Imaging of the Hip & Bony Pelvis: Techniques and Applications

407 Pages·2006·12.81 MB·English

by  Ugne Julia Skripkus MD

Contents I
MEDICAL RADIOLOGY
Diagnostic Imaging
Editors:
A. L. Baert, Leuven
K. Sartor, Heidelberg
Contents III
A. M. Davies, K. Johnson, and R. W. Whitehouse (Eds.)
Imaging of the
Hip & Bony Pelvis
Techniques and Applications
With Contributions by
J. E. Adams · H. Alizadeh · A. Basille · T. H. Berquist · G. Bierry · S. Bianchi ·X. Buy
V. N. Cassar-Pullicino · D. Connell · P. Cunningham · J. Cupelli · C. Czerny · A. M. Davies
S. Eustace · I. Fogelman · A. Gangi · A. Gentili · S. F. Hain · P. Hughes · H. Imhof · K. J. Johnson
A. G. Jurik · J. Kramer · G. Koulouris · G. Laub · F. E. Lecouvet · B. Maldague · J. Malghem
C. Martinoli · W. C. G. Peh · J. J. Peterson · M. P. Recht · D. Ritchie · U. J. Skripkus · J. Teh
K. Tallroth · B. J. Tins · B. C. Vande Berg · D. Vanel · R. W. Whitehouse · H. Williams · D. Wilson
N. B. Wright
Foreword by
A. L. Baert
With 413 Figures in 756 Separate Illustrations, 45 in Color and 28 Tables
123
IV Contents
A. Mark Davies, MD
Consultant Radiologist
The MRI Centre
Royal Orthopaedic Hospital
Birmingham B31 2AP
UK
Karl J. Johnson, MD
Consultant Paediatric Radiologist
Princess of Wales
Birmingham Children’s Hospital
Steelhouse Lane
Birmingham B4 6NH
UK
Richard William Whitehouse, MD
Department of Clinical Radiology
Manchester Royal Infi rmary
Oxford Road
Manchester, M13 9WL
UK
Medical Radiology · Diagnostic Imaging and Radiation Oncology
Series Editors: A. L. Baert · L. W. Brady · H.-P. Heilmann · M. Molls · K. Sartor
Continuation of Handbuch der medizinischen Radiologie
Encyclopedia of Medical Radiology
Library of Congress Control Number: 200417403
ISBN 3-540-20640-X Springer Berlin Heidelberg New York
ISBN 978-3-540-20640-8 Springer Berlin Heidelberg New York
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Contents V
Foreword
It is my great pleasure and privilege to introduce another volume on modern musculo-
skeletal imaging edited by A. M. Davies, K. Johnson and R. Whitehouse.
The hip joint and the bony pelvis are anatomical structures that are subject to f requent
and various disease processes. Radiologists, orthopedic surgeons, and rheumatologists
are confronted in their daily practice with many of these conditions. Due to the continuous
progress in diagnostic imaging modalities and new insights into the pathophysiology
and biomechanics of the hip joint and bony pelvis there is a need for regular updates of
our knowledge in this fi eld.
The concept of this book is based on a comprehensive coverage of both the imaging
modalities and the applications of all these techniques to a specifi c anatomic area and
all the pathologic conditions related to it.
The short preparation period of this volume – less than 15 months – ensures, as in the
other volumes on musculoskeletal radiology in this series edited by A. M. Davies, that the
most recent advances of hip joint and bony pelvis imaging are included.
I am greatly indebted to the three editors for their brilliant editorial work and
their superb personal contributions. I congratulate them on their judicious choice of
contributing authors, all well-known and internationally recognized experts in the
fi eld.
I am convinced that this excellent volume will be of great interest for radiologists in
training and certifi ed radiologists, and also for orthopedic surgeons and rheumatolo-
gists.
It is my sincere wish that this work meets the same success as so many other volumes
previously published in the series Medical Radiology – Diagnostic Imaging.
Leuven Albert L. Baert
Contents VII
Preface
As our understanding of the disease processes and the biomechanics of the hip joint and
bony pelvis improves, there is a need to continuously update radiologists, orthopaedic
surgeons and other professionals working in this fi eld. This book, in common with sev-
eral others published in this series, takes a dual approach to the subject.
The fi rst section acquaints the reader with the full range of techniques available for
imaging the hip joint and musculoskeletal pelvic pathology, emphasizing the indications
and contraindications. The six chapters include contributions on radiography, computed
tomography and CT arthrography, magnetic resonance imaging and MR arthrography,
ultrasound, nuclear medicine and interventional techniques. The remaining 18 chapters
discuss the optimal application of these techniques to specifi c pathologies, highlighting
practical solutions to both common and uncommon clinical problems.
