Semin Musculoskelet Radiol 2017; 21(05): 507-517
DOI: 10.1055/s-0037-1606136
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Hip Imaging: Normal Variants and Asymptomatic Findings

Patrick Omoumi
1   Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
,
Bruno Vande Berg
2   Department of Radiology, Cliniques Universitaires St. Luc, Brussels, Belgium
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
12. Oktober 2017 (online)

Abstract

With the increasing use of imaging as a diagnostic tool for hip pain, more and more anatomical variants are detected, and more findings are seen in asymptomatic populations, especially in older individuals. The radiologist must be aware of these variants and asymptomatic findings to avoid interpretative errors and overdiagnosis. In this review, we cover frequently encountered anatomical variants and asymptomatic findings that can be found in the bony structures of the hip, the joint itself, as well as in the surrounding soft tissues.

 
  • References

  • 1 Lequesne M, Malghem J, Dion E. The normal hip joint space: variations in width, shape, and architecture on 223 pelvic radiographs. Ann Rheum Dis 2004; 63 (09) 1145-1151
  • 2 Johnstone WH, Keats TE, Lee ME. The anatomic basis for the superior acetabular roof notch “superior acetabular notch.”. Skeletal Radiol 1982; 8 (01) 25-27
  • 3 Lien LC, Hunter JC, Chan YS. Tubular acetabular intraosseous contrast tracking in MR arthrography of the hip: prevalence, clinical significance, and mechanisms of development. AJR Am J Roentgenol 2006; 187 (03) 807-810
  • 4 Keats TE, Anderson MW. Atlas of Normal Roentgen Variants That May Simulate Disease. Philadelphia, PA: Elsevier Saunders; 2013
  • 5 Dietrich TJ, Suter A, Pfirrmann CWA, Dora C, Fucentese SF, Zanetti M. Supraacetabular fossa (pseudodefect of acetabular cartilage): frequency at MR arthrography and comparison of findings at MR arthrography and arthroscopy. Radiology 2012; 263 (02) 484-491
  • 6 Goergen TG, Resnick D, Greenway G, Saltzstein SL. Dorsal defect of the patella (DDP): a characteristic radiographic lesion. Radiology 1979; 130 (02) 333-336
  • 7 Ly JQ, Bui-Mansfield LT, Kline MJ, DeBerardino TM, Taylor DC. Bare area of the glenoid: magnetic resonance appearance with arthroscopic correlation. J Comput Assist Tomogr 2004; 28 (02) 229-232
  • 8 Norman-Taylor FH, Villar RN. Arthroscopic surgery of the hip: current status. Knee Surg Sports Traumatol Arthrosc 1994; 2 (04) 255-258
  • 9 Nguyen MS, Kheyfits V, Giordano BD, Dieudonne G, Monu JUV. Hip anatomic variants that may mimic abnormalities at MRI: labral variants. AJR Am J Roentgenol 2013; 201 (03) W394-400
  • 10 Lecouvet FE, Vande Berg BC, Malghem J. , et al. MR imaging of the acetabular labrum: variations in 200 asymptomatic hips. AJR Am J Roentgenol 1996; 167 (04) 1025-1028
  • 11 Blankenbaker DG, Tuite MJ. Acetabular labrum. Magn Reson Imaging Clin N Am 2013; 21 (01) 21-33
  • 12 Tuite MJ, Currie JW, Orwin JF, Baer GS, del Rio AM. Sublabral clefts and recesses in the anterior, inferior, and posterior glenoid labrum at MR arthrography. Skeletal Radiol 2013; 42 (03) 353-362
  • 13 Thomas JD, Li Z, Agur AM, Robinson P. Imaging of the acetabular labrum. Semin Musculoskelet Radiol 2013; 17 (03) 248-257
