MRI Hip — routine
For occult fracture and avascular necrosis, both hips and the whole pelvis including the sacrum and pubic rami in a large field of view. For a joint-specific question, add a small field-of-view series over the symptomatic hip.
Typical, not policy
Timings, volumes and delays here are representative values drawn from published guidance. Scanner generation, injector, cardiac output and local preference all move them. Confirm against your department's own protocol before you rely on a number.
When to use it
- Suspected occult proximal femoral fracture after a fall with normal or equivocal radiographs.
- Suspected avascular necrosis of the femoral head, including on corticosteroid therapy or after transplantation.
- Transient osteoporosis of the hip or subchondral insufficiency fracture.
- Femoroacetabular impingement and labral pathology in a young adult with groin pain.
- Unexplained hip or groin pain where the differential includes muscle, tendon and bone.
Technique
- Large field-of-view coronal T1 and coronal fluid-sensitive fat-suppressed or STIR sequence across the pelvis — this pair answers the occult fracture question and simultaneously covers the pubic rami and sacrum, which are common alternative sites.
- Axial imaging through the affected hip; small field-of-view oblique-axial and radial sequences aligned to the femoral neck where impingement or labral pathology is the question.
- Sagittal or oblique planes added for femoral head assessment in suspected avascular necrosis.
- Metal-artefact-reduction techniques where there is arthroplasty; these change the sequence set substantially.
Where it goes wrong
- Imaging only the symptomatic hip with a small coil, missing the pubic rami, sacrum and contralateral femur that account for a substantial share of occult fractures.
- STIR or fluid-sensitive sequence omitted, so a non-displaced fracture line without displacement is invisible on T1 alone.
- Radial imaging omitted when impingement was the question, so the anterosuperior labrum is not adequately assessed.
- Arthroplasty artefact not anticipated, producing a non-diagnostic study on a standard protocol.
Contrast
None
- Unenhanced for fracture, avascular necrosis and marrow oedema questions. Contrast is added for suspected infection or tumour.
Acquisition
- Breathing
- Free breathing; a large field-of-view pelvic series is relatively motion-tolerant.
- Preparation
- For suspected occult neck of femur fracture, image both hips with a large field of view — a unilateral small-coil study can miss the pubic rami and sacrum. For impingement, supply the radiographs; alpha-angle and version questions are planned from them. Declare hip arthroplasty; metal-artefact-reduction sequences change the whole protocol.
Safety checks this protocol carries
Derived from the contrast agent and phases above, not authored here — which is why they cannot drift apart from what the protocol actually does.
- MR safety screening for implants and foreign bodies· radiographer at scan