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Acad Radiol. 2014 Oct;21(10):1240-7. doi: 10.1016/j.acra.2014.04.014. Epub 2014 Jun 26.

Improving visualization of the central compartment of the hip with direct MR arthrography under axial leg traction: a feasibility study.

Author information

1
Section for Rheuma- and Sports Imaging, Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria. Electronic address: florian.schmaranzer@student.i-med.ac.at.
2
Section for Rheuma- and Sports Imaging, Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
3
Department of Radiology, District Hospital St. Johann in Tyrol, St. Johann in Tyrol, Austria.
4
Department of Radiology, Medical University Innsbruck, Innsbruck, Austria.
5
Department for Applied Systems Research and Statistics, Johannes Kepler University, Linz, Austria.
6
Department of Orthopedic Surgery, District Hospital St.Johann in Tyrol, St. Johann in Tyrol, Austria.

Abstract

RATIONALE AND OBJECTIVES:

To evaluate the feasibility of a modified approach for direct magnetic resonance (MR) arthrography of the hip under leg traction in achieving a sufficient femoroacetabular interface and improving the visualization of the ligamentum teres.

MATERIALS AND METHODS:

Forty-six MR arthrograms of 44 patients who underwent MR arthrography with and without leg traction were included into the study. Traction approach included injection of 18-27 mL of fluid (local anesthetic, contrast agent), application of weight-adapted traction load (15-23 kg), and the use of a supporting plate. Patients were instructed to report on pain and complications with an integer pain scale. Joint distraction was measured on coronal images obtained with and without traction, and two radiologists independently evaluated whether femoroacetabular cartilage layers and the ligamentum teres could be seen as distinct entities. McNemar test was used and interobserver agreement was assessed.

RESULTS:

No patient asked for termination of the examination. There were no cases of neuropraxia. Mean difference in distraction was 3.7 mm/3.6 mm (reader 1/reader 2). Cartilage layers could be seen as distinct entities in 43/43 (93.5%/93.5%) and 6/8 (13%/17.4%) of the joints with/without traction (P < .001/P < .001), respectively. The ligamentum teres could be differentiated in 33/30 (71.7%/65.2%) cases with traction, in 33/30 (71.7%/65.2%) cases without traction (P < .999/P < .999), and in 40/37 (87%/80.4%) cases with both the techniques combined.

CONCLUSIONS:

Traction MR arthrography is safe and technically feasible. It enabled the differentiation between femoroacetabular cartilage layers in most cases. Visualization of the ligamentum teres was optimal by combining imaging with both modalities.

KEYWORDS:

MR arthrography; articular cartilage; hip joint; ligamentum teres; traction

PMID:
24981959
DOI:
10.1016/j.acra.2014.04.014
[Indexed for MEDLINE]

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