  • 14 Kwee RM, Kavanagh EC, Adriaensen MEAPM. Normal anatomical variants of the labrum of the hip at magnetic resonance imaging: a systematic review. Eur Radiol 2013; 23 (06) 1694-1710
  • 15 Petersilge C. Imaging of the acetabular labrum. Magn Reson Imaging Clin N Am 2005; 13 (04) 641-652 , vi
  • 16 Lee AJJ, Armour P, Thind D, Coates MH, Kang ACL. The prevalence of acetabular labral tears and associated pathology in a young asymptomatic population. Bone Joint J 2015; 97-B (05) 623-627
  • 17 Cotten A, Boutry N, Demondion X. , et al. Acetabular labrum: MRI in asymptomatic volunteers. J Comput Assist Tomogr 1998; 22 (01) 1-7
  • 18 Frank JM, Harris JD, Erickson BJ. , et al. Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers: a systematic review. Arthroscopy 2015; 31 (06) 1199-1204
  • 19 Byers PD, Contepomi CA, Farkas TA. A post mortem study of the hip joint. Including the prevalence of the features of the right side. Ann Rheum Dis 1970; 29 (01) 15-31
  • 20 Ninomiya S, Shimabukuro A, Tanabe T, Kim YT, Tachibana Y. Ossification of the acetabular labrum. J Orthop Sci 2000; 5 (05) 511-514
  • 21 Cerezal L, Kassarjian A, Canga A. , et al. Anatomy, biomechanics, imaging, and management of ligamentum teres injuries. Radiographics 2010; 30 (06) 1637-1651
  • 22 Ipplito E, Ishii Y, Ponseti IV. Histologic, histochemical, and ultrastructural studies of the hip joint capsule and ligamentum teres in congenital dislocation of the hip. Clin Orthop Relat Res 1980; (146) 246-258
  • 23 DuBois DF, Omar IM. MR imaging of the hip: normal anatomic variants and imaging pitfalls. Magn Reson Imaging Clin N Am 2010; 18 (04) 663-674
  • 24 Blankenbaker DG, Davis KW, De Smet AA, Keene JS. MRI appearance of the pectinofoveal fold. AJR Am J Roentgenol 2009; 192 (01) 93-95
  • 25 Bencardino JT, Kassarjian A, Vieira RLR, Schwartz R, Mellado JM, Kocher M. Synovial plicae of the hip: evaluation using MR arthrography in patients with hip pain. Skeletal Radiol 2011; 40 (04) 415-421
  • 26 Fu Z, Peng M, Peng Q. Anatomical study of the synovial plicae of the hip joint. Clin Anat 1997; 10 (04) 235-238
  • 27 Llopis E, Fernandez E, Cerezal L. MR and CT arthrography of the hip. Semin Musculoskelet Radiol 2012; 16 (01) 42-56
  • 28 Katz LD, Haims A, Medvecky M, McCallum J. Symptomatic hip plica: MR arthrographic and arthroscopic correlation. Skeletal Radiol 2010; 39 (12) 1255-1258
  • 29 Atlihan D, Jones DC, Guanche CA. Arthroscopic treatment of a symptomatic hip plica. Clin Orthop Relat Res 2003; (411) 174-177
  • 30 Blankenbaker DG, Tuite MJ. The painful hip: new concepts. Skeletal Radiol 2006; 35 (06) 352-370
  • 31 Kassarjian A. Hip MR arthrography and femoroacetabular impingement. Semin Musculoskelet Radiol 2006; 10 (03) 208-219
  • 32 Tannast M, Siebenrock KA, Anderson SE. Femoroacetabular impingement: radiographic diagnosis—what the radiologist should know. AJR Am J Roentgenol 2007; 188 (06) 1540-1552
  • 33 Omoumi P, Thiery C, Michoux N, Malghem J, Lecouvet FE, Vande Berg BC. Anatomic features associated with femoroacetabular impingement are equally common in hips of old and young asymptomatic individuals without CT signs of osteoarthritis. AJR Am J Roentgenol 2014; 202 (05) 1078-1086
