MRI has been shown to be 85.92% accurate for identification of acetabular chondral rim lesions when compared to arthroscopy [85]. Various MRI techniques such as T2 mapping, T1rho, and sodium imaging allow for the ultrastructural assessment of articular cartilage [98]. Although these techniques are primarily used in the research setting, some have also been applied in the routine evaluation of clinical patients. US Hip US is limited in the hip by its inability to evaluate the acetabular or the majority of the femoral head cartilage. The acoustic window to see articular cartilage in the hip is limited. Variant 6: Chronic hip pain. Radiographs suspicious for intra-articular synovial hyperplasia or neoplasia including nodular synovitis, diffuse tenosynovial giant cell tumor, osteochondromatosis, other synovial neoplasm. Next imaging study. Image-Guided Aspiration Hip Image-guided aspiration/injections demonstrate brown or bloody aspirate in patients with the diffuse form of tenosynovial giant cell tumor [99,100]. The diagnosis of synovial hyperplasia/neoplasia may require a tissue sample. Bone Scan Hip There is no relevant literature to support the use of bone scan of the hip in the assessment of the intra-articular synovial hyperplasia/neoplasia in a patient with chronic hip pain. CT Arthrography Hip CT arthrography may be helpful in evaluating whether there are intra-articular bodies or hypertrophic synovium. CT Hip With IV Contrast There is no relevant literature to support the use of CT hip with IV contrast for the workup of synovial hyperplasia/neoplasia in a patient with chronic hip pain. CT Hip Without and With IV Contrast It can be quite difficult to distinguish diffuse tenosynovial giant cell tumor from synovial chondromatosis and other proliferative synovial processes on imaging. CT without IV contrast might help to detect calcification. However, there is no added benefit of administering IV contrast for the diagnosis of a synovial proliferative process.
Chronic Hip Pain PCAs. MRI has been shown to be 85.92% accurate for identification of acetabular chondral rim lesions when compared to arthroscopy [85]. Various MRI techniques such as T2 mapping, T1rho, and sodium imaging allow for the ultrastructural assessment of articular cartilage [98]. Although these techniques are primarily used in the research setting, some have also been applied in the routine evaluation of clinical patients. US Hip US is limited in the hip by its inability to evaluate the acetabular or the majority of the femoral head cartilage. The acoustic window to see articular cartilage in the hip is limited. Variant 6: Chronic hip pain. Radiographs suspicious for intra-articular synovial hyperplasia or neoplasia including nodular synovitis, diffuse tenosynovial giant cell tumor, osteochondromatosis, other synovial neoplasm. Next imaging study. Image-Guided Aspiration Hip Image-guided aspiration/injections demonstrate brown or bloody aspirate in patients with the diffuse form of tenosynovial giant cell tumor [99,100]. The diagnosis of synovial hyperplasia/neoplasia may require a tissue sample. Bone Scan Hip There is no relevant literature to support the use of bone scan of the hip in the assessment of the intra-articular synovial hyperplasia/neoplasia in a patient with chronic hip pain. CT Arthrography Hip CT arthrography may be helpful in evaluating whether there are intra-articular bodies or hypertrophic synovium. CT Hip With IV Contrast There is no relevant literature to support the use of CT hip with IV contrast for the workup of synovial hyperplasia/neoplasia in a patient with chronic hip pain. CT Hip Without and With IV Contrast It can be quite difficult to distinguish diffuse tenosynovial giant cell tumor from synovial chondromatosis and other proliferative synovial processes on imaging. CT without IV contrast might help to detect calcification. However, there is no added benefit of administering IV contrast for the diagnosis of a synovial proliferative process.