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Schmitt L, Pfirrmann CWA, Buck FM, Hany TF, Rosskopf AB. Value of MR arthrography for evaluation of children and adolescents with clinically suspected intraarticular cause of hip pain. Skeletal Radiol 2024; 53:1269-1278. [PMID: 38206356 PMCID: PMC11093865 DOI: 10.1007/s00256-023-04552-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE To evaluate the distribution of intra- and extraarticular MRI findings in children and adolescents with clinically suspected intraarticular cause of hip pain in order to assess the need for additional intraarticular contrast administration. MATERIAL AND METHODS Database was searched over a period of 34 months retrospectively for consecutive hip MR arthrography in young patients (8-17 years) with suspected intraarticular cause of hip or groin pain. Exclusion criteria were prior hip surgery, follow-up examination due to known intraarticular pathology, incomplete examination, qualitatively non-diagnostic examinations, and missing informed consent. Reports of fellowship-trained MSK radiologists were searched for intraarticular versus extraarticular findings explaining hip or groin pain. RESULTS Seventy patients (68% female; median age: 14.5 years; range:10.8-16.9 years) were analyzed. No reason for pain was found in 30 (42.9%) hips, extraarticular reasons in 20 (28.6%) cases, intraarticular in 14 (20.0%), and both (intra- and extraarticular) in 6 (8.6%) hips. Most common extraarticular reasons were apophysitis (14.3%), other bony stress reactions (12.9%), intramuscular edema (7%), tendinitis (5.7%), and trochanteric bursitis (4.3%). Labral pathology was the most common intraarticular finding (overall:34.3%; partial tear:15.7%, complete tear:15.7%), most frequent at the anterosuperior position (81.8%). Cartilage defects (1.4%), intraarticular neoplasia (1.4%), and tear of the femoral head ligament (2.8%) were rarely found. Synovitis and loose bodies were not observed. Cam-(37.1%) and pincer-configurations (47.1%) were common while hip dysplasia was rare (5.7%). CONCLUSION MRI in children and adolescents with hip pain should be done primarily without intraarticular contrast administration since most cases show an extraarticular pain reason or no diagnosis detectable with MRI.
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Affiliation(s)
- Laura Schmitt
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Christian W A Pfirrmann
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Medical Radiological Institute (MRI) Zurich, Schulthess Clinic, Lengghalde 2, CH-8008, Zurich, Switzerland
| | - Florian M Buck
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Medical Radiological Institute (MRI) Zurich, Schulthess Clinic, Lengghalde 2, CH-8008, Zurich, Switzerland
| | - Thomas F Hany
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Medical Radiological Institute (MRI) Zurich, Schulthess Clinic, Lengghalde 2, CH-8008, Zurich, Switzerland
| | - Andrea B Rosskopf
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.
- Medical Radiological Institute (MRI) Zurich, Schulthess Clinic, Lengghalde 2, CH-8008, Zurich, Switzerland.
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Dietrich TJ, Vaeth D, Wildermuth S, Waelti S, Leschka S, Graf N, Fischer T. Age-related prevalence and imaging characteristics of the superior acetabular roof notch in children, adolescents, and young adults. Skeletal Radiol 2024; 53:43-49. [PMID: 37261477 PMCID: PMC10661799 DOI: 10.1007/s00256-023-04370-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 04/24/2023] [Accepted: 05/21/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To determine the age-related prevalence and imaging characteristics of the superior acetabular roof notch (SARN) on hip MRI and radiographs in a young study population. MATERIALS AND METHODS Retrospective analysis of 304 MRI examinations and corresponding available radiographs of patients between the ages of 4 and 24 years. Two observers classified SARN with fluid-like findings on MRI as type-1, whereas SARN with fat-like findings on MRI were classified as type-2. Sensitivity and specificity of radiographic SARN findings were determined using MRI as the reference standard. Logistic regression models were used to assess the age-related prevalence on MRI. RESULTS Twelve patients (3.9%) had fluid-like SARN type-1, 27 patients (8.9%) had fat-like SARN type-2, while 265 patients (87.2%) had no SARN on MRI. The odds ratio (OR) for age (years) with respect to the presence of a fluid-like SARN type-1 on MRI was 0.79 (95% CI: 0.70-0.89), meaning that with each year, the likelihood for SARN type-1 decreased by 21% (p < 0.001). The OR for age with respect to the presence of a fat-like SARN type-2 on MRI was 1.14 (95% CI: 1.02-1.27) (p = 0.017). The diagnostic sensitivity for detecting a SARN on radiographs compared to MRI as the reference standard was between 0.75 and 0.83 and the corresponding specificity was between 0.85 and 0.89 for both observers. CONCLUSION SARN is a common finding on MRI and radiographs. The present data suggest that SARN undergoes an age-related imaging characteristic from a fluid-like appearance to a fat-like appearance on MRI during adolescence.
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Affiliation(s)
- Tobias Johannes Dietrich
- Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland.
| | - Desiree Vaeth
- Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
| | - Simon Wildermuth
- Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
| | - Stephan Waelti
- Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
| | - Sebastian Leschka
- Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
| | - Nicole Graf
- Clinical Trials Unit, Kantonsspital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Tim Fischer
- Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
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Klontzas ME, Vassalou EE, Zibis AH, Karantanas AH. Imaging of Anatomical Variants Around the Hip. Semin Musculoskelet Radiol 2023; 27:182-197. [PMID: 37011619 DOI: 10.1055/s-0043-1762593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Considering the current widespread use of imaging as an integral part of managing hip pain, variable hip geometries and anatomical variants are increasingly being detected. These variants are commonly found in the acetabulum and proximal femur, as well as the surrounding capsule-labral tissues. The morphology of specific anatomical spaces confined by the proximal femur and the bony pelvis may also vary significantly among individuals. Familiarity with the spectrum of imaging appearances of the hip is necessary to identify variant hip morphologies with or without potential clinical relevance and reduce an unnecessary work-up and overdiagnosis. We describe anatomical variations and variable morphologies of the bony structures comprising the hip joint and the soft tissues, around the hip. The potential clinical significance of these findings is further analyzed in conjunction with the patient's profile.
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Affiliation(s)
- Michail E Klontzas
- Department of Radiology, School of Medicine, University of Crete, Crete, Greece
- Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology, Heraklion, Crete, Greece
- Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Evangelia E Vassalou
- Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Crete, Greece
- Department of Radiology, General Hospital of Sitia, Xerokamares, Sitia, Lasithi, Crete, Greece
| | - Aristeidis H Zibis
- Department of Anatomy, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Apostolos H Karantanas
- Department of Radiology, School of Medicine, University of Crete, Crete, Greece
- Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology, Heraklion, Crete, Greece
- Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Crete, Greece
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Particularities on Anatomy and Normal Postsurgical Appearances of the Hip. Radiol Clin North Am 2023; 61:167-190. [PMID: 36739140 DOI: 10.1016/j.rcl.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Detailed knowledge of anatomy helps to understand pathologic processes. This article focuses on the anatomy and functionality of the hip, with emphasis on recently studied concepts and anatomic features that have an association with the development of symptoms. The most common anatomic variants posing a challenge for diagnosis and other common findings in asymptomatic patients are reviewed. Good understanding of the different surgical procedures helps in providing as much information as possible to guarantee a favorable outcome, improving prognosis. We review what are the commonly expected postsurgical appearances and the most common postsurgical complications.
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