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Open Access 01-12-2023 | Magnetic Resonance Imaging | Original Article

Hip MRI in flexion abduction external rotation for assessment of the ischiofemoral interval in patients with hip pain—a feasibility study

Authors: Alexander F. Heimann, Jonas Walther, Moritz Tannast, Joseph M. Schwab, Moritz Wagner, Alexander Brunner, Till D. Lerch, Simon D. Steppacher, Peter Vavron, Ehrenfried Schmaranzer, Florian Schmaranzer

Published in: Insights into Imaging | Issue 1/2023

Abstract

Objectives

To assess the feasibility of flexion-abduction-external rotation (FABER) magnetic resonance imaging (MRI) of the hip to visualize changes in the ischiofemoral interval and ability to provoke foveal excursion over the acetabular rim.

Methods

IRB-approved retrospective single-center study. Patients underwent non-contrast 1.5-T hip MRI in the neutral and FABER position. Two readers measured the ischiofemoral interval at three levels: proximal/distal intertrochanteric distance and ischiofemoral space. Subgroup analysis was performed for hips with/without high femoral torsion, or quadratus femoris muscle edema (QFME), respectively. A receiver operating curve with calculation of the area under the curve (AUC) for the prediction of QFME was calculated. The presence of foveal excursion in both positions was assessed.

Results

One hundred ten patients (121 hips, mean age 34 ± 11 years, 67 females) were evaluated. FABER-MRI led to narrowing (both p < .001) of the ischiofemoral interval which decreased more at the proximal (mean decrease by 26 ± 7 mm) than at the distal (6 ± 7 mm) intertrochanteric ridge. With high femoral torsion/ QFME, the ischiofemoral interval was significantly narrower at all three measurement locations compared to normal torsion/no QFME (p < .05). Accuracy for predicting QFME was high with an AUC of .89 (95% CI .82–.94) using a threshold of ≤ 7 mm for the proximal intertrochanteric distance.

With FABER-MRI foveal excursion was more frequent in hips with QFME (63% vs 25%; p = .021).

Conclusion

Hip MRI in the FABER position is feasible, visualizes narrowing of the ischiofemoral interval, and can provoke foveal excursion.

Critical relevance statement

FABER MRI may be helpful in diagnosing ischiofemoral impingement and detecting concomitant hip instability by overcoming shortcomings of static MR protocols that do not allow visualization of dynamic changes in the ischiofemoral interval and thus may improve surgical decision making.

Key points

• FABER MRI enables visualization of narrowing of the ischiofemoral interval proximal to the lesser trochanter.

• Proximal intertrochanteric distance of ≤ 7 mm accurately predicts quadratus femoris muscle edema.

• Foveal excursion was more frequent in hips with quadratus femoris muscle edema.

Graphical Abstract

Available only for authorised users

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Title: Hip MRI in flexion abduction external rotation for assessment of the ischiofemoral interval in patients with hip pain—a feasibility study
Authors: Alexander F. Heimann
Jonas Walther
Moritz Tannast
Joseph M. Schwab
Moritz Wagner
Alexander Brunner
Till D. Lerch
Simon D. Steppacher
Peter Vavron
Ehrenfried Schmaranzer
Florian Schmaranzer
Publication date: 01-12-2023
Publisher: Springer Vienna
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Femuroacetabular Impingement
Edema
Hip Arthroscopy
Published in: Insights into Imaging / Issue 1/2023
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1186/s13244-023-01524-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Hip MRI in flexion abduction external rotation for assessment of the ischiofemoral interval in patients with hip pain—a feasibility study

Abstract

Objectives

Methods

Results

Conclusion

Critical relevance statement

Key points

Graphical Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Critical relevance statement

Key points

Graphical Abstract

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