DOI QR코드

DOI QR Code

Direct MR Arthrography of the Hip: Diagnosis and Pitfalls of Acetabular Labral Lesions

고관절 직접 자기공명관절조영술: 비구순 병변의 진단 및 함정

  • Eun Sol Lim (Department of Radiology, Chonnam National University Hospital) ;
  • Yong Kyun Kim (Department of Radiology, Chonnam National University Hospital) ;
  • Hye Mi Park (Department of Radiology, Chonnam National University Hwasun Hospital) ;
  • Seung Jin Lee (Department of Radiology, Chonnam National University Hospital)
  • 임은솔 (전남대학교병원 영상의학과) ;
  • 김용균 (전남대학교병원 영상의학과) ;
  • 박혜미 (화순전남대학교병원 영상의학과) ;
  • 이승진 (전남대학교병원 영상의학과)
  • Received : 2020.08.06
  • Accepted : 2020.10.30
  • Published : 2021.09.01

Abstract

Tearing of the acetabular labrum is a common cause of chronic hip pain. MR arthrography (MRA) of the hip is the imaging procedure of choice for the evaluation of acetabular labrum. Familiarity with the various imaging findings of MRA of the hip allows recognition of normal variants and differentiation from true pathologic conditions. This article comprehensively reviews the technical aspects and interpretation of MRA of the hip. The appearances of normal and abnormal labra in MRA are discussed. Potential pitfalls in labral tear interpretation, such as sulci around the hip, normal variants of the labrum and plicae, and osseocartilaginous and soft tissue lesions identified on MRA of the hip are also described.

비구순 파열은 만성 고관절 통증의 흔한 원인 중 하나이며, 고관절 자기공명관절조영술은 비구순의 평가를 위한 중요한 검사 방법이다. 비구순의 정상변이와 비정상 상태를 구별하여 정확한 진단을 하기 위해서는 고관절 자기공명관절조영술에서 보이는 다양한 영상 소견을 숙지하는 것이 필요하다. 본 글에서는 고관절 자기공명관절조영술 시행의 기술적인 방법 및 영상해석에 관해 종합적으로 검토하고자 한다. 고관절 자기공명관절조영술에서 비구순의 정상 및 비정상 소견을 살펴본다. 또한 비구순 파열과 유사하게 보여 감별이 필요한 고관절 주위틈, 비구순의 정상변이, 주름 등에 대해 알아보고, 고관절 자기공명관절조영술에서 볼 수 있는 골연골 및 연조직 병변 등의 소견에 관해 기술한다.

