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Discussion Forty four The agreement between the x-ray findings and the MR imaging regarding osteonecrosis was Plain x-rays showed Fast MR takaoja with fat suppressed sequences is necessary and adequate as a single method for the investigation of painful skeletal sites in patients with already diagnosed hip osteonecrosis. It allows early diagnosis of the potentially debilitating multiple juxta-articular lesions and consequently their prompt management. Femoral head is the most commonly affected site of the skeleton with approximately 20, new cases reported each year in the United States and ON is a clinical entity affecting young individuals in their 30s and early 40s Plakseychuk et al.
There are two major types of ON: The disease in the majority of the patients is affecting the hip joint followed by the shoulder, the knee, the ankle and less commonly the elbow and wrist Lee et al. As most of the symptomatic lesions are sub-articular or para-articular, the weight bearing in daily activities may soome lead to fatigue failure takaoa the infarct and articular surface collapse. An early diagnosis and immediate intervention is therefore very important and might takakka the joint from collapse with a variety of joint salvage procedures. Since most of the patients are young, a diagnostic test skipping radiation burden would be clinically useful.
Any attempt to depict an osteonecrotic lesion should use MRImages with adequate fat suppression, since the contrast of the lesion against the low signal intensity of the bone marrow is high. Applying a larger field of view and lower acquisition matrix values, the examination time might be significantly reduced. Therefore, at the presentation of a patient with a painful hip and musculoskeletal pain other than that at the buttock, hip and thigh area, 2—3 additional anatomical sites can be screened at the same time as the one subjected to a detailed MRI scan.
The purpose of this study was to assess the value of a fast MR imaging protocol for the multi-site investigation of patients with femoral head ON, who present with skeletal pain in sites other than the known osteonecrosis at the hip joint. Materials and methods Between andpatients with non-traumatic femoral head ON were included to the present prospective case series.
Dedicated pelvic coils or iin with larger number of coil elements over a small anatomic area, such as a cardiac coil, tend to provide better image quality for targeted imaging of the pelvis. Small tumors may be zome in an underdistended bladder. Bladder overdistention ln lead to discomfort, which might result in increased voluntary motion and decreased sensitivity to fot and small tumors. Optimal bladder distention can be achieved by asking the patient to void 2 hours prior to imaging. Motion artifacts as a result of bowel peristalsis can degrade images, although administering hyoscyamine oral or sublingual or glucagon intramuscular or intravenous prior to imaging can be helpful.
Increasing the receiving bandwidth and changing the direction of the frequency-encoding gradient are ways to reduce or displace this artifact, respectively. Patients are asked to avoid ejaculation at least 3 days prior to imaging to increase seminal vesicle distention. In postbiopsy patients, imaging should be avoided, if possible, for at least 6 weeks after the procedure because hemorrhage and architectural distortion may mimic or obscure tumors as well as capsular disruption. The fast, sequential acquisitions enabled by these sequences are particularly useful in the upper abdomen where diaphragmatic motion can result in significant image degradation.
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The addition Lloking fat-suppression strategies helps improve image contrast. T2-weighted multishot sequences provide the additional benefits of greater image contrast, SNR, and spatial resolution compared with single-shot techniques, although they are more vulnerable to motion artifacts. Multishot techniques can be combined with a variety of respiratory compensation strategies to eliminate or improve motion artifacts, although imaging times are further increased. Heavily T2-weighted images using long echo times and thick-slice profile acquired in the coronal plane are useful in the evaluation of the collecting system and ureters.
These rely on the intrinsic long T2 relaxation time of urine to display hyperintense signal in the GU track against the dark, suppressed background on a single 2-D image. Fat saturation techniques can provide additional optimization in the background suppression.
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