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MRI of the Hip: Detailed Anatomy

This webpage presents the anatomical structures found on hip MRI.

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T1 Axial view - T1 Coronal view

Hip MRI Anatomy: T1-weighted axial view. Image 1. 1, Iliacus m. 2, Rectus abdominis m. 3, Ilium. 4, Gluteus medius m. 5, Gluteus minimus m. 6, Gluteus maximus m.

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  • Hip MRI Anatomy: T1-weighted axial view. Image 1. 1, Iliacus m. 2, Rectus abdominis m. 3, Ilium. 4, Gluteus medius m. 5, Gluteus minimus m. 6, Gluteus maximus m.

  • Hip MRI Anatomy: T1-weighted axial view. Image 2. 1, Tensor fasciae latae m. 2, Iliac vessels. 3, Small bowel. 4, Sartorius m. 5, Piriformis m.. 6, Rectum. 7, Gluteus minimus m.

  • Hip MRI Anatomy: T1-weighted axial view. Image 3. 1, Tensor fasciae latae m. 2, Iliacus m. 3, Rectus abdominis m. 4, Sartorius m. 5, Gluteus minimus m. 6, Gluteus maximus m. 7, Piriformis m.. 8, Gluteus medius m.

  • Hip MRI Anatomy: T1-weighted axial view. Image 4. 1, Anterior inferior iliac spine. 2, Rectus abdominis m. 3, Tensor fasciae latae m. 4, Gluteus medius m. 5, Obturator internus m. 6, Gluteus maximus m. 7, Gluteus minimus m.

  • Hip MRI Anatomy: T1-weighted axial view. Image 5. 1, Tensor fasciae latae m. 2, Sartorius m. 3, Iliopsoas m. 4, Iliac vessels. 5, Urinary bladder. 6, Gluteus medius m. 7, Gluteus minimus m. 8, Gluteus maximus m.

  • Hip MRI Anatomy: T1-weighted axial view. Image 6. 1, Tensor fasciae latae m. 2, Sartorius m. 3, Iliac vessels. 4, Urinary bladder. 5, Gluteus medius m. 6, Gluteus minimus m. 7, Rectum. 8, Gluteus maximus m.

  • Hip MRI Anatomy: T1-weighted axial view. Image 7. 1, Sartorius m. 2, Iliac vessels. 3, Urinary bladder. 4, Iliopsoas m. 5, Tensor fasciae latae m. 6, Gluteus medius m. 7, Sacrum. 8, Gluteus maximus m.

  • Hip MRI Anatomy: T1-weighted axial view. Image 8. 1, Right femoral head. 2, Femoral vessels. 3, Urinary bladder. 4, Iliopsoas m. 5, Sartorius m. 6, Tensor fasciae latae m. 7, Rectum. 8, Gluteus maximus m.

  • Hip MRI Anatomy: T1-weighted axial view. Image 9. 1, Tensor fasciae latae m. 2, Rectus femoris m. 3, Sartorius m. 4, Urinary bladder. 5, Iliopsoas m 6, Gluteus medius m. 7, Obturator internus m. 8, Rectum. 9, Gluteus maximus m. 10, Femoral head.

  • Hip MRI Anatomy: T1-weighted axial view. Image 10. 1, Gluteus medius m. 2, Rectus femoris m. 3, Urinary bladder. 4, Iliopsoas m. 5, Sartorius m. 6, Tensor fasciae latae m. 7, Gluteus maximus m. 8, Femoral head.

  • Hip MRI Anatomy: T1-weighted axial view. Image 11. 1, Gluteus medius m. 2, Rectus femoris m. 3, Femoral vessels. 4, Urinary bladder. 5, Iliopsoas m. 6, Sartorius m. 7, Tensor fasciae latae m. 8, Femoral head. 9, Obturator internus m. 10, Gluteus maximus m.

  • Hip MRI Anatomy: T1-weighted axial view. Image 12. 1, Sartorius m. 2, Iliopsoas m. 3, Gluteus medius m. 4, Gluteus maximus m. 5, Obturator internus m. 6, Ischiorectal fossa. 7, Right femoral head.