Keywords

References

  1. McCarthy JC. Hip arthroscopy: applications and technique. J Am Acad Orthop Surg 1995; 3:115-122 
  2. Narvani AA, Tsiridis E, Tai CC, Thomas P. Acetabular labrum and its tears. Br J Sports Med 2003;37:207-211 
  3. Rubin DA. Femoroacetabular impingement: fact, fiction, or fantasy? AJR Am J Roentgenol 2013;201:526-534 
  4. Naraghi A, White LM. MRI of labral and chondral lesions of the hip. AJR Am J Roentgenol 2015;205:479-490 
  5. Drape JL, Thelen P, Gay-Depassier P, Silbermann O, Benacerraf R. Intraarticular diffusion of Gd-DOTA after intravenous injection in the knee: MR imaging evaluation. Radiology 1993;188:227-234 
  6. Winalski CS, Aliabadi P, Wright RJ, Shortkroff S, Sledge CB, Weissman BN. Enhancement of joint fluid with intravenously administered gadopentetate dimeglumine: technique, rationale, and implications. Radiology 1993;187:179-185 
  7. Kramer J, Recht MP, Imhof H, Stiglbauer R, Engel A. Postcontrast MR arthrography in assessment of cartilage lesions. J Comput Assist Tomogr 1994;18:218-224 
  8. Flannigan B, Kursunoglu-Brahme S, Snyder S, Karzel R, Del Pizzo W, Resnick D. MR arthrography of the shoulder: comparison with conventional MR imaging. AJR Am J Roentgenol 1990;155:829-832 
  9. Masi JN, Newitt D, Sell CA, Daldrup-Link H, Steinbach L, Majumdar S, et al. Optimization of gadodiamide concentration for MR arthrography at 3 T. AJR Am J Roentgenol 2005;184:1754-1761 
  10. Andreisek G, Froehlich JM, Hodler J, Weishaupt D, Beutler V, Pfirrmann CW, et al. Direct MR arthrography at 1.5 and 3.0 T: signal dependence on gadolinium and iodine concentrations--phantom study. Radiology 2008;247:706-716 
  11. Choi JY, Kang HS, Hong SH, Lee JW, Kim NR, Jun WS, et al. Optimization of the contrast mixture ratio for simultaneous direct MR and CT arthrography: an in vitro study. Korean J Radiol 2008;9:520-525 
  12. Yao L, Gentili A, Seeger LL. Saline versus gadolinium-enhanced magnetic resonance arthrography of porcine cartilage. Acad Radiol 1997;4:127-131 
  13. Zanetti M, Hodler J. Contrast media in MR arthrography of the glenohumeral joint: intra-articular gadopentetate vs saline: preliminary results. Eur Radiol 1997;7:498-502 
  14. Sahin G, Demirta,s M. An overview of MR arthrography with emphasis on the current technique and applicational hints and tips. Eur J Radiol 2006;58:416-430 
  15. Petersilge CA. MR arthrography for evaluation of the acetabular labrum. Skeletal Radiol 2001;30:423-430 
  16. Czerny C, Hofmann S, Neuhold A, Tschauner C, Engel A, Recht MP, et al. Lesions of the acetabular labrum: accuracy of MR imaging and MR arthrography in detection and staging. Radiology 1996;200:225-230 
  17. Chan BY, Allen H, Davis KW, Blankenbaker DG. MR imaging of the hip: avoiding pitfalls, identifying normal variants. Appl Radiol 2018;47:8-14 
  18. Kelly BT, Weiland DE, Schenker ML, Philippon MJ. Arthroscopic labral repair in the hip: surgical technique and review of the literature. Arthroscopy 2005;21:1496-1504 
  19. McCarthy JC, Noble PC, Schuck MR, Wright J, Lee J. The Otto E. Aufranc award: the role of labral lesions to development of early degenerative hip disease. Clin Orthop Relat Res 2001;393:25-37 
  20. Lewis CL, Sahrmann SA. Acetabular labral tears. Phys Ther 2006;86:110-121 
  21. Chan YS, Lien LC, Hsu HL, Wan YL, Lee MS, Hsu KY, et al. Evaluating hip labral tears using magnetic resonance arthrography: a prospective study comparing hip arthroscopy and magnetic resonance arthrography diagnosis. Arthroscopy 2005;21:1250 
  22. Ito K, Leunig M, Ganz R. Histopathologic features of the acetabular labrum in femoroacetabular impingement. Clin Orthop Relat Res 2004;429:262-271 
  23. Blankenbaker DG, De Smet AA, Keene JS, Fine JP. Classification and localization of acetabular labral tears. Skeletal Radiol 2007;36:391-397 
  24. McCarthy J, Noble P, Aluisio FV, Schuck M, Wright J, Lee JA. Anatomy, pathologic features, and treatment of acetabular labral tears. Clin Orthop Relat Res 2003;406:38-47 