  • 34 Lepage-Saucier M, Thiéry C, Larbi A, Lecouvet FE, Vande Berg BC, Omoumi P. Femoroacetabular impingement: normal values of the quantitative morphometric parameters in asymptomatic hips. Eur Radiol 2014; 24 (07) 1707-1714
  • 35 Ahn T, Kim C-H, Kim TH. , et al. What is the prevalence of radiographic hip findings associated with femoroacetabular impingement in asymptomatic Asian volunteers?. Clin Orthop Relat Res 2016; 474 (12) 2655-2661
  • 36 Nardo L, Parimi N, Liu F. , et al; Osteoporotic Fractures in Men (MrOS) Research Group. Femoroacetabular impingement: prevalent and often asymptomatic in older men: the Osteoporotic Fractures in Men study. Clin Orthop Relat Res 2015; 473 (08) 2578-2586
  • 37 Diesel CV, Ribeiro TA, Scheidt RB, Macedo CA, Galia CR. The prevalence of femoroacetabular impingement in radiographs of asymptomatic subjects: a cross-sectional study. Hip Int 2015; 25 (03) 258-263
  • 38 Mineta K, Goto T, Wada K. , et al. CT-based morphological assessment of the hip joint in Japanese patients: association with radiographic predictors of femoroacetabular impingement. Bone Joint J 2016; 98-B (09) 1167-1174
  • 39 Kang ACL, Gooding AJ, Coates MH, Goh TD, Armour P, Rietveld J. Computed tomography assessment of hip joints in asymptomatic individuals in relation to femoroacetabular impingement. Am J Sports Med 2010; 38 (06) 1160-1165
  • 40 Larson CM, Moreau-Gaudry A, Kelly BT. , et al. Are normal hips being labeled as pathologic? A CT-based method for defining normal acetabular coverage. Clin Orthop Relat Res 2015; 473 (04) 1247-1254
  • 41 Anderson LA, Anderson MB, Kapron A. , et al. The 2015 Frank Stinchfield Award: Radiographic abnormalities common in senior athletes with well-functioning hips but not associated with osteoarthritis. Clin Orthop Relat Res 2016; 474 (02) 342-352
  • 42 Reiman MP, Thorborg K, Covington K, Cook CE, Hölmich P. Important clinical descriptors to include in the examination and assessment of patients with femoroacetabular impingement syndrome: an international and multi-disciplinary Delphi survey. Knee Surg Sports Traumatol Arthrosc 2017; 25 (06) 1975-1986
  • 43 Rubin DA. Femoroacetabular impingement: fact, fiction, or fantasy?. AJR Am J Roentgenol 2013; 201 (03) 526-534
  • 44 Reiman MP, Thorborg K. Femoroacetabular impingement surgery: are we moving too fast and too far beyond the evidence?. Br J Sports Med 2015; 49 (12) 782-784
  • 45 Pitt MJ, Graham AR, Shipman JH, Birkby W. Herniation pit of the femoral neck. AJR Am J Roentgenol 1982; 138 (06) 1115-1121
  • 46 Daenen B, Preidler KW, Padmanabhan S. , et al. Symptomatic herniation pits of the femoral neck: anatomic and clinical study. AJR Am J Roentgenol 1997; 168 (01) 149-153
  • 47 Panzer S, Augat P, Esch U. CT assessment of herniation pits: prevalence, characteristics, and potential association with morphological predictors of femoroacetabular impingement. Eur Radiol 2008; 18 (09) 1869-1875
  • 48 Nokes SR, Vogler JB, Spritzer CE, Martinez S, Herfkens RJ. Herniation pits of the femoral neck: appearance at MR imaging. Radiology 1989; 172 (01) 231-234
