Hip Imaging

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 1.00
Procedures: 1.00
Head, Spine, and Musculoskeletal: 1.00

Magnetic Resonance Imaging: 2.00
Procedures: 2.00
Musculoskeletal: 2.00

Radiography: 0.75
Patient Care: 0.25
Patient Interactions and Management: 0.25
Procedures: 0.50
Head, Spine and Pelvis Procedures: 0.50

Registered Radiologist Assistant: 4.25
Procedures: 4.25
Musculoskeletal and Endocrine Sections: 4.25

Sonography: 1.00
Patient Care: 0.25
Patient Interactions and Management: 0.25
Procedures: 0.75
Superficial Structures and Other Sonographic Procedures: 0.75

Outline

1. Introduction
2. Labrum
   1. Imaging
   2. Pitfalls
3. Articular Cartilage
   1. Imaging
   2. Cartilage Mapping
4. Femoroacetabular Impingement
   1. Background
   2. Acetabular Retroversion
   3. Acetabular Depth
   4. Geometric Deformities of the Femoral Head and Neck
   5. Assessment of Cam-Type Deformities
   6. Threshold Dilemma for the Alpha Angle
   7. New Insights form Asymptomatic Volunteer Studies
   8. New Ways out of the Controversy
5. Miscellaneous Structures
   1. Ligamentum Teres
   2. Synovial Folds
   3. Bursae
   4. Acetabular Fossa
   5. Microinstability
   6. Extracapsular Ligaments
   7. Iliocapsularis Muscle
   8. Abductor Tendons
6. Summary

Objectives

Upon completion of this course, students will:

1. be able to describe the classification of the hip joint
2. understand which of the new medical imaging modalities play a role in diagnosing hip trauma and pathology
3. be able to describe the anatomical components of the acetabular labrum
4. be able to describe the prevalence of acetabular lesions in the elderly patient population
5. be familiar with which medical imaging modality is most relevant for the assessment of acetabular labrum integrity
6. understand the anatomical quadrants that make up the acetabular labrum
7. be able to describe which MR sequences are preferred for depicting a labral tear
8. know what portion of the population lacks the anterior portion of the acetabular labrum
9. be able to describe various anatomic variants that may be mistaken as labral tears
10. be familiar with the anatomical variants of the acetebular labrum that may be visualized on an MR exam
11. know the function of the articular cartilage of the acetabulum
12. understand the clinical importance of cartilage delamination
13. know the various classification systems for determining the degree of osteoarthritis in the hip with conventional radiography
14. understand the role of dGEMRIC
15. be able to name the anatomic variants of femoroacetabular impingement
16. be familiar with the clinical radiographic sign indicative of an acetabular retroversion
17. know the specificity and a sensitivity of the ischial spine sign
18. describe coxa profunda
19. describe protrusio acetabuli
20. define the Wiberg angle on conventional hip radiographs
21. know which MR reformations are used for patients who may be surgical candidates for osteochondroplasty of the femoral head neck junction
22. know what type of deformity a “pistol grip” radiographic sign depicts
23. describe where the maximum cam-type deformity of the femoral neck is located
24. name the angle used to quantify the degree of femoral deformity on both conventional radiography and MR imaging
25. understand the use, application and limitations of sonography for hip imaging
26. describe cam-, pincer- and mixed-type impingements
27. know which medical imaging techniques are used to identify the alpha angle measurement
28. know the cutoff value that is most often used in both orthopedic and radiology literature for the alpha angle
29. name other measurements used in various medical imaging procedures that have been investigated to assess cam-type deformities in the femoral head
30. know the surgical procedure that an orthopedic surgeon should consider if a patient presents with a cam-type FAI and substantially reduced femoral antetorision
31. be familiar with the miscellaneous anatomic structures of the hip joint such as the ligamentum teres
32. know the name of the ligament that is ruptured when a hip dislocation occurs
33. understand the miscellaneous anatomic structures of the hip joint and their functions
34. list the three synovial folds that are visualized on MR arthrography
35. name the synovial fold which is more prominent around the femoral neck
36. know on what portion of MR hip arthrograms the pectinoveal fold can be identified
37. name which bursa lies between the musculotendinous portion of the iliopsoas muscle and the hip joint capsule
38. understand which disease processes the presence of hip bursae can be indicative of
39. know which fossa lies in the medial part of the acetabulum and is surrounded by the lunate surface and covered by articular cartilage
40. know the name of the strongest ligament in the human body