Severe Degenerative Changes of the Hip Joints

Clinical History:
This 74-year-old woman presented with a longstanding history of hip and leg pain on both sides but more pronounced on the right side. She is also suffers from a significant scoliosis.

Diagnosis:
Severe degenerative changes of the right hip with subchondral cyst formation

MR Technique: 
The exam was acquired on a 64-channel 3 T scanner (Siemens MAGNETOM Skyra). The MRI protocol included high-resolution T1-weighted and DESS (double echo steady state) images. For signal reception an 18-element body matrix coil and two clusters of the in-built 32-element spine matrix coil were used, resulting in a total of 26 coil elements. For the (A) T1-weighted TSE coronal scan, parameters were: TR/TE 525/11 ms, section thickness 3 mm, FOV 350×241 mm², matrix 768×422, spatial resolution 0.5×0.6×3 mm³, and acquisition time 98 sec. Parallel imaging was utilized (GRAPPA), with an acceleration factor of 2. For the (B) coronal DESS scan, parameters were TR/TE 15.5/5.2 ms, section thickness 0.7 mm, FOV 200×400, matrix 271×576, spatial resolution 0.7 mm isotropic, and acquisition time 352 sec. Parallel imaging was utilized (GRAPPA), with an acceleration factor of 2.

Imaging Findings:
There is narrowing of the joint space of the right hip with markedly reduced cartilage thickness particularly along the lateral aspect of the joint where there is also a prominent osteophyte. The adjacent osseous structures demonstrate slight edema (roof of the acetabulum) and massive subchondral bone cyst formation which is more pronounced in the femur. The subchondral bone cysts are partly septated. The left side is far less affected with only minor loss of cartilage. No subchondral bone cysts are seen in the weight-bearing parts of the joint. Only a small cystic lesion within the lateral femoral neck can be appreciated which most likely represents a small herniation pit. An incidental diverticulum of the urinary bladder can also be seen on the left.