  25. Saddik D, Troupis J, Tirman P, O'Donnell J, Howells R. Prevalence and location of acetabular sublabral sulci at hip arthroscopy with retrospective MRI review. AJR Am J Roentgenol 2006;187:W507-W511 
  26. Studler U, Kalberer F, Leunig M, Zanetti M, Hodler J, Dora C, et al. MR arthrography of the hip: differentiation between an anterior sublabral recess as a normal variant and a labral tear. Radiology 2008;249:947-954 
  27. Petersilge C. Imaging of the acetabular labrum. Magn Reson Imaging Clin N Am 2005;13:641-652 
  28. DuBois DF, Omar IM. MR imaging of the hip: normal anatomic variants and imaging pitfalls. Magn Reson Imaging Clin N Am 2010;18:663-674 
  29. Dinauer PA, Murphy KP, Carroll JF. Sublabral sulcus at the posteroinferior acetabulum: a potential pitfall in MR arthrography diagnosis of acetabular labral tears. AJR Am J Roentgenol 2004;183:1745-1753 
  30. Nguyen MS, Kheyfits V, Giordano BD, Dieudonne G, Monu JU. Hip anatomic variants that may mimic pathologic entities on MRI: nonlabral variants. AJR Am J Roentgenol 2013;201:W401-W408 
  31. Stoller DW. Magnetic resonance imaging in orthopaedics and sports medicine. Philadelphia: Lippincott Williams & Wilkins 2007 
  32. Aydingoz U, Ozturk MH. MR imaging of the acetabular labrum: a comparative study of both hips in 180 asymptomatic volunteers. Eur Radiol 2001;11:567-574 
  33. Bencardino JT, Kassarjian A, Vieira RL, Schwartz R, Mellado JM, Kocher M. Synovial plicae of the hip: evaluation using MR arthrography in patients with hip pain. Skeletal Radiol 2011;40:415-421 
  34. Blankenbaker DG, Davis KW, De Smet AA, Keene JS. MRI appearance of the pectinofoveal fold. AJR Am J Roentgenol 2009;192:93-95 
  35. Arho AO. Accessory bones of extremities in roentgen picture. Duodecim 1940;56:399-410 
  36. Dietrich TJ, Suter A, Pfirrmann CW, Dora C, Fucentese SF, Zanetti M. Supraacetabular fossa (pseudodefect of acetabular cartilage): frequency at MR arthrography and comparison of findings at MR arthrography and arthroscopy. Radiology 2012;263:484-491 
  37. Byrd JW. Hip arthroscopy. Portal technique and arthroscopic anatomy. Orthopade 2006;35:41-42, 44-50, 52-43 
  38. Lien LC, Hunter JC, Chan YS. Tubular acetabular intraosseous contrast tracking in MR arthrography of the hip: prevalence, clinical significance, and mechanisms of development. AJR Am J Roentgenol 2006;187:807-810 
  39. Varma DG, Richli WR, Charnsangavej C, Samuels BI, Kim EE, Wallace S. MR appearance of the distended iliopsoas bursa. AJR Am J Roentgenol 1991;156:1025-1028 
  40. Blankenbaker DG, De Smet AA, Keene JS. Sonography of the iliopsoas tendon and injection of the iliopsoas bursa for diagnosis and management of the painful snapping hip. Skeletal Radiol 2006;35:565-571 
  41. Blankenbaker DG, Tuite MJ. Iliopsoas musculotendinous unit. Semin Musculoskelet Radiol 2008;12:13-27 
  42. Guerra J Jr, Armbuster TG, Resnick D, Goergen TG, Feingold ML, Niwayama G, et al. The adult hip: an anatomic study. Part II: the soft-tissue landmarks. Radiology 1978;128:11-20 
  43. Robinson P, White LM, Agur A, Wunder J, Bell RS. Obturator externus bursa: anatomic origin and MR imaging features of pathologic involvement. Radiology 2003;228:230-234 
  44. Bardakos NV, Villar RN. The ligamentum teres of the adult hip. J Bone Joint Surg Br 2009;91:8-15 
  45. Rao J, Zhou YX, Villar RN. Injury to the ligamentum teres. Mechanism, findings, and results of treatment. Clin Sports Med 2001;20:791-799, vii 
  46. Cerezal L, Kassarjian A, Canga A, Dobado MC, Montero JA, Llopis E, et al. Anatomy, biomechanics, imaging, and management of ligamentum teres injuries. Radiographics 2010;30:1637-1651 
  47. Datir A, Xing M, Kang J, Harkey P, Kakarala A, Carpenter WA, et al. Diagnostic utility of MRI and MR arthrography for detection of ligamentum teres tears: a retrospective analysis of 187 patients with hip pain. AJR Am J Roentgenol 2014;203:418-423