The discerning reader may note a few minor contradictions in the text (recommended
gauge of needle, volume of contrast medium, use or not of local anaesthetics for arthrog-
raphy, etc.) refl ecting the different practices of the authors. The editors have deliberately
not edited out these inconsistencies, thereby allowing the reader to appreciate that, even
between centres of excellence, practices can and will vary.
The editors are grateful to the international panel of authors for their contributions
to this book, which aims to provide a comprehensive overview of current imaging of the
hip joint and musculoskeletal pelvis.
Birmingham A. Mark Davies
Birmingham Karl Johnson
Manchester Richard W. Whitehouse
Contents IX
Contents
Imaging Techniques and Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1 Radiographic Evaluation
Ugne Julia Skripkus and Amilcare Gentili. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2 Computed Tomography (CT) and CT Arthrography
Richard W. Whitehouse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
3 MR and MR Arthrography
Josef Kramer, Gerhard Laub, Christian Czerny,
and Michael P. Recht. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
4 Ultrasound
Stefano Bianchi and Carlo Martinoli. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
5 Nuclear Medicine
Sharon F. Hain and Ignac Fogelman. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
6 Interventional Procedures
Afshin Gangi, Antonio Basille, Houman Alizadeh, Xavier Buy,
Juan Cupelli, and Guillaume Bierry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Clinical Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
7 Congenital and Developmental Abnormalities
Karl J. Johnson and A. Mark Davies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
8 Developmental Dysplasia of the Hip 1: Child
Helen Williams and Karl J. Johnson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
9 Developmental Dysplasia of the Hip 2: Adult
Kaj Tallroth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
10 Imaging of the Irritable Hip and Hip Infection
James Teh and David Wilson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
11 Perthes’ Disease
Neville B. Wright . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
12 Slipped Upper Femoral Epiphysis
Bernhard J. Tins and Victor N. Cassar-Pullicino. . . . . . . . . . . . . . . . . . . . . . . . . 173
X Contents
13 Osteonecrosis and Transient Osteoporosis of the Femoral Head
Bruno C. Vande Berg, Frederic E. Lecouvet, Baudouin Maldague,
and Jacques Malghem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
14 Bony Trauma 1: Pelvic Ring
Philip Hughes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
15 Bony Trauma 2: Proximal Femur
Jeffrey J. Peterson and Thomas H. Berquist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
16 Bone Trauma 3: Stress Fractures
Wilfred C. G. Peh and A. Mark Davies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
17 Soft Tissue Injuries
George Koulouris and David Connell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
18 Arthritis 1: Hip
Herwig Imhof . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
19 Arthritis 2: Sacroiliac Joint
Anne Grethe Jurik. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
20 Bone and Soft Tissue Infection
A. Mark Davies and Richard W. Whitehouse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
21 Metabolic and Endocrine Disorders
Judith Adams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
22 Tumours and Tumour-Like Lesions
David Ritchie, A. Mark Davies, and Daniel Vanel . . . . . . . . . . . . . . . . . . . . . . . . . 353
23 Paget’s Disease of Bone
Richard W. Whitehouse and A. Mark Davies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381
24 Hip Prosthesis
Stephen Eustace and Patricia Cunningham . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393
Subject Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403
List of Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409
Radiographic Evaluation 1
Imaging Techniques and Procedures
Radiographic Evaluation 3
1 Radiographic Evaluation
Ugne Julia Skripkus and Amilcare Gentili
CONTENTS
1.1 Radiographic Technique 3 1.6 Radiographic Projections of the Hip 11
1.2 Radiographic Projections of the Pelvis 3 1.6.1 AP Projection of the Hip 11
1.2.1 Anteroposterior Projection of the Pelvis 1.6.1.1 Technique: Supine 11
(Bilateral Hips) 4 1.6.1.2 Radiographic Evaluation 12
1.2.1.1 Technique: Supine 4 1.6.2 Lateral Projection of the Hip
1.2.1.2 Radiographic Evaluation 4 (Lauenstein and Hickey) 12
1.2.2 AP Axial Projection of the Pelvis 1.6.2.1 Technique: Supine 12
(Frogleg–Cleaves or Modified Cleaves Method) 4 1.6.2.2 Radiographic Evaluation 13
1.2.2.1 Technique 5 1.6.3 Axiolateral Inferosuperior Projection of the Hip
1.2.2.2 Radiographic Evaluation 6 (Danelius–Miller) 13
1.2.3 Posterior Oblique Pelvis – Acetabulum (“Judet”) 6 1.6.3.1 Technique: Supine (Danelius–Miller Modification
1.2.3.1 Technique 6 of Lorenz) 13
