NAME OF STUDY: MRI of bilateral hip.
REFERRING PHYSICIAN: John Doe, MD
DATE OF STUDY: MM/DD/YYYY
INDICATION FOR STUDY: Osteoarthritis, now with right hip pain.
TECHNIQUE: The patient was brought in for MRI of bilateral hip. Routine imaging in all three planes was performed. No gadolinium was used.
Both of the femoral heads are well maintained. No evidence of edema or crescent-shaped fractures is noted of either femoral head to indicate avascular necrosis. No lytic or blastic lesions within the femoral head noted. The joint spaces are well maintained.
There is a 1 cm focus of high signal involving the posterior right acetabulum. This abuts the posterior cortex. Fatty structures are noted just posterior. No unusual masses are seen adjacent to this posterior right acetabulum. The muscle beds also appear intact. This appears to be an isolated small bone lesion.
There is high signal on T2 and low on T1 suggesting edema. Often times, there can be a microfracture or stress fracture with edema around it. Other pathology cannot be excluded such as metastasis; however, given the fact that there are no surrounding soft tissue edema or musculature changes, that is felt less likely.
Dependent on the patient’s other physical history, one may want to proceed to a bone scan to see if this is the only focal area, which takes up radionuclide or there are multiple other sites that would be more suggestive of a metastatic lesion.
Given the appearance and should it be a single lesion, then one would most likely suggest this as a stress fracture. The iliac wings are unremarkable to sacrum and alar wings seen on this exam all appear normal.
The upper intertrochanteric regions of the femur and upper half of the femoral shaft all appear within normal limits as well.
IMPRESSION:
1. The right hip joint and the right femoral head are unremarkable. This is also true on the left.
2. There is 1 cm ill-defined focus of high signal on T2 weighted imaging involving the posterior right acetabulum. This does not abut the anterior cortex, but it is more posterior in its location. No evidence of breakage to the cortex is seen by MRI. It is high on T2 and low on T1 suggesting of inflammatory edema. Differential is most likely contusion or stress fracture versus less likely a metastasis. No surrounding soft tissue changes or musculature changes are seen that would suggest a metastasis. The remaining bony structures seen on the exam show no pathology.
3. Bone scan may be helpful.
Thank you for your kind referral.
