Hip MRI and Anatomy

• An MRI is useful for evaluating pain around the hip joint.
• MRI can detect inflamed or degenerated tendons around the hip.
• Bursitis, located laterally in the hip, can be painful and detected with MRI.
• Injuries from recent trauma or excessive athletic activity can be detected by MRI.
• Muscle strains can be detected by MRI.

Anatomical Overview - Hip Joint

• The hip joint is a ball and socket synovial joint.
• It is formed by an articulation between the pelvic acetabulum and the head of the femur.
• The acetabulum is a cup-like depression on the inferolateral aspect of the pelvis.
• The cavity of the acetabulum is deepened by the presence of the acetabular labrum.
• The head of the femur is hemispherical.
• The head of the femur fits completely into the concavity of the acetabulum.

MRI Hip Protocol and Indications

• The MRI hip protocol includes different MRI sequences for assessment of the single hip joint.
• Indications for hip MRI include:
  • Osteonecrosis of the hip.
  • Femoral insufficiency or stress fracture.
  • Different forms of hip impingement.
  • Labral and/or chondral injury.
  • Trochanteric syndrome.
  • Rectus femoris injury.

MRI Procedure - Hip Joint

• Place the pelvic array coil on the table.
• Position the patient supine, feet first, legs extended and straight.
• Patient's arms should be at the sides or resting on the abdomen, but not on the pelvis.
• Use comfort cushions at pressure points.
• Use patient straps to immobilize the patient.
• Provide support for the arms.
• Tape the feet together to immobilize legs and hips.

Scout Slice Placement

• Coronal localizer for axial slice:
  • Slice acquisition: Superior to inferior.
  • Slice alignment: Parallel to the femoral heads.
  • Anatomic coverage: Iliac fossa to proximal femur, including the lesser trochanter.
• Axial localizer for coronal slice:
  • Slice acquisition: Anterior to posterior.
  • Slice alignment: Parallel to femoral heads.
  • Anatomic coverage: Pubis to posterior ischium.
• Axial localizer for sagittal slice:
  • Slice acquisition: Lateral to medial.
  • Slice alignment: Parallel to the labrum of the acetabulum.
  • Anatomic coverage: Greater trochanter to the superior pubic ramus.

MRI Sequences - Hip

• Axial (T1) FSE: TR 525, TE 10-20, ETL 4, Slice thickness 4mm
• Coronal (T1) FSE: TR 350, TE 10-20, ETL 4, Slice thickness 4mm
• Sagittal (T2) FSE: TR 3400, TE 60, ETL 23, Slice thickness 4mm
• Axial (T2) FSE: TR 3400, TE 60, ETL 13, Slice thickness 4mm
• Axial (PD) (FS): TR 3500, TE 20, ETL 7, Slice thickness 4mm

Introduction - Knee MRI

• MRI is the preferred method for imaging and diagnosing knee pathology.
• MRI can guide patient management and treatment for the knee.
• The knee is a frequently injured joint.
• Knee pain can affect all age groups.
• The MRI knee protocol should ensure detailed detection of soft tissue and osseous structures.
• Understanding knee anatomy and MRI appearance is critical for proper diagnosis.

Anatomical Overview - Knee Joint

• The knee joint is a hinge type synovial joint.
• The knee joint mainly allows flexion and extension.
• A small degree of medial and lateral rotation is possible in the knee joint.
• The knee joint is formed by articulations between the patella, femur, and tibia.

MRI Knee Protocol and Indications

• The MRI knee protocol includes MRI sequences for assessing internal knee pathologies.
• The pathologies include meniscal, ligament, and cartilage injuries.
• Indications for knee MRI include:
  • Disruption of knee ligaments, such as ACL, PCL, MCL, or LCL.
  • Patellofemoral disease.
  • Osteonecrosis.
  • Mass, e.g., giant cell tumor.
  • Arthritis (OA or RA).

MRI Procedures - Knee

• The patient should be supine, feet first.
• Position the knee in the extremity coil as close to the isocenter as possible.
• Surround the knee with sponges, cushion under the heel to support the lower leg and ankle.

Scout Slice Placement - Knee

• Sagittal localizer for axial slice:
  • Slice acquisition: Superior to inferior.
  • Slice alignment: Parallel to the tibial plateau.
  • Anatomic coverage: From above the patella through the tibial tuberosity and patella tendon insertion.
• Coronal localizer for sagittal slice:
  • Slice acquisition: Medial to lateral.
  • Slice alignment: Parallel to the anterior cruciate ligament.
  • Anatomic coverage: From the medial condyle of the femur to the lateral condyle of the femur.
• Sagittal localizer for coronal slice:
  • Slice acquisition: Anterior to posterior.
  • Slice alignment: Parallel to the posterior margins of the femoral condyles.
  • Anatomic coverage: From the patella through the femoral condyles.

MRI Sequences - Knee

• PD (FS) (FSE) (sag, cor, and axial): TR 3000, TE 20-40, ETL 10, slice thickness 3.5
• Sagittal (T1) (FSE): TR 600, TE Min, ETL 4, slice thickness 3.5
• Sagittal (T2WI) (FSE): TR 5075, TE 85, ETL 16, slice thickness 3.5