  • Hip MRI Anatomy: T1-weighted axial view. Image 13. 1, Rectus femoris m. 2, Femoral vessels. 3, Urinary bladder. 4, Iliopsoas m. 5, Sartorius m. 6, Tensor fasciae latae m. 7, Gluteus medius m. 8, Obturator internus m. 9, Ischiorectal fossa. 10, Gluteus maximus m.

  • Hip MRI Anatomy: T1-weighted axial view. Image 14. 1, Tensor fasciae latae m. 2, Iliopsoas m. 3, Urinary bladder. 4, Femoral vessels. 5, Sartorius m. 6, Rectus femoris m. 7, Gluteus medius m. 8, Left femoral head. 9, Obturator internus m. 10, Quadrilateral plate. 11, Posterior pillar. 12, Gluteus maximus m. 13, Greater trochanter.

  • Hip MRI Anatomy: T1-weighted axial view. Image 15. 1, Tensor fasciae latae m. 2, Rectus femoris m. 3, Femoral vessels. 4, Urinary bladder. 5, Iliopsoas m. 6, Sartorius m. 7, Femoral neck. 8, Obturator internus m. 9, Gluteus maximus m.

  • Hip MRI Anatomy: T1-weighted axial view. Image 16. 1, Tensor fasciae latae m. 2, Rectus femoris m. 3, Femoral vessels. 4, Sartorius m. 5, Gluteus maximus m. 6, Obturator internus m. 7, Quadratus femoris m. 8, Greater trochanter.

  • Hip MRI Anatomy: T1-weighted axial view. Image 17. 1, Femoral neck. 2, Femoral vessels. 3, Urinary bladder. 4, Sartorius m. 5, Rectus femoris m. 6, Tensor fasciae latae m. 7, Gluteus maximus m. 8, Obturator internus m.

  • Hip MRI Anatomy: T1-weighted axial view. Image 18. 1, Rectus femoris m. 2, Femoral vessels. 3, Pectineus m. 4, Sartorius m. 5, Iliopsoas m. 6, Quadratus femoris m. 7, Obturator internus m. 8, Gluteus maximus m.

  • Hip MRI Anatomy: T1-weighted axial view. Image 19. 1, Tensor fasciae latae m. 2, Rectus femoris m. 3, Sartorius m. 4, Symphysis pubis. 5, Femoral vessels. 6, Iliopsoas m. 7, Quadratus femoris m. 8, Obturator internus m. 9, Gluteus maximus m.

  • Hip MRI Anatomy: T1-weighted axial view. Image 20. 1, Tensor fasciae latae m. 2, Rectus femoris m. 3, Symphysis pubis. 4, Iliopsoas m. 5, Quadratus femoris m. 6, Obturator externus m. 7, Obturator internus m. 8, Gluteus maximus m.

  • Hip MRI Anatomy: T1-weighted axial view. Image 21. 1, Tensor fasciae latae m. 2, Rectus femoris m. 3, Obturator externus m. 4, Symphysis pubis. 5, Pectineus m. 6, Iliopsoas m. 7, Quadratus femoris m. 8, Obturator internus m. 9, Gluteus maximus m.

  • Hip MRI Anatomy: T1-weighted axial view. Image 22. 1, Tensor fasciae latae m. 2, Iliopsoas m. 3, Femoral vessels. 4, Sartorius m. 5, Rectus femoris m. 6, Quadratus femoris m. 7, Obturator externus m. 8, Ischiatic tuberosity. 9, Semimembranous m. 10, Gluteus maximus m.

  • Hip MRI Anatomy: T1-weighted axial view. Image 23. 1, Tensor fasciae latae m. 2, Iliopsoas m. 3, Pectineus m. 4, Symphysis pubis. 5, Sartorius m. 6, Rectus femoris m. 7, Vastus lateralis m. 8, Obturator externus m. 9, Quadratus femoris m. 10, Gluteus maximus m.

  • Hip MRI Anatomy: T1-weighted axial view. Image 24. 1, Tensor fasciae latae m. 2, Rectus femoris m. 3, Sartorius m. 4, Pectineus m. 5, Femoral vessels. 6, Iliopsoas m. 7, Vastus lateralis m. 8, Gluteus maximus m.

  • Hip MRI Anatomy: T1-weighted coronal view. Image 1. 1, Iliac crest. 2, Iliacus m. 3, Gluteus medius m. 4, Tensor fasciae latae m. 5, Pectineus m. 6, Urinary bladder. 7, Symphysis pubis. 8, Gluteus minimus m.

  • Hip MRI Anatomy: T1-weighted coronal view. Image 2. 1, Iliac crest. 2, Gluteus medius m. 3, Gluteus minimus m. 4, Tensor fasciae latae m. 5, Iliopsoas m. 6, Pectineus m. 7, Urinary bladder. 8, Symphysis pubis.

  • Hip MRI Anatomy: T1-weighted coronal view. Image 3. 1, Iliac crest. 2, Gluteus medius m. 3, Gluteus minimus m. 4, Iliopsoas m. 5, Urinary bladder. 6, Symphysis pubis. 7, Pectineus m.

  • Hip MRI Anatomy: T1-weighted coronal view. Image 4. 1, Iliac crest. 2, Gluteus medius m. 3, Gluteus minimus m. 4, Right femoral head. 5, Urinary bladder. 6, Symphysis pubis. 7, Pectineus m. 8, Iliopsoas m. 9, Tensor fasciae latae m.

  • Hip MRI Anatomy: T1-weighted coronal view. Image 5. 1, Gluteus medius m. 2, Gluteus minimus m. 3, Right femoral head. 4, Iliopsoas m. 5, Pectineus m. 6, Urinary bladder. 7, Symphysis pubis. 8, Femoral vessels. 9, Tensor fasciae latae m.

  • Hip MRI Anatomy: T1-weighted coronal view. Image 6. 1, Gluteus medius m. 2, Gluteus minimus m. 3, Right femoral head. 4, Urinary bladder. 5, Symphysis pubis. 6, Femoral vessels. 7, Iliopsoas m. 8, Left femoral head. 9, Tensor fasciae latae m. 10, Iliac crest.

  • Hip MRI Anatomy: T1-weighted coronal view. Image 7. 1, Gluteus medius m. 2, Gluteus minimus m. 3, Iliacus m. 4, Right femoral head. 5, Urinary bladder. 6, Symphysis pubis. 7, Obturator externus m. 8, Left femoral head. 9, Iliopsoas m.

  • Hip MRI Anatomy: T1-weighted coronal view. Image 8. 1, Gluteus medius m. 2, Gluteus minimus m. 3, Right femoral head. 4, Obturator internus m. 5, Urinary bladder. 6, Obturator externus m. 7, Left femoral head. 8, Femoral vessels. 9, Fémur.

  • Hip MRI Anatomy: T1-weighted coronal view. Image 9. 1, Gluteus medius m. 2, Gluteus minimus m. 3, Greater trochanter. 4, Femoral neck. 5, Femoral head. 6, Urinary bladder. 7, Obturator internus m. 8, Obturator externus m.

  • Hip MRI Anatomy: T1-weighted coronal view. Image 10. 1, Greater trochanter. 2, Femoral neck. 3, Right femoral head. 4, Obturator internus m. 5, Obturator externus m. 6, Urinary bladder. 7, Acetabulum. 8, Gluteus minimus m. 9, Gluteus medius m.

  • Hip MRI Anatomy: T1-weighted coronal view. Image 11. 1, Gluteus maximus & medius m. 2, Gluteus minimus m. 3, Acetabulum. 4, Obturator internus m. 5, Obturator externus m. 6, Urinary bladder. 7, Iliac wing. 8, Left femoral head. 9, Femoral neck. 10, Greater trochanter.

  • Hip MRI Anatomy: T1-weighted coronal view. Image 12. 1, Greater trochanter. 2, Femoral neck. 3, Right femoral head. 4, Urinary bladder. 5, Obturator internus m. 6, Obturator externus m. 7, Iliac wing. 8, Gluteus minimus m. 9, Gluteus maximus & medius m.

  • Hip MRI Anatomy: T1-weighted coronal view. Image 13. 1, Gluteus maximus & medius m. 2, Gluteus minimus m. 3, Greater trochanter. 4, Obturator externus m. 5, Obturator internus m. 6, Sacroiliac joint. 7, Femoral neck.

  • Hip MRI Anatomy: T1-weighted coronal view. Image 14. 1, Greater trochanter. 2, Acetabulum. 3, Right sacroiliac joint. 4, Obturator internus m. 5, Obturator externus m. 6, Left femoral head. 7, Gluteus medius & minimus m.

  • Hip MRI Anatomy: T1-weighted coronal view. Image 15. 1, Greater trochanter. 2, Obturator externus m. 3, Obturator internus m. 4, Sacroiliac joint. 5, Gluteus minimus m. 6, Left femoral head.

  • Hip MRI Anatomy: T1-weighted coronal view. Image 16. 1, Right sacroiliac joint. 2, Greater trochanter. 3, Lesser trochanter. 4, Obturator externus m. 5, Obturator internus m. 6, Gluteus muscle(s).

Magnetic resonance imaging (MRI) utilizes magnet and radio waves to produce diagnostic images that allow a doctor to visualize the hips. This medical imaging method can detect stress fractures or bone bruises that a regular X-ray usually misses.

According to a study, MRI is the modality of choice when determining X-ray results’ abnormalities and the diagnosis of various hip conditions. This modality is considered safe, non-invasive, and depicts accurate anatomical details(1). 

How Does Hip MRI Work in Medical Diagnosis?

MRI is a medical imaging tool that evaluates various causes of pain surrounding the hip joint. This tool can show changes in the cartilage and the underlying bone, helping doctors detect arthritis’ early signs(2). 

Several tendons insert around the hip and may become inflamed or degenerated. MRI determines the causes of hip pain that may originate from nearby structures, like the pubic bones, sacroiliac joints, or the lower lumbar spine(3). 

Other sources of pain that can be detected by MRI include tumors, infection, or necrosis of the bone (avascular necrosis or AVN)(4). 

Anatomy of the Hip

Understanding the anatomy of the hip is essential for diagnosing its pathology. The alignment and the marrow are the critical elements of the osseous (bony) structures on MR imaging(5). 

Normal variations that involve the cartilage include the supra-acetabular fossa (acetabular cartilage) and the stellate lesion. Meanwhile, labral sulcus and absent labrum are normal variations in the labrum (ring of cartilage). 

The hip’s essential muscles are the sartorius, rectus femoris, gluteus minimus and medius, iliopsoas, adductors, and hamstrings. 

The iliofemoral, pubofemoral, and ischiofemoral ligaments represent the thickenings of the joint capsule. These ligaments reinforce and stabilize the hip joint(6). 

The sciatic nerve, the femoral nerve, and the obturator nerve are the largest nerves in the hip and thigh. 

Hip Conditions or Pathologies

Hip Fractures

Hip fractures encompass a wide range of types and various imaging techniques. The most common hip fracture types are stress fractures and occult fractures (not detectable using radiograph).

Despite their ease of use and immediate results, radiographs have low reliability in picking up fractures in their early stages(7). 

MRI is considered the gold standard in detecting hip fractures due to its high sensitivity. A study demonstrated that radiographs have only a 15% to 35% sensitivity on initial stress fracture exam, increasing to 30% to 70% on follow-up visits(8). 

Meanwhile, MRI had 100% sensitivity, 95% accuracy, 93% positive predictive value, 86% specificity, and 100% negative predictive value(9). 

T-1 weighted and T2-weighted scans are the most common MRI sequences. T1-weighted images are generated using short TE (time to echo) and TR (repetition time), while T-2 weighted images are generated using longer TE and TR times(10). 

Time to echo refers to the time between the application of the radiofrequency pulse and the peak of the echo signal induced in the coil. Meanwhile, repetition time is the time between the application of successive pulse sequences to the same slice(11). 

It was suggested that a combination of a T1- and T2-weighted MRI is the best method of detecting occult fractures(12). 

This combination allows the differentiation of fractures from soft tissue injuries. 

When reading MRI for hip OA, one should look for the following:

  • Low-intensity signal located within or on the edge of the bone
  • T2-weighted MRI – edema surrounding bone
  • Displacement of bone (in the case of large fracture)

Hip Osteoarthritis (OA) 

Osteoarthritis is a multi-factorial condition that involves the breakdown of hyaline cartilage along articulating joints. A radiograph or MRI is the most commonly used source of imaging for hip OA. 

The gold standard for imaging hip OA is MRI because the articular cartilage is visible. The MRI also has a higher resolution of surrounding tissues(13). 

When reading MRI for hip OA, one should look for the following:

  • Joint narrowing
  • Reduced signal frequency of hyaline cartilage
  • Increased edema 
  • Osteophyte formation
  • Fast spin-echo images, such as fast spin-echo T2-weighted fat-suppressed images
  • Gradient-echo images, such as T1-weighted 3-dimensional fat-suppressed images

Trochanteric Bursitis or Tendonitis

Trochanteric bursitis or tendonitis is the inflammation of the tendons or greater trochanter around the same region(14). 

This condition is likely positive with maximum hip flexion, adduction, internal or external rotation, and positive palpation to the affected bursa or tendon. 

Additionally, tendonitis has a positive isometric contraction with activation to the affected muscle group.  

A radiograph is not as helpful in diagnosing trochanteric bursitis as soft tissues and muscles are not visible to any degree(15). 

When suspicious of hip bursitis or tendonitis, a T2-weighted MR image is considered the most beneficial. An MR image can detect asymmetric sites of fluid accumulation and edema(16). 

A fluid sensitive T2 helps detect soft tissue lesions, muscular strain, or tears that may accompany trochanteric bursitis or tendonitis. This MRI allows for high sensitivity of detecting the hip condition(17).

When reading MRI for hip OA, one should look for the following:

  • Asymmetrical collection of fluid in the high signal intensity peripheral of bone
  • The presence of bursal distension
  1. Turamari, R. U., Channaveerappanavar, P. B., Prakash, A., Jayaram, N., HM, C., & Muralidhar, A. Role of MRI in the Diagnosis of Hip Joint Pain. Alcohol, 5, 17-8.
  2. Zilkens, C., Miese, F., Jäger, M., Bittersohl, B., & Krauspe, R. (2011). Magnetic resonance imaging of hip joint cartilage and labrum. Orthopedic reviews, 3(2), e9. https://doi.org/10.4081/or.2011.e9
  3. Mengiardi, B., Pfirrmann, C. W., & Hodler, J. (2007). Hip pain in adults: MR imaging appearance of common causes. European Radiology, 17(7), 1746-1762.
  4. Zilkens, C., et al. op. cit.
  5. Chang, C. Y., & Huang, A. J. (2013). MR imaging of normal hip anatomy. Magnetic resonance imaging clinics of North America, 21(1), 1–19. https://doi.org/10.1016/j.mric.2012.08.006
  6. ibid.
  7. Berger, F. H., de Jonge, M. C., & Maas, M. (2007). Stress fractures in the lower extremity: the importance of increasing awareness amongst radiologists. European journal of radiology, 62(1), 16-26.
  8. ibid.
  9. ibid.
  10. Case.edu. Magnetic Resonance Imaging (MRI) of the Brain and Spine: Basics. Retrieved from: https://case.edu/med/neurology/NR/MRI%20Basics.htm.
  11. ibid.
  12. Ohishi, T., Ito, T., Suzuki, D., Banno, T., & Honda, Y. (2012). Occult hip and pelvic fractures and accompanying muscle injuries around the hip. Archives of orthopaedic and trauma surgery, 132(1), 105-112.
  13. Recht, M. P., Goodwin, D. W., Winalski, C. S., & White, L. M. (2005). MRI of articular cartilage: revisiting current status and future directions. American Journal of Roentgenology, 185(4), 899-914.
  14. Williams, B. S., & Cohen, S. P. (2009). Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment. Anesthesia & Analgesia, 108(5), 1662-1670.
  15. Strudwick, M. W., Anderson, S. E., Dimmick, S., Saltzman, M. D., & Hsu, W. K. (2011). The pearls and pitfalls of magnetic resonance imaging of the upper extremity. journal of orthopaedic & sports physical therapy, 41(11), 861-872.
  16. ibid.
  17. ibid.

 

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