Magnetic resonance imaging of the pelvis. New orthopaedic applications

A preliminary study of using magnetic resonance angiography to detect occult proximal thrombi in patients who had hip arthroplasty was done. Despite the presence of susceptibility artifact caused by metallic components, diagnostic visualization of thigh vessels was made in a preliminary series of 15 patients. Confirmation of all previously documented (by contrast venogram via dorsal foot vein cannulation or Doppler study) proximal thrombi was made in all 15 patients. One patient had a thrombus in the contralateral extremity that had been undetected by Doppler study; 4 additional pelvic thrombi occurred in 3 patients, which had been undocumented previously. Because magnetic resonance angiography is noninvasive, requiring no contrast agent, it has advantages over conventional venography to detect occult proximal thrombi. New fast spin echo sequences are discussed that enhance visualization of regional anatomic structures adjacent to metallic prosthetic components. Emphasis was placed on assessing the posterior soft tissue envelope in patients having recurrent dislocations after total hip arthroplasty, despite acceptable component alignment. Preliminary results show a consistent absence of a posterior pseudocapsule in patients having dislocations, as compared with control patients having no dislocations.