Assessment of peritrochanteric high T2 signal depending on the age and gender of the patients

https://doi.org/10.1016/j.ejrad.2009.03.039Get rights and content

Abstract

Introduction

The aim of this study is to evaluate the incidence of peritrochanteric high T2 signal (peritrochanteric edema, peritendinitis) on routine MR imaging studies and to determine whether reporting peritrochanteric edema is always clinically relevant depending on the age and gender of the patients.

Materials and methods

We evaluated 79 consecutive bilateral hip MR images performed in our department between January 2006 and December 2006 (57 female, 22 male patients, mean age 49 years). Each study was evaluated for areas of T2 hyperintensity representing edema around the greater trochanter. Patients with a known fracture, tumor, history of radiation therapy, history of hip surgery and prothesis were excluded from the study. Patients with signal intensity alterations within the thickened gluteus medius/minimus tendons (tendinitis) or peritrochanteric bursal fluid accumulation (bursitis) were also excluded. All patients were scanned with our routine MR imaging protocol for hip imaging.

Results

In 55 of the 79 patients (70%) peritrochanteric edema was detected on MR images and 52 of these 55 patients (95%) had these changes on both hips. The median age was 56 years for the patients with peritrochanteric edema and 35.5 years for the patients without peritrochanteric edema. There was statistical significance between the median ages of the patients and a significant increased risk of peritrochanteric edema was found over 40 years of age. There was no significant difference between male and female patients.

Conclusion

Bilateral peritrochanteric high T2 signal may be a part of the degeneration process and we suggest that it may not be necessarily reported if the clinical findings do not support greater trochanteric pain syndrome.

Introduction

Lateral hip pain is the most common clinical presentation of the greater trochanteric pain syndrome, and may also be a symptom of several other conditions including lumbar radiculopathy, entrapment neuropathies, undisplaced femoral neck fracture, and abductor muscle strain besides trochanteric bursitis [1]. In most cases patient's history and physical examination findings would lead the clinician rule out most of the differential diagnoses. Although not specific, marked tenderness over the greater trochanter and exacerbation of the pain by hip movements, especially by abduction, are the most common clinical findings of greater trochanteric pain syndrome which is frequently due to trochanteric bursitis and tendinopathy involving the gluteus medius and minimus tendons [2], [3]. Plain films have a limited value in the diagnosis of gluteal tendinopathy, and can show calcