Radiologic Exam of Pelvis and Hip Flashcards
Signs and Symptoms of slipped femoral capital epiphysis (SFCE):
- Vague pain in ___ or ____
- Limited _____
- _____ leg and limp
- _____ onset
- twice as common in boys => _____ and delayed maturation are common characteristics
- hip or knee
- limited ROM
- Shortened leg and limp
- insidious onset
- obesity
Fractures to the proximal Femur
- ____ = in capsule
- ____= out of capsule
- Intracapsular
- Extracapsular
Which type of imaging is uses to typically assess hip fractures?
Convential Radiographs
The image is an example of which type of MRI and which imaging plane?
T2 coronal MRI hip
Which imaging plane allows for visulization of the following with CT of the hip:
- anterior inclination of acetabular cup
- acetabular roof
- iliopsoas muscle
- sacroiliac joints
- pubic symphysis
Sagittal Plane CT of Hip
Radiographic eval of avascular necrosis
- ____ = appear normal for several weeks
- ____ = identify increased uptake soon after injury
- ____ = earliest senstivity and specificity => considered most appropriate study
- Radiographs
- Bone scans
- MRI
- on image, you can no longer see ball and socket => arrows are pointing to “cresent” sign = sign which shows the collapse of subchondral bone
Which imaging view of the hip is described by the following:
- greater trochanter is superimposed behind the neck
- lesser trochanter is anterior
Lateral Frog-Leg
Different presentations of avascular necrosis of the hip:
- _______ _____ = localized
- _____ _____ _____ = affect entire epiphysis
- osteochondritis dissecans
- epiphyseal ischemic necrosis
Stable fractures
- ____ is often the direct result of an impact to the iliac crest due:
- to contact during sporting activity
- fall onto hip
- this injury could result in a bruise or ____ fracture.
- Hip pointer
- avulsion fracture
Classification for trauma to the pelvis
- ___ = low energy injuries (no disruption to joint)
- ___ = high energy injuries
- stable
- unstable
Posteromedioinferior displacement of the proximal femoral epiphysis that occurs during childhood or adolescence
Slipped Femoral Capital Epiphysis
DJD of the Hip
- ___ = develops without a precursor
- ___ = pre-existing conditions include:
- paget’s
- fracture
- epiphyseal disorders
- congential dislocation
- avascular necrosis
- other inflammatory arthritides
- Primary
- Secondary
Complete the following ABCDs for MRI at the hip:
- Alignment and Anatomy = head/neck of femur ____ and alignment
- Bone density = ____ signal intensities (e.g. bone brusies or marrow edema)
- Cartilage Space: normal appearnce of labrum, tears will image as a ___ ___ signal
- soft tissues = edema = ___ look for inflammatory components (bony and soft tissue)
- contour
- irregular
- high bright signal
- T2
_____ _____ of the hip = complicated process initiated by an interrupted blood supply causing tissue death
Avascular necrosis
Complete the following ABCDs for CT at the pelvis and hip
- Alignment and Anatomy = ____ or dislocation
- Bone Density = ____ of bone; breaks in corticol margins
- Cartilage Space = Loose bodies or free fragments (not visible unless with ____); spacing betwen femoral head, acetabulum, and labrum
- Soft tissues = ____ (most commonly seen with deistension of bursa and joint capsule)
- fracture
- destruction
- arthography
- effusion
Which imaging view of the hip assesses the following:
- shenton’s line = big arch that forms a part of the obturator foramen
- iliofemoral line = look for smooth curve off of ilium onto the neck of the femur
- Femoral neck angle = decrease in angle could indicate fracture
- disruptions associated with fracture
- dislocation (e.g. SCFE)
AP HIP
- Shenton’s line = orange
- Iliofemoral line = green
- Femoral Neck angle = red
Which imaging view assesses for the following at the pelvis:
symmetry
- equal size of ililiac ala
- equal size obturator foramina
- sacral symmetry
- sacrum, occyx, pubic symphysis aligned
- femoral head line
AP Pelvis
DJD of the hip: clinical presentation
- Aymmetrical ____ ____ narrowing
- Sclerotic _____ bone
- Osteophytes at ___ _____
- ___
- Migration of the ____ _____
- joint space
- subchondral bone
- joint margins
- cyst
- femoral head
- The MRI protocol for the hip uses which 3 image views?
- FOV = entire pelvis and hips => ____ to the ____
- axial, sagittial, and coronal
- iliac crests to the lesser trochanters
RA of the Hip
- Osteoporosis of ______ area
- Symmetric and Concentric _____ ____ narrowing
- _____ erosions
- ____ ___ in nearby bone
- ____
- Axial migration of ____ ____
- Acetabular _____
- periarticular area
- joint space narrowing
- articular erosions
- synovial cysts
- effusion
- femoral head
- acetabular protrusion
The following are all indications for which type of imaging at the pelvis and hip:
- severe trauma
- fracture fragments
- loose bodies
- fractures of acetabulum or sacrum
- congential hip dislocations or joint replacements
CT scan
- also indicated for use if MRI is contraindicated
The image is an example of which type of MRI image of the hip?
Arthrogram (Arthrography) MRI of Hip
Routine imaging series
- Pelvis = ?
- Hip = ?
- AP
- AP and Lateral Frog-Leg
Unstable Pelvis Fractures: on the image,
What types of fractures/injuries on depicted?
- A, B, C = vertical sheer fractures
- D = straddle fracture
- E = bucket-handle fracture
- F = “open book” injury
Fractures of proximal Femur
- Intracapsualr
- Potential injury to circumflex ____ arteries
- post-op complications including AVN and ____ (altered blood flow)
- to treat, younger = ____; older = _____
- Extracapuslar
- Intertrochanteric make up ____ of proximal femur fractures
- treatment = ____
Intracapsular
- circumflex femoral arteries
- AVN and non-union
- younger = ORIF; older = THA
Extracapsular
- 50%
- ORIF
Which variation of MRI will allow for additional assessment of intra-articualr distension that will help identify labral tears or impingement disorders?
arthrography
Which imaging plane allows for visulization of the following with CT of the hip:
- Bilateral hip joints
- Femoral heads, necks, shafts
- Greater and lesser trochanters
- sacrum
- ilia
- SIJs
Coronal Plane CT of Hip
On the image:
- A = asymmetrical loss of ___ ___
- B (upper) = marginal _____
- B (lower) = ___
- C = sclerotic _____ bone
- D = loss of articular cartilage has caused the ____ of the femur to migrate superomedially (bone bulge)
- A = asymmetrical loss of joint space
- B (upper) = marginal osteophytes
- B (lower) = spur
- C = sclerotic subchondral bone
- D = loss of articular cartilage has caused the head of the femur to migrate superomedially (bone bulge)
- Axial MRI used to diagnose ____.
- Alpha angle of the head-to-neck is assessed on ___ ___ view.
- Cam, pincer, or mixed type of femoroacetabular ____ can be evaluated.
- FAI
- axial oblique
- impingement
What is the FOV for CT at the hip?
- Pelvis from ____ to ____
- bilateral ____
- One ____
- Pelvis from ilium to ischium
- Bilateral hips
- one hip
Which imaging plane allows for the visualization of the following structures with MRI for the hip:
- acetabulum
- labrum
- pulvinar (tissue around acetabulum fossa of hip)
- Femoral head and neck
- greater and lesser trochanters
- sacrum
- ilium
- SIJs
- Pubic smphysis
Axial MRI of Hip
- image is an example of T2 => T1 can also be used to see urinary bladder and synovial fluid in joint space
The image is an example of which type of MRI and which imaging plane?
T1 Coronal MRI of Hip
The image is an example of which MRI view of the hip?
Coronal MRI of Hip
Which imaging plane allows for visulization of the following with CT of the hip:
- femoral head in acetabular fossa
- medial wall of acetabulum
- anterior and posterior rims of acetabulum
- sacrum
- pubic rami
- greater and lesser trochanters
Axial Plane CT of Hip
Stable trauma to pelvis
- most fractures seen in ____
Unstable trauma to pelvis
- fractures to ___ or more sites of the pelvic ring
- associated ___ damage makes this potentially life-threatening
- assessed quickly with ___ (thorax, abdomen, pelvis)
- AP
- 2 or more sites
- visceral damage
- CT
Radiologic findings of SFCE:
- ___ view shows blurring and widening of epiphysis
- _____ view demonstrates amount of displacement
- AP
- Lateral frog-leg
- Note; on image, black dots denote normal epiphyseal contour on the R
Radiographs are initial study. Then:
- Radiographic findings may be ____ to diagnose the condition and direct treatment, OR
- Radiographic information is expected to be ____ for completion of the diagnositc picture because
- Radiographs are limited to indentifying ____ changes in bone density, AND
- are unable to differentiate the ___ ____ with any specificity.
- sufficient
- insuffcient
- late changes
- soft tissues
Etiologies of avascular necrosis of the hip:
- External vessel _____ (trauma, infection, steroids)
- _____ of vessel walls (radiation, lupus, giant cell arthritis)
- ______ processes (alcoholism, diabetes, sickle cell disease)
- external vessel compression
- thickening of vessel walls
- thromboembolic processes
Unstable pelvic fractures: trauma to the acetabulum
- Most common mode is impaction of the femoral head into the acetabulum
- label the types seen in the image
- A = anterior (in front of acetabulum)
- B = Posterior (behind the acetabulum)
- C = Transverse (across)
- D = T-shaped
Classification is determined by the potential for serious harm
Stable Fractures: On the image,
- white arrows indicate a ____ fracture
- small black arrows indicate an ____ fracture
- large black arrow indicates a fracture of the inferior ____
- Combined with significant swelling of the left hip and upper thigh, this presentation is known as a _____ fracture
- complete transverse fracture = white arrows
- impaction fracture (small black arrows)
- fracture of inferior acetabulum (large black arrow)
- dashboard fracture/injury = bent knee causes impact of head of femur into acetabulum
What are the 3 basic imaging planes for CT of the hip?
- Axial
- Sagittal
- Coronal
CT, MRI, and bone scans are more useful for ____ ____(negative radiographs but suspicions are still high).
Occult Fractures
Indications for the use of MRI at the Hip is to help give direct visualization of anatomy, namely
- ___ changes
- Bone ____ disease
- ____ fractures (hidden)
- Childhood hip disorders and _____ deficits
- _____ and labral involvement
- Bursitis/inflammation in ____ (e.g. herniation)
- Osteochondral ____
- ____ involvement (nerve)
- Avascular changes
- Bone marrow disease
- occult fractures
- childhood hip disorders and long-term deficits
- impingement and labral involvement
- bursitis/inflammation in soft tissues
- osteochondral abnormalities
- sacrul plexus involvement
The image is an example of which MRI view of the hip?
Sagittal MRI of Hip
