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Femoral head decentration on hip MRI: comparison between imaging planes, methods of contrast administration, and hip
Florian Schmaranzer1,2, Tadeus A Becker3, Alexander F Heimann4,5
1Department of Diagnostic-, Interventional-, and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 20, 3010, Bern, Switzerland. florian.schmaranzer@insel.ch.
Objectives:
To compare the prevalence of femoral head decentration (FHD) on different MR imaging planes in patients undergoing direct/indirect hip MR arthrography (MRA) with asymptomatic controls and to evaluate its association with osseous deformities.
Methods:
IRB-approved retrospective single-center study of symptomatic hips undergoing direct or indirect hip MRA at 3 T. Asymptomatic participants underwent non-contrast hip MRI at 3 T. FHD was defined as a continuous fluid layer between the acetabulum and femoral head and assessed on axial, sagittal and radial images. The association of intra-articular/intra-venous contrast agents and the prevalence of FHD was evaluated. The association of FHD with osseous deformities and joint damage was assessed using multiple logistic regression analysis.
Results:
Three-hundred ninety-four patients (447 hips, mean age 31 ± 9 years, 247 females) were included and compared to 43 asymptomatic controls (43 hips, mean age 31 ± 6 years, 26 females). FHD was most prevalent on radial images and more frequent in symptomatic hips (30% versus 2%, p < 0.001). FHD prevalence was not associated with the presence/absence of intra-articular contrast agents (30% versus 22%, OR = 1.5 (95% CI 0.9-2.5), p = 0.125). FHD was associated with hip dysplasia (OR = 6.1 (3.3-11.1), p < 0.001), excessive femoral torsion (OR = 3.0 (1.3-6.8), p = 0.010), and severe cartilage damage (OR = 3.6 (2.0-6.7), p < 0.001).
Conclusion:
While rare in asymptomatic patients, femoral head decentration in symptomatic patients is associated with osseous deformities predisposing to hip instability, as well as with extensive cartilage damage.
Critical Relevance Statement:
Decentration of the femoral head on radial MRA may be interpreted as a sign of hip instability in symptomatic hips without extensive cartilage defects. Its presence could unmask hip instability and yield promise in surgical decision-making.
Key Points:
The best method of identifying femoral head decentration is radial MRI. The presence/absence of intra-articular contrast is not associated with femoral head decentration. Femoral head decentration is associated with hip deformities predisposing to hip instability.
Insights
Femoral head decentration (FHD) is more common in symptomatic hips and linked to hip instability and deformities. Radial MRI is the best imaging method for detecting FHD, which is rare in asymptomatic individuals.
Area of Science:
- Orthopedic imaging
- Hip biomechanics
- Radiology
Background:
- Femoral head decentration (FHD) is a potential indicator of hip instability.
- Understanding FHD prevalence across different imaging planes and its association with hip morphology is crucial for diagnosis.
Purpose of the Study:
- To compare the prevalence of FHD on various MR imaging planes in symptomatic versus asymptomatic hips.
- To investigate the association between FHD and osseous deformities, joint damage, and contrast agent use.
Main Methods:
- Retrospective analysis of 3T hip MR arthrography (MRA) in symptomatic patients and non-contrast MRI in asymptomatic controls.
- FHD assessment on axial, sagittal, and radial images, defined as a fluid layer between acetabulum and femoral head.
- Logistic regression used to evaluate associations with deformities, joint damage, and contrast type.
Main Results:
- FHD was significantly more prevalent in symptomatic hips (30%) compared to asymptomatic controls (2%), particularly on radial images.
- FHD prevalence was not associated with intra-articular or intravenous contrast agent use.
- FHD strongly correlated with hip dysplasia, excessive femoral torsion, and severe cartilage damage.
Conclusions:
- Radial MRI is optimal for identifying FHD.
- In symptomatic hips, FHD is associated with underlying osseous deformities that predispose to instability.
- FHD may serve as a marker for hip instability, aiding surgical decision-making.
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