Radiologic Eval of Hip and Pelvis

Question 1

list radiologic views and projections for the hip and pelvis that may be included in a routine exam

Answer 1

1. Project
   
   1. AP of pelvis → bilateral hips
   2. AP of the Hip and proximal femur
   3. lateral frog leg
2. Other possible
   
   1. axiolateral inferosuperior

Question 2

what can be viewed in the AP view of pelvis

Answer 2

1. acetabular roof
2. anterior rim
3. posterior rim
4. iliopubic line
5. ilioischial line
6. radiographic teardrop

Question 3

what can be viewed in AP view of the hip and proximal femur?

Answer 3

1. positioning of head in acetabulum
   
   1. Shenton’s hip line
   2. iliofemoral line
   3. femoral neck angle

Question 4

what can be viewed in the lateral frog-leg view?

Answer 4

1. expanse of femoral head
2. greater and lesser trochanters from medial

Question 5

list indications/key findings for CT of the hip

Answer 5

1. severe trauma
2. fracture assessment
3. loose bodies
4. assess bone geometry/alignment
5. other → CT arthrogram when MRI arthrogram contraindicated

Question 6

other info about CT of the hip

Answer 6

1. best for bony alignment/pre-op planning, and fracture assessment
2. basic protocol
   
   1. pelvis vs level of bilateral hips
   2. axial slices, reformatted for coronal and sagittal

Question 7

describe the basic protocol for MRI of the hip and what it is good for

Answer 7

1. best for detecting lesions of the labrum, marrow cartilage, and soft tissues
2. basic protocol:
   
   1. both hips and the pelvis
   2. T1 → define anatomy
   3. T2 → detect abnormal fluid

Question 8

list general indications/key findings of MRIs of the hip

Answer 8

1. AVN
2. occult fractures
3. osteochondral defect (OCD)
4. pediatric hip disorders
5. athletic pubalgia
6. femoroacetabular impingement (FAI)
7. tears of the labrum
8. tendinopathies
9. sacral plexus abnormalities

Question 9

what is the cross-over sign?

Answer 9

indicated retroversion of the acetabulum (associated with anterior FAI)

Question 9

list different types of proximal femur fractures

Answer 9

1. Intracapsular
   
   1. femoral head fracture
   2. subcapital fracture
   3. femoral neck fracture
2. Extracapsular
   
   1. intertrochanteric fracture
   2. subtrochanteric fracture
   3. shaft fracture

Question 10

list ACR appropriateness criteria for the hip and pelvis

Answer 10

1. chronic hip pain
2. acute hip pain → suspected fracture
3. imaging after total hip arthroplasty

Question 11

what initial imaging study is most appropriate for a pt with acute hip pain from a fall or minor trauma?

Answer 11

Radiography of hip and pelvis

Question 12

what follow up imaging study is most appropriate for a pt with acute hip pain from a fall or minor trauma after they have negative radiographs but a fracture is still suspected?

Answer 12

MRI pelvis and affected hip

CT pelvis and hips

Question 13

what is the first imaging test for a pt with chronic hip pain?

Answer 13

Pelvis and hip radiographs

Question 14

if radiographs were negative, equivocal or nondiagnostic; what follow-up study is most appropriate for a pt with chronic hip pain and there are suspected extra-articular noninfectious soft-tissue abnormalities such as tendonitis?

Answer 14

MRI hip

US hip

Question 15

if radiographs were negative, equivocal, or nondiagnostic; what follow-up study is most appropriate for a pt with chronic hip pain and suspected impingement?

Answer 15

MRI hip

CT arthrography hip

Question 16

if radiographs were negative, equivocal, or nondiagnostic; what follow-up study is most appropriate for a pt with chronic hip pain and suspected labral tear with/without clinical findings consistent with or suggestive of impingement?

Answer 16

MR arthrography hip

CT arthrography hip

Question 17

if radiographs were negative, equivocal, or showing mild osteoarthritis; what follow-up study is most appropriate for a pt with chronic hip and low back, pelvic, or knee pathology and you want to exclude the hip as the source?

Answer 17

MRI hip

image guided anesthetic +/- corticosteroid injection hip joint or surrounding structures

Question 18

what imaging should be performed following a THA for a follow-up of the asymptomatic pt?

Answer 18

Radiograph hip