2007; 15: 909-917.
 
45.
Albers CE, Wambeek N, Hanke MS, et al. Imaging of femoroacetabular impingement-current concepts. J Hip Preserv Surg 2016; 3: 245-261.
 
46.
Leunig M, Beck M, Kalhor M, et al. Fibrocystic changes at anterosuperior femoral neck: prevalence in hips with femoroacetabular impingement. Radiology 2005; 236: 237-246.
 
47.
Nepple JJ, Vigdorchik JM, Clohisy JC. What is the association between sports participation and the development of proximal femoral cam deformity? Am J Sports Med 2015; 43: 2833-2840.
 
48.
Nötzli HP, Wyss TF, Stoecklin CH, et al. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 2002; 84: 556-560.
 
49.
Pfirrmann CWA, Duc SR, Zanetti M, et al. MR arthrography of acetabular cartilage delamination in femoroacetabular cam impingement. Radiology 2008; 249: 236-241.
 
50.
Sutter R, Pfirrmann CWA. Update on femoroacetabular impingement: what is new, and how should we assess it? Semin Musculoskelet Radiol 2017; 21: 518-528.
 
51.
Tannast M, Hanke MS, Zheng G, et al. What are the radiographic reference values for acetabular under- and overcoverage? Clin Orthop Relat Res 2015; 473: 1234-1246.
 
52.
Corten K, Ganz R, Chosa E, et al. Bone apposition of the acetabular rim in deep hips: a distinct finding of global pincer impingement. J Bone Joint Surg Br 2011; 93: 10-16.
 
53.
Larson CM, Stone RM. The rarely encountered rim fracture that contributes to both femoroacetabular impingement and hip stability: a report of 2 cases of arthroscopic partial excision and internal fixation. Arthroscopy 2011; 27: 1018-1022.
 
54.
Fritz B, Bensler S, Leunig M, et al. MRI assessment of supra- and infratrochanteric femoral torsion: association with femoroacetabular impingement and hip dysplasia. Am J Roentgenol 2018; 211: 155-161.
 
55.
Sutter R, Dietrich TJ, Zingg PO, et al. Femoral antetorsion: comparing asymptomatic volunteers and patients with femoroacetabular impingement. Radiology 2012; 263: 475-483.
 
56.
Carton P, Filan D. Anterior inferior iliac Spine (AIIS) and subspine hip impingement. Muscles Ligaments Tendons J 2016; 6: 324-336.
 
57.
Hetsroni I, Poultsides L, Bedi A, et al. Anterior inferior iliac spine morphology correlates with hip range of motion: A classification system and dynamic model hip. Clin Orthop Relat Res 2013; 471: 2497-2503.
 
58.
Samim M, Walter W, Gyftopoulos S, et al. MRI assessment of subspine impingement: Features beyond the anterior inferior iliac spine morphology. Radiology 2019; 293: 412-421.
 
59.
Beltran LS, Rosenberg ZS, Mayo JD, et al. Imaging evaluation of developmental hip dysplasia in the young adult. Am J Roentgenol 2013; 200: 1077-1088.
 
60.
Chen L, Boonthathip M, Cardoso F, et al. Acetabulum protrusio and center edge angle: New MR-imaging measurement criteria – a correlative study with measurement derived from conventional radiography. Skeletal Radiol 2009; 38: 123-129.
 
61.
Boutry N, Paul C, Leroy X, et al. Original report of the hip: MR imaging findings. AJR Am J Roentgenol 2002; 179: 657-663.
 
62.
Murphey MD, Vidal JA, Fanburg-Smith JC, et al. From the archives of the AFIP: imaging of synovial chondromatosis with radiologic-pathologic correlation. Radiographics 2007; 27: 1465-1488.
 
63.
Steinmetz S, Rougemont AL, Peter R. Pigmented villonodular synovitis of the hip. EFORT Open Rev 2016; 1: 260-266.
 
64.
Murphey MD, Rhee JH, Lewis RB, et al. From the archives of the AFIP pigmented villonodular synovitis: radiologic-pathologic correlation. Radiographics 2008; 28: 1493-1518.
 
65.
Ali AM, Teh J, Whitwell D, et al. Ischiofemoral impingement: a retrospective analysis of cases in a specialist orthopaedic centre over a four year period. Hip Int 2013; 23: 263-268.
 
66.
Torriani M, Souto SCL, Thomas BJ, et al. Ischiofemoral impingement syndrome: An entity with hip pain and abnormalities of the quadratus femoris muscle. Am J Roentgenol 2009; 193: 186-190.
 
67.
Akça A, Safak KY, Ilis ED, et al. Ischiofemoral impingement: assessment of MRI findings and their reliability. Acta Ortop Bras 2016; 24: 318-321.
 
68.
Yoong P, Mansour R, Teh JL. Multiple hereditary exostoses and ischiofemoral impingement: a case-control study. Skeletal Radiol 2014; 43: 1225-1230.
 
69.
Agten CA, Sutter R, Dora C, et al. MR imaging of soft tissue alterations after total hip arthroplasty: comparison of classic surgical approaches. Eur Radiol 2017; 27: 1312-1321.v.
 
Journals System - logo
Scroll to top