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Review
. 2015 Sep;205(3):502-12.
doi: 10.2214/AJR.15.14463.

Regional Articular Cartilage Abnormalities of the Hip

Thomas M Link  1 , Benedikt J Schwaiger  1 , Alan L Zhang  2
Affiliations
Review

Regional Articular Cartilage Abnormalities of the Hip

Thomas M Link et al. AJR Am J Roentgenol. 2015 Sep.

Abstract

Objective: Imaging of hip cartilage is challenging because of its limited thickness and complex geometry and therefore requires advanced MRI techniques. However, cartilage abnormalities are found in a number of disease entities, and their diagnosis may impact patient management. This article will provide pertinent information about the motivation to image hip cartilage, which imaging techniques to use, and how to analyze cartilage; finally, we will discuss disease entities with regional cartilage lesions, including the typical MRI findings.

Conclusion: Because the detection and quantification of regional cartilage abnormalities are critical for guidance of operative and nonoperative management of hip disorders, radiologists should be familiar with imaging and analysis techniques for assessing hip cartilage.

Keywords: MRI; T1rho; T2 relaxation time; cartilage; femoroacetabular impingement; hip; quantitative imaging.

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Figures

Fig. 1—
Fig. 1—
Left hip of healthy volunteer. (Courtesy of Han M and Krug R, University of California at San Francisco, San Francisco, CA) A–C, Sagittal (A), coronal (B), and obligue axial (C) reformation images (slice thickness, 2 mm) of 3D intermediate-weighted fast spin-echo seguence (Cube, GE Healthcare) originally obtained with 0.8 × 0.8 × 0.8 mm3 isotropic spatial resolution and 7-minute acguisition time. In this study, both acetabular cartilage and femoral cartilage are well delineated.
Fig. 2—
Fig. 2—
Right hip of 50-year-old woman with osteoarthritis. A and B, Spoiled T2*-weighted MERGE (Multiple Echo Recombined Gradient Echo, GE Healthcare) image (A) and 2D intermediate-weighted fast spin-echo (FSE) image (B). MERGE image provides good separation of acetabular cartilage and femoral cartilage; however, both partial-thickness focal acetabular cartilage lesion (long arrow, B) and cartilage signal inhomogeneity (short arrows, B), which are clearly shown on 2D FSE image, are insufficiently depicted on MERGE image.
Fig. 3—
Fig. 3—
T1rho color maps of acetabular cartilage and femoral cartilage. (Courtesy of Samaan M and Souza RB, University of California at San Francisco, San Francisco, CA) A and B, Composite T1rho color maps of both acetabular cartilage and femoral cartilage of left hip obtained in sagittal plane in healthy 35-year-old control subject (A) and 30-year-old woman with early hip osteoarthritis (B). T1rho values are elevated (yellow, orange, and red) in weight-bearing regions of osteoarthritis patient (in particular, in superolateral and superomedial acetabular and femoral cartilage), indicating changes in regional proteoglycan composition. Also note that patient (B) does not have joint space narrowing and that joint space appears mildly widened compared with control subject (A); joint space widening in patient potentially reflects cartilage swelling. Blue and green = normal T1rho values.
Fig. 4—
Fig. 4—
Coronal 2D fat-suppressed intermediate-weighted fast spin-echo image of right hip of 42-year-old woman with degenerative disease of hip and femoroacetabular impingement. According to score obtained using SHOMRI (scoring hip osteoarthritis with MRI) scoring system [21], femoral cartilage is separated into four subregions and acetabular cartilage into three subregions in coronal image. There is full-thickness acetabular cartilage loss with diameter of 10 mm (white arrows) in superolateral subregion, which would be scored as grade 2 lesion according to SHOMRI. There is also subchondral cyst (black arrow) in superolateral region. Findings were arthroscopically confirmed. Long lines show separate lateral, superolateral, and superomedial regions, and short lines = indicate foveal regions.
Fig. 5—
Fig. 5—
MR arthrography of right hip of 40-year-old man with clinical diagnosis of femoroacetabular impingement (FAI). A, Coronal T1-weighted fat-suppressed (FS) fast spin-echo (FSE) image shows focal cartilage defect (long arrow) at acetabular cartilage in direct proximity to labral insertion and osteophyte (short arrow) at margin of femoral head. B, Coronal T1-weighted FS FSE image shows additional cartilage delamination at acetabulum (long arrow) and marginal osteophytes (short arrows). C, Oblique axial intermediate-weighted FS FSE image shows typical deformity (asphericity) of femoral head with prominence at head-neck junction (long arrow) along with diffuse cartilage loss (short arrows). Patient underwent arthroscopic FAI surgery, which verified cartilage delamination.
Fig. 6—
Fig. 6—
MR arthrography of left hip of 26-year-old man with clinical diagnosis of femoroacetabular impingement. A and B, Unenhanced coronal intermediate-weighted fat-saturated fast spin-echo (FSE) MR arthrograms obtained at 1.5 T (A) and at 1.5 T, unehanced 3-T MRI, and arthroscopy at 3T (B) show area of bright signal intensity along superior acetabulum with adjacent darker hypointense cartilage (arrow) consistent with delamination. C, Sagittal intermediate-weighted fat-saturated FSE image obtained at 3 T shows findings (arrows) similar to coronal images (A and B). D, Arthroscopic image shows acetabular cartilage delamination (arrows) with injured cartilage layer being débrided by arthroscopic biter (asterisk).
Fig. 7—
Fig. 7—
Cartilage delamination in 55-year-old man with clinical signs of femoroacetabular impingement. A, Sagittal intermediate-weighted fat-saturated fast spin-echo (FSE) image obtained at 3 T shows abnormal cartilage at acetabulum with bright signal intensity along subchondral bone and layer of darker hypointense cartilage covering this area (arrows). B, Arthroscopic image shows acetabular cartilage delamination at chondrolabral junction as pressure applied to labrum by arthroscopic probe (asterisk) causes positive wave sign to underlying delaminated cartilage (arrows).
Fig. 8—
Fig. 8—
Axial intermediate-weighted fat-suppressed fast spin-echo image of right femoral head shows posttraumatic focal cartilage defect (long arrow) at posterior aspect of femoral head with some adjacent mild bone marrow signal abnormalities (short arrow).
Fig. 9—
Fig. 9—
42-year-old man with moderate hip osteoarthritis characterized by joint space narrowing. A and B, Sagittal (A) and coronal (B) intermediate-weighted fat-suppressed fast spin-echo images show diffuse cartilage loss in weight-bearing central and anterior regions of acetabulum (arrows, A) and in superolateral region (short arrows, B). Also, note labral tear (long arrow, B).
Fig. 10—
Fig. 10—
Sagittal intermediate-weighted fat-suppressed fast spin-echo image of 65-year-old woman shows femoral head subchondral insufficiency fracture (long arrows) and joint space narrowing. Diffuse cartilage lossisseen in weight-bearing central and anterior regions of acetabulum and femoral head (short arrows). There is also mild bone marrow edema pattern in femoral head adjacent to fracture.
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