21 year-old collegiate rower: R/O labral tear

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Isaac Harrell
6 years ago
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Imaging The Coleman Chair, MRI Research Hospital

Medical College of Cornell University MRI of the

entire pelvis: body coil Coronal FMIR (fat

$fracture or malignancy Surface coil (shoulder PA;$ sagittal, axial FSE 332 x 442µ by 2.

(rather than diagnostic) tool 21 year-old

cartilage Viscoelastic substance with strong

properties dependent on: Cellular composition of

sequence utilized Moderate TE FSE more sensitive

1 Hip MRI Primer AOSSM 2014 Hollis G. Potter, MD Chair, Department of Radiology & Imaging The Coleman Chair, MRI Research Hospital for Special Surgery Professor of Radiology Weill Medical College of Cornell University MRI of the Hip: Technical Considerations Survey images of entire pelvis: body coil Coronal FMIR (fat suppression) Axial FSE Evaluate for occult pelvic fracture or malignancy Surface coil (shoulder PA; center over head) Cartilage-sensitive coronal, sagittal, axial FSE 332 x 442µ by 2.5-3mm Preserves hip arthroscopy as a therapeutic (rather than diagnostic) tool 21 year-old collegiate rower: R/O labral tear Articular cartilage Viscoelastic substance with strong imaging and biomechanical anisotropy Signal properties dependent on: Cellular composition of collagen, proteoglycans and water MR pulse sequence utilized Moderate TE FSE more sensitive to partial thickness lesions Orientation of collagen in different laminae of cartilage 53 year-old woman with preserved joint space

NONCONTRAST MRI OF THE HIP: DIAGNOSTIC ACCURACY HSS study: 92

independent MR radiologists; 2 surgeons LABRUM 84/88 labral

92% interobserver agreement 38% associated with paralabral

using standardized forms 87% of cases MRI was within one grade

88%, kappa 0.8 (p<0.001) Labral tears: Noncontrast MRI vs.

$osteochondral fracture Measurement of the α angle on oblique$ Center of femoral neck at narrowest margin and center of head

2 NONCONTRAST MRI OF THE HIP: DIAGNOSTIC ACCURACY HSS study: 92 pts. (mean age 39 yrs); preop MRI followed by arthroscopy 2 independent MR radiologists; 2 surgeons LABRUM 84/88 labral tears seen on MRI 84/88 anterior Sensitivity 97%; Accuracy 93% 92% interobserver agreement 38% associated with paralabral cysts CARTILAGE Graded by modified Outerbridge classification using standardized forms 87% of cases MRI was within one grade of arthroscopy Femoral head: Sensitivity 86%, specificity 88%, accuracy 87%, kappa 0.7 (p<0.001) Acetabulum: Sensitivity 91%, specificity 85%, accuracy 88%, kappa 0.8 (p<0.001) Labral tears: Noncontrast MRI vs. MRA Traumatic chondral injury: isolated chondral shear vs osteochondral fracture Measurement of the α angle on oblique axial MR images (abnormal >55 degrees): 1. Center of femoral neck at narrowest margin and center of head 2. Center of femoral head to where bump exceeds head radius Notzli et al; JBJS(Br) 2002; 84: Pfirrmann et al; Radiology 2006; 240:

3 22 year-old Olympic gold medalist in figure skating: 1.5T Note full thickness cartilage loss over the anterior dome and femoral head 23 year-old man with classic FAI: left hip 17 year-old girl with early features of FAI 20 year-old woman with FAI + coxa valga + DDH

4 41 year-old woman with anterior labral tear AND micro-instability 28 year-old woman excessive femoral anteversion: Preoperative MRI 4/10 Postoperative treatment for FAI 2/11: features of anterior instability 30 year-old 8 months post arthroscopy with anterior subluxation

32 year-old ballet dancer with hip pain preoperative

42 year-old woman with DDH being considered for PAO

and water content T1rho in the Hip T1rho using mean

assessing hip cartilage (Dillon et al; ISMRM 2011)

5T in 20 patients with and without FAI: mean values

stratification of T1rho and prolonged values in the

94B:1187-1192) Assessment of cartilage matrix depletion

3D CT in FAI patients T2 and T1rho values in and

were compared T2 Mapping Results (n=30 hips)

5 32 year-old ballet dancer with hip pain preoperative study 11/04 Post arthroscopic labral debridement 9/06 42 year-old woman with DDH being considered for PAO FSE: morphology T 2 : collagen orientation T1 ρ : PG and water content T1rho in the Hip T1rho using mean ROIs has been shown to be highly reproducible for assessing hip cartilage (Dillon et al; ISMRM 2011) Pilot study of T1rho at 1.5T in 20 patients with and without FAI: mean values were simliar but the FAI group demonstrated a lack of stratification of T1rho and prolonged values in the deeper zones (Rakhra; Beaule et al, JBJS Br 2012; 94B: ) Assessment of cartilage matrix depletion by QMRI as predicted by subchondral bone impaction on 3D CT in FAI patients T2 and T1rho values in and outside of the zone of collision (identified on CT) were compared T2 Mapping Results (n=30 hips) Superficial In vs. Superficial Out- difference in means: 8.93 ms, (p<0.001) Deep In vs. Deep Out difference in means: ms (p< 0.001)

