mrimaster

MRI Hip Arthrogram Protocol and Planning

Indications for MRI hip arthrogram

Contraindications

Patient preparation for MRI Hip Arthrogram

Positioning pre arthrogram

MRI hip arthrogram positioning photo

Recommended HIP Pre Arthrogram Protocols and Planning

localizer pre arthrogram

A three-plane localizer must be taken at the beginning to localize and plan the sequences. Localizers are normally less than 25 seconds, T1-weighted low-resolution scans.

T2 stir coronal 3mm pre arthrogram

Plan the coronal slices on the axial plane; angle the positioning block parallel to the RT and LT femoral heads. Check the positioning block in the other two planes. An appropriate angle must be given in the sagittal plane (parallel to the femur). The slices should adequately encompass the hip joints, starting from the ischial tuberosities and extending up to the line of pubic symphysis. To minimize ghosting artifacts caused by peristalsis and breathing, consider using a saturation band over the coronal block.

MRI hip arthrogram coronal image planning and protocol

Parameters

TR

4000-5000

TE

110

FLIP

130

NEX

2

SLICE

3 MM

MATRIX

320X320

FOV

350-380

PHASE

R>L

GAP

10%

TI

130

T1 tse axial 3mm pre arthrogram

Plan the axial slices on the coronal plane and angle the positioning block parallel to both the right and left femoral heads. Check the positioning block in the other two planes. Ensure an appropriate angle is maintained in the sagittal plane, which should be perpendicular to the femur. The slices must be sufficient to cover the hip joints from the anterior superior iliac spine to 1 inch below the lesser trochanter. To minimize ghosting artifacts caused by peristalsis and breathing, consider using a saturation band over the axial block.

MRI hip arthrogram axial image planning and protocol

Parameters

TR

400-600

TE

15-25

SLICE

3 MM

FLIP

90

PHASE

R>L

MATRIX

320X320

FOV

340-360

GAP

10%

NEX(AVRAGE)

2

Arthrography

An arthrogram is a diagnostic procedure used to examine joint capsule conditions. During this interventional process, a radiologist injects contrast medium into the joint space to assess any abnormalities. For MRI hip arthrograms, the injections are typically administered with X-ray fluoroscopic guidance, although some radiologists may opt for ultrasound guidance.

Positioning for injection:- Proper hip positioning plays a vital role in performing an arthrogram. Begin by placing the patient in a supine position with the hip internally rotated. Partially flex the knees and provide support by placing a pillow under the knee. To immobilize the leg, use sandbags over the ankle joint.

Marking for injection:- When marking the injection site, it is crucial to steer clear of the iliopsoas tendon and femoral artery.

Using fluoroscopic guidance, create an imaginary line that divides the femoral head and neck equally. Then, draw a second line perpendicular to the first one. Identify a point slightly above the intersection of the two lines at the junction of the femoral head and neck and mark it using a marking pen.

Injection: – Only a trained radiologist should perform the injection. Radiographers should only assist with the preparation. The following instructions are intended for a trained person authorized to perform joint injections.

Begin by cleansing the designated site using betadine. Subsequently, administer local anesthesia to the skin and subcutaneous tissues using 1% lidocaine.

Typically, a 22 G 3½” needle is used for all MR arthrogram injections.

Now place the tip of the needle directly onto the marked spot, then check under fluoroscopic guidance to confirm intra-articular needle placement.

Proceed to inject 10 to 15cc of diluted Magnevist.

Positioning post joint injection

MRI hip arthrogram positioning photo

Recommended MRI Hip Arthrogram Protocols and Planning

localizer unilateral

A three-plane localizer must be taken at the beginning to localize and plan the sequences. Localizers are normally less than 25 seconds, T1-weighted low-resolution scans.

T1 vibe 3d DIXON coronal 0.9mm small FOV

Plan the coronal 3D block on the axial plane. Angle the positioning block perpendicular to the acetabulum (i.e., parallel to the femoral head and neck). Check the positioning block in the other two planes. An appropriate angle must be given in the sagittal plane (perpendicular to the acetabulum). The slices should adequately encompass the hip joint, starting from the ischial tuberosities and extending up to the line of the pubic symphysis. To minimize ghosting artifacts resulting from peristalsis, vascular pulsation, and breathing, consider incorporating a saturation band at the top and bottom of the coronal block.

MRI unilateral hip arthrogram planning of coronal 3d scans

Parameters

TR

6-7

TE

2.39 4.77

SLICE

.9 MM

FLIP

12

PHASE

R>L

MATRIX

224X224

FOV

180-220

GAP

10%

NEX(AVRAGE)

2

T1 vibe 3d DIXON AXIAL 0.9mm small FOV

Plan the axial 3D block on the coronal plane and angle the positioning block horizontally across the femoral heads. Check the positioning block in the other two planes to ensure an appropriate angle is maintained in the sagittal plane, which should be perpendicular to the femur. The slices must be sufficient to cover the hip joints from 1 inch above the anterior inferior iliac spine to 1 inch below the lesser trochanter. To minimize ghosting artifacts resulting from peristalsis, vascular pulsation, and breathing, consider incorporating a saturation band at the top and bottom of the axial block.

MRI unilateral hip arthrogramplanning of axial 3d scans

Parameters

TR

6-7

TE

2.39 4.77

SLICE

.9 MM

FLIP

12

PHASE

A>P

MATRIX

224X224

FOV

180-220

GAP

10%

NEX(AVRAGE)

2

T1 tse fat sat axial 3mm SFOV

Plan the axial slices on the coronal plane and angle the positioning block horizontally across the femoral heads. Check the positioning block in the other two planes to ensure an appropriate angle is maintained in the sagittal plane, which should be perpendicular to the femur. The slices must be sufficient to cover the hip joints from 1 inch above the anterior inferior iliac spine to 1 inch below the lesser trochanter. To minimize ghosting artifacts resulting from peristalsis, vascular pulsation, and breathing, consider incorporating a saturation band at the top and bottom of the axial block.

Parameters

TR

400-600

TE

15-20

FLIP

150

NEX

3

SLICE

3 MM

MATRIX

256X256

FOV

180

PHASE

A>P

OVERSAMPLE

100%

FAT SAT

SPAIR

T1 tse fat sat sagittal 3mm SFOV

Plan the sagittal slices on the coronal plane; angle the position block parallel to the femur. Check the positioning block in the other two planes. An appropriate angle must be given in the axial plane (perpendicular to the femoral head). Slices must be sufficient to cover the hip joint from outer cortex of the greater trochanter up to the inner portion of the acetabulum. To minimize ghosting artifacts caused by peristalsis and breathing, consider using a saturation band over the axial block.

Parameters

TR

400-600

TE

15-20

FLIP

150

NEX

3

SLICE

3 MM

MATRIX

256X256

FOV

180

PHASE

A>P

OVERSAMPLE

100%

FAT SAT

SPAIR

T1 axial oblique 3mm SFOV

Plan the axial oblique slices on the coronal plane, angling the positioning block parallel to the femoral neck. Verify the positioning block alignment in the other two planes. Ensure an appropriate angle is established in the axial plane, perpendicular to the femoral head. The slices should adequately cover the hip joint, spanning one inch above the superior border of the acetabulum to one inch below the inferior border of the acetabulum. To minimize ghosting artifacts caused by peristalsis and breathing, consider using a saturation band over the axial oblique block.

Parameters

TR

400-600

TE

15-20

FLIP

150

NEX

3

SLICE

3 MM

MATRIX

256X256

FOV

180

PHASE

A>P

OVERSAMPLE

100%

FAT SAT

OFF

Optional Scans

T1 TSE FAT SAT sagittal oblique 3mm SFOV

Plan the sagittal oblique slices on the coronal plane; angle the positioning block perpendicular to the femoral neck. Check the positioning block in the other two planes. Ensure an appropriate angle is set in the axial plane (perpendicular to the femoral head). The slices should sufficiently cover the hip joint, extending one inch above the acetabulum to one inch below the greater trochanter. To minimize ghosting artifacts caused by peristalsis and breathing, consider using a saturation band over the sagittal oblique block.

Parameters

TR

400-600

TE

15-20

FLIP

150

NEX

3

SLICE

3 MM

MATRIX

256X256

FOV

180

PHASE

A>P

OVERSAMPLE

100%

FAT SAT

SPAIR