Wk 3, Case 5 - Review

EXAM: MRI of the bilateral hips without contrast

INDICATION: 15-year-old boy with acute lymphoid leukemia, in remission

TECHNIQUE: Multiple axial, sagittal, and coronal images were obtained of the hips utilizing T1, T2 fat saturation, and STIR pulse sequences.

FINDINGS:

In the right hip, there is mildly abnormal T2 hyperintense signal throughout the femoral head and intertrochanteric region. In addition, there is a focal area near the anterior medial right femoral head that is T2 hyperintense with an indistinct rim of T1/T2 hypointensity. There is no evidence of collapse of the right femoral head.

On the left, there is marked abnormal signal throughout the femoral head and neck. There are at least 2 focal regions of subcortical T2 hyperintensity with a surrounding serpiginous rim of T1/T2 hypointensity. In addition, there is mild generalized collapse of the midportion of the articular surface of the left femoral head with slight associated expansion of the joint space on that side. There is no significant edema within the surrounding left hip musculature. The bone marrow signal of the pelvis/acetabula is unremarkable.

The soft tissue and muscular structures of the pelvis and proximal thighs are unremarkable. No abnormal soft tissue fluid collections. No joint effusions. The sacroiliac joints are normal.

IMPRESSIONS:

Patchy bilateral abnormal T2 hyperintense signal within both femoral heads, as well as areas of subcortical infarction, compatible with avascular necrosis. This is most pronounced on the left. In addition, there is mild collapse of the midportion of the left femoral head.