6 Superficial In vs. Deep In- difference in means:.43 ms, (p=.657) ) indicating loss of stratification in the zone of collision Superficial Out vs. Deep Out - difference in means: 3.22 ms (p< 0.001) T1rho (n=22 hips) In vs. Out difference in means: 9.10 ms, (p<0.001) 41 year-old woman with synovial chondromatosis 41 year-old man with PVNS and rapidly progressive OA Utility of gradient echo imaging Abductor tendinosis Gluteus minimus and medius tendons: rotator cuff of the hip +/- trochanteric bursitis Evaluate degree of atrophy

17 year-old R/O labral tear MRI of Hip Cartilage Standardized, validated sequences should be utilized FAI presents with many different patterns on MRI Consider optimized

assess both PG and collagen Registration methodology helpful in longitudinal analysis References 1. Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J.

Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology 2006; 240(3):778-85. 3.

T2 relaxation time and delayed gadolinium-enhanced MRI of cartilage (dgemric) of human patellar cartilage at 1.5 T and 9.4 T: Relationships with tissue mechanical properties. 4.

magnetic resonance imaging of cartilage. J Bone Joint Surg 2003;85A:1987-1992 5. Cunningham T, Jessel R, Zurakowski D, Millis MB, Kim YJ.

2006;88(7):1540-8. 6. Nishii T, Tanaka H, Sugano N, Sakai T, Hananouchi T, Yoshikawa H.

7 17 year-old R/O labral tear MRI of Hip Cartilage Standardized, validated sequences should be utilized FAI presents with many different patterns on MRI Consider optimized noncontrast imaging as an alternative to intra-articular contrast: Visualize native capsule Preserves MR as noninvasive; reduced cost Quantitative evaluation should ideally assess both PG and collagen Registration methodology helpful in longitudinal analysis References 1. Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral headneck junction as a predictor for the risk of anterior impingement. JBJS Br 2002; 84: Pfirrmann CW, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J.Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology 2006; 240(3): Lammentausta E, Kiviranta P, Nissi MJ, Laasanen MS, Kiviranta I, Nieminen MT, Jurvelin JS. T2 relaxation time and delayed gadolinium-enhanced MRI of cartilage (dgemric) of human patellar cartilage at 1.5 T and 9.4 T: Relationships with tissue mechanical properties. 4. Kim YJ, Jaramillo D, Millis MB, Gray ML, Burstein D. Assessment of early osteoarthritis in hip dysplasia with delayed gadolinium-enhanced. magnetic resonance imaging of cartilage. J Bone Joint Surg 2003;85A: Cunningham T, Jessel R, Zurakowski D, Millis MB, Kim YJ. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage to predict early failure of Bernese periacetabular osteotomy for hip dysplasia. J Bone Joint Surg Am. 2006;88(7): Nishii T, Tanaka H, Sugano N, Sakai T, Hananouchi T, Yoshikawa H. Evaluation of cartilage matrix disorders by T2 relaxation time in patients with hip dysplasia. Osteoarthritis Cartilage 2008;16(2): Mintz DN, Hooper TR, Connell DA, Buly R, Padgett DE, Potter HG. Magnetic resonance imaging of the hip: detection of labral and chondral abnormalities using non-contrast imaging. Arthroscopy 2005; 21(4): Maier CF, Tan SG, Hariharan H, Potter HG. T 2 quantitation of articular cartilage at 1.5T. J Magn Reson Imaging 2003; 17(3):

8 9. Hayter CL, Koff MF, Potter HG. Magnetic resonance imaging of the postoperative hip. J Magn Reson Imaging (5): Hayter CL, Gold SL, Potter HG. Magnetic resonance imaging of the wrist: bone and cartilage injury. J Magn Reson Imaging 2013; 37(5): Rakhra KS, Lattanzio PJ, Cárdenas-Blanco A, Cameron IG, Beaulé PE. Can T1-rho MRI detect acetabular cartilage degeneration in femoroacetabular impingement?: a pilot study. J Bone Joint Surg Br Sep;94(9): Dillon, et al. ISMRM Proceedings 2011.

FAI syndrome with or without labral tear.

FAI syndrome with or without labral tear. Case This 16-year-old female, soccer athlete was treated for pain in the right groin previously. Now has acute onset of pain in the left hip. The pain was in the groin that was worse with activities. Diagnosis