Overview

Indications

Scheduling

Patient Prep

Series Details

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ICD9 Codes

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Hips: Routine Protocol (7.30.08)

Overview

This examination evaluates both hips with T1 and T2 weighted image contrast to look for occult fractures, avascular necrosis, effusions, masses and soft tissue injuries. This can be done in the body or torso phased array coil. The sacroiliac joints and pubic rami are included in the field-of-view because “hip” pain may often be referred from these other sites and many abnormalities, such as insufficiency fractures, may occur in multiple locations. When the symptoms are localized to one hip, it is useful to obtain higher signal to noise images localized to that one side using a dedicated hip coil or by combining the shoulder coil with a surface coil. These images evaluate the cartilage, labrum and surrounding soft tissues including the region of the sciatic notch and sciatic nerve. Proton density imaging is used for these smaller field-of-view, higher resolution images because of its inherently high SNR and utility for soft tissues and cartilage. This exam can be supplemented with routine lumbo-sacral spine imaging for patients with vague pain that may also be related to disc disease.

 

Common Indications	ICD9 Codes
Hip pain	719.45
Hip instability	718.85
Hip mass	719.65

 

Scheduling Guidelines

·       Order as           MRI pelvis                   30 minutes

                       or           MRI pelvis with Gd     60 minutes

·       First Ask

1) Is there a mass or tumor?______ When did you first discover the mass?  _________________

2) Does the problem relate to a recent injury?  YES   NO    DATE  ______________________

            3) Where does the hip hurt (FRONT - BACK - INSIDE - OUTSIDE)?

4) Have you had surgery on your hip or pelvis?   YES   NO  DATE   ______________________

            5) Have you had an x-ray?  

• If “mass” or “tumor” then schedule in early morning with Radiologist monitoring. Patient needs gadolinium.
• If no mass or tumor, schedule anytime.
• Instruct patient to bring x-rays if available.

 

Patient Preparation:

 

·       Fill out safety screening and clinical information form

·       Valium (5-10mg po) or Xanax (1-2 mg po) if patient is claustrophobic

 

Coil:  The first two series, which are of the pelvis in two planes, are performed in the body coil.  The third, fourth and fifth series are dedicated smaller FOV studies of the hip in question.  These series can be performed with a dedicated hip coil or a coil set up adapted for hip imaging.  We use a dual coil set up in lieu of a dedicated hip coil.   We use a shoulder coil placed over the anterior aspect of the hip and a 5cm round surface coil placed under the posterior aspect of the hip joint.  The two are then connected through a dual connector box that is then plugged into the dog house.

 

Patient Positioning:  Supine, feet first.  It is helpful to tape or wrap the feet together to reduce leg movement. 

 

Landmark:  Pubic symphysis

 

Series 1:

 

This T1 weighted axial series of the entire pelvis using the body coil is intended primarily to evaluate for pelvic pathology that may be associated with hip pain.  It is an optimal sequence to evaluate for adenopathy.  SI joint disease and sacral fractures can also be evaluated on this series.  I t is designed to automatically cover from above iliac crest to below femoral head when the landmark is on the pubic symphysis.  No locator series is necessary. 

 

Series 2:

 

The FSEIR series in the coronal plane using the body coil is intended to evaluate for signs of marrow edema involving the affected hip or elsewhere in the bony pelvis.  It is particularly helpful in diagnosing AVN.   AVN is often a bilateral and therefore both hips are included in this series.  The series should include the SI joints and sacrum to evaluate for pathology in these areas.  “Hip pain” is often referred from the SI joints and sacral ala Which can have insufficiency fractures.  

 

Series 3:

 

This is a high resolution axial sequence obtained using the dual coil system described above or a dedicated hip coil that is optimized for evaluating bone, soft tissue, and cartilage.  The sciatic nerve can be seen going through the greater sciatic foramen on the more superior axial images.

 

 

Series 4:

 

This is a high resolution sagittal sequence using the dual coil system or a dedicated hip coil.  It is especially useful in evaluating the labrum and cartilage in addition to the bone and soft tissues.

 

Series 5:

 

This is a high resolution sequence in the coronal plane using the dual coil system or a dedicated hip coil.  It is useful for evaluating cartilage, bone and soft tissues.  The sciatic nerve can be well seen on this sequence also.  

 

 

Filming Instructions:

 

All sequences : 12 on 1

 

 

Billing Instructions:

 

 

ICD9 Codes:

Osteoarthritis	715.9
Osteonecrosis	730.1

 

 

Sample Normal Dictation:

 

Clinical Statement: 

 

Technique:      1.5 Tesla: body coil for both hips and a dual surface coil over the left hip

Axial T1 (both hips)

Coronal, Axial and Sagittal proton density of left hip, The sagittalis somewhat limited by motion.

 

Findings: Both hips are normal with normal allignment and no evidence of osteonecrosis, osteoarthritis, occult fracture, tumor or other osseous abnormality. This is no significant hip joint effusion.   The sacro-iliac joints and pubic rami are also normal.  High resolution images of the symptomatic, right (or left) hip show a normal sciatic nerve in the sciatic notch, no significant cartilage abnormality and only minor signal alteration in the labrum which is worst anteriorly. 

 

 

 

Impression:

 

No right (or left) hip abnormality identified.

 

Examples:

Case 1