Imaging of the Hip & Bony Pelvis: Techniques and Applications PDF
Preview Imaging of the Hip & Bony Pelvis: Techniques and Applications
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 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifi - cally the rights of translation, reprinting, reuse of illustrations, recitations, broadcasting, reproduction on microfi lm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law. Springer is part of Springer Science+Business Media http//www.springeronline.com © Springer-Verlag Berlin Heidelberg 2006 Printed in Germany The use of general descriptive names, trademarks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every case the user must check such information by consulting the relevant literature. Medical Editor: Dr. Ute Heilmann, Heidelberg Desk Editor: Ursula N. Davis, Heidelberg Production Editor: Kurt Teichmann, Mauer Cover-Design and Typesetting: Verlagsservice Teichmann, Mauer Printed on acid-free paper – 21/3151xq – 5 4 3 2 1 0 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.
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