1.2.3.2 Radiographic Evaluation 6 1.6.3.2 Radiographic Evaluation 13
1.3 Radiographic Projections of the Anterior Pelvic 1.7 Arthrographic Evaluation of the Hip 13
Bones 6 1.7.1 Technique: Supine 13
1.3.1 AP Axial “Outlet” Projection of the Anterior Pelvic 1.7.2 Radiographic Evaluation 14
Bones (Taylor) 7 Suggested Reading 14
1.3.1.1 Technique: Supine 7
1.3.1.2 Radiographic Evaluation 7
1.3.2 AP Axial “Inlet” Projection of the Anterior Pelvic
Bones (Lilienfeld) 7
1.3.2.1 Technique: Seated Erect 7
1.3.2.2 Technique: Supine 7
1.3.2.3 Radiographic Evaluation 8
1.4 Radiographic Projections of the Sacroiliac Joints 8 1.1
1.4.1 AP Oblique Projection of the Sacroiliac Joints 8
Radiographic Technique
1.4.1.1 Technique: Supine 8
1.4.1.2 Radiographic Evaluation 9
1.5 Radiographic Projections of the Sacrum For pelvic and hip pathology, radiographic evalu-
and Coccyx 9 ation can prove to be a relatively quick and inex-
1.5.1 AP/PA Projection of the Sacrum and Coccyx 9 pensive first line of imaging. In this chapter, basic
1.5.1.1 Technique: Prone or Supine 9
imaging principles including patient positioning
1.5.1.2 Radiographic Evaluation 9
and radiographic projections will be discussed. For
1.5.2 Lateral Projection of the Sacrum and Coccyx 9
1.5.2.1 Technique: Recumbent 9 all imaging techniques discussed, gonadal shield-
1.5.2.2 Radiographic Evaluation 11 ing should be maximally utilized to decrease the
amount of patient radiation exposure without com-
promising radiographic image quality.
U. J. Skripkus, MD 1.2
Musculoskeletal Radiology Fellow, University of California, Radiographic Projections of the Pelvis
San Diego, 200 West Arbor Drive, San Diego, CA 92075, USA
A. Gentili, MD
Standard projections for the evaluation of the pelvis
Professor, Department of Radiology, University of Califor-
include AP, AP axial (“frogleg”) and posterior
nia, San Diego, 9300 Campus Point Drive, La Jolla, CA 92037,
USA oblique (“Judet”).
4 U. J. Skripkus and A. Gentili
1.2.1 should be flexed and the palms of the hands should
Anteroposterior Projection of the Pelvis rest gently on the chest or upper abdomen.
(Bilateral Hips) Alternatively, the arms may rest at the patient’s
sides. The shoulders should be in the same trans-
1.2.1.1 verse plane as the pelvis. A pillow or other support-
Technique: Supine ing structure should be placed behind the head and
the knees. The central ray is directed perpendicu-
The patient is lying supine with the midsagittal larly to the midpoint of the film approximately 2 in.
plane of the pelvis centered with the midline of the (5 cm) superior to the pubic symphysis or midway
long axis of the table. The pelvis should be in true between the level of the anterior superior iliac spines
AP position, with the distance from the table top and symphysis pubis. Respiration is suspended.
to the anterior superior iliac spine on both sides of If imaging is done as part of a hip evaluation, the
the pelvis being equal, to minimize rotation of the centering should be performed approximately 2 in.
pelvis. Unless contraindicated, the feet are inter- (5 cm) caudad, to include more of the proximal
nally rotated approximately 15° to get the long axis femurs. Gonadal shielding should be used on all
of the femora parallel to the film. The feet may be male patients. Ovarian shielding in female patients
gently taped together or a sandbag may be placed may obscure portions of the pelvis.
across the ankles to minimize movement during
image acquisition. In the case of trauma, or when
femoral neck fracture or dislocation is suspected, 1.2.1.2
the feet should not be internally rotated. The elbows Radiographic Evaluation
On this projection, the entire pelvis, including L5,
sacrum and coccyx, as well as the proximal femurs,
including the greater trochanters, should be visual-
ized. The lesser trochanters, if seen, should be dem-
onstrated along the medial borders of the femurs.
The femoral heads, which should be equal in size and
position, should be well seen through the acetabula.
Fractures, dislocations, osseous lesions and
degenerative changes are demonstrated. Congeni-
tal dislocation of the hip, evidenced by an abnor-
mal relationship of the femoral head with the
a acetabulum can be visualized by two additional
AP images of the pelvis, described by Martz and
Taylor (1954). The first technique requires the
central ray to be directed perpendicularly to the
symphysis pubis to detect any lateral or superior
displacement of the femoral head. The second tech-
nique is obtained with the central ray directed to
the symphysis pubis at a cephalic angulation of 45°
which will demonstrate anterior or posterior dis-
placement of the femoral head.
1.2.2
AP Axial Projection of the Pelvis
(Frogleg–Cleaves or Modified Cleaves Method)
b
Fig. 1.1. a Patient positioning for anteroposterior (AP) pelvic This position is contraindicated in patients sus-
radiograph. b AP pelvic radiograph pected of having a fracture, dislocation of the hip.