  • 49 Crabbe JP, Martel W, Matthews LS. Rapid growth of femoral herniation pit. AJR Am J Roentgenol 1992; 159 (05) 1038-1040
  • 50 Leunig M, Beck M, Kalhor M, Kim Y-J, Werlen S, Ganz R. Fibrocystic changes at anterosuperior femoral neck: prevalence in hips with femoroacetabular impingement. Radiology 2005; 236 (01) 237-246
  • 51 de Bruin F, Reijnierse M, Farhang-Razi V, Bloem JL. Radiographic signs associated with femoroacetabular impingement occur with high prevalence at all ages in a hospital population. Eur Radiol 2013; 23 (11) 3131-3139
  • 52 Ji H-M, Baek J-H, Kim K-W, Yoon J-W, Ha Y-C. Herniation pits as a radiographic indicator of pincer-type femoroacetabular impingement in symptomatic patients. Knee Surg Sports Traumatol Arthrosc 2014; 22 (04) 860-866
  • 53 Kim JA, Park JS, Jin W, Ryu K. Herniation pits in the femoral neck: a radiographic indicator of femoroacetabular impingement?. Skeletal Radiol 2011; 40 (02) 167-172
  • 54 Klaue K, Durnin CW, Ganz R. The acetabular rim syndrome. A clinical presentation of dysplasia of the hip. J Bone Joint Surg Br 1991; 73 (03) 423-429
  • 55 Martinez AE, Li SM, Ganz R, Beck M. Os acetabuli in femoro-acetabular impingement: stress fracture or unfused secondary ossification centre of the acetabular rim?. Hip Int 2006; 16 (04) 281-286
  • 56 Hergan K, Oser W, Moriggl B. Acetabular ossicles: normal variant or disease entity?. Eur Radiol 2000; 10 (04) 624-628
  • 57 Vande Berg BC, Malghem J, Lecouvet FE, Maldague B. Magnetic resonance imaging of the normal bone marrow. Skeletal Radiol 1998; 27 (09) 471-483
  • 58 Vande Berg BC, Lecouvet FE, Moysan P, Maldague B, Jamart J, Malghem J. MR assessment of red marrow distribution and composition in the proximal femur: correlation with clinical and laboratory parameters. Skeletal Radiol 1997; 26 (10) 589-596
  • 59 Vande Berg BC, Malghem J, Lecouvet FE, Maldague B. Magnetic resonance imaging of normal bone marrow. Eur Radiol 1998; 8 (08) 1327-1334
  • 60 Blankenbaker DG, Ullrick SR, Davis KW, De Smet AA, Haaland B, Fine JP. Correlation of MRI findings with clinical findings of trochanteric pain syndrome. Skeletal Radiol 2008; 37 (10) 903-909
  • 61 Steinert L, Zanetti M, Hodler J, Pfirrmann CWA, Dora C, Saupe N. Are radiographic trochanteric surface irregularities associated with abductor tendon abnormalities?. Radiology 2010; 257 (03) 754-763
  • 62 Resnick D, Niwayama G. Entheses and enthesopathy. Anatomical, pathological, and radiological correlation. Radiology 1983; 146 (01) 1-9
  • 63 Varma DG, Richli WR, Charnsangavej C, Samuels BI, Kim EE, Wallace S. MR appearance of the distended iliopsoas bursa. AJR Am J Roentgenol 1991; 156 (05) 1025-1028
  • 64 Kassarjian A, Llopis E, Schwartz RB, Bencardino JT. Obturator externus bursa: prevalence of communication with the hip joint and associated intra-articular findings in 200 consecutive hip MR arthrograms. Eur Radiol 2009; 19 (11) 2779-2782
  • 65 Robinson P, White LM, Agur A, Wunder J, Bell RS. Obturator externus bursa: anatomic origin and MR imaging features of pathologic involvement. Radiology 2003; 228 (01) 230-234
  • 66 Philippon MJ, Devitt BM, Campbell KJ. , et al. Anatomic variance of the iliopsoas tendon. Am J Sports Med 2014; 42 (04) 807-811