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Three-Dimensional CT and 3D MRI of Hip- Important Aids to Hip Preservation Surgery
Ajit Kohli1, Shuda Xia1, Joel E Wells2
1Department of Radiology, UT Southwestern, Dallas, TX.
Insights
Three-dimensional (3D) CT and MRI enhance hip preservation surgery by improving visualization of bony and soft tissue structures. These advanced imaging techniques aid in diagnosing conditions like femoroacetabular impingement (FAI) and hip dysplasia.
Area of Science:
- Orthopedics
- Radiology
- Medical Imaging
Background:
- Common hip derangements like femoroacetabular impingement (FAI), developmental dysplasia of hip (DDH), and avascular necrosis (AVN) require accurate pre-operative assessment.
- Conventional 2D MRI has limitations in visualizing subtle hip pathologies due to artifacts and lack of multiplanar reconstructions.
Purpose of the Study:
- To review the advantages and technical aspects of 3D CT and MRI in hip preservation surgery.
- To highlight the role of advanced imaging in diagnosing and managing common hip conditions.
Main Methods:
- Discussion of 3D CT for bony anatomy assessment.
- Review of novel isotropic 3D MR Proton Density imaging for soft tissue and osseous structure visualization.
- Exploration of multiplanar and radial reconstructions for detailed hip joint analysis.
Main Results:
- 3D MRI allows for improved detection and measurement of labral tears without MR arthrogram.
- Isotropic 3D imaging enhances visualization of soft tissues and osseous structures, aiding surgical decision-making.
- Radial reconstructions from 3D data enable comprehensive femoral head assessment.
Conclusions:
- 3D CT and MRI significantly improve pre-operative planning for hip preservation surgery.
- Advanced 3D imaging techniques are crucial for diagnosing and managing complex hip derangements, including FAI, DDH, and AVN.
- These modalities offer superior visualization, leading to better surgical outcomes.
Abstract:
Common hip internal derangements include femoroacetabular impingement (FAI), developmental dysplasia of hip (DDH) dysplasia, and avascular necrosis (AVN) of the femoral head. These are initially screened by radiographs. For preoperative planning of hip preservation, 3-dimensional (3D) CT is commonly performed to assess bony anatomy and its alterations. Magnetic resonance imaging (MRI) is used to evaluate labrum, hyaline cartilage, tendons, synovium, and loose bodies, and provides vital information for surgical decision-making. However, conventional 2D MRI techniques are limited by lack of isotropic multiplanar reconstructions and partial volume artifacts. With advancements in hardware and software, novel isotropic 3D MR Proton Density images are acquired with acceptable acquisition times leading to improved visualization of soft tissue and osseous structures for various hip conditions. Three-Dimensional MRI allows multiplanar non-gap reconstructions along the structures of interest. It results in detection of small, otherwise inconspicuous labral tears without the need for MR arthrogram, which can be subsequently measured. In addition, radial reconstructions of the femoral head can be performed from original 3D volume MR imaging and CT imaging without the need for individual different plane acquisitions. Three-Dimensional MRI thus impacts surgical decision-making for the important common hip derangement conditions. For example, femoral head hyaline cartilage loss may make hip preservation difficult or impossible. In this review, we discuss the advantages and technical details of 3D CT and MRI and their significant role in aiding hip preservation surgery for common hip conditions. The conditions discussed in this article include FAI, DDH, AVN, synovial disorders, cartilaginous tumors, and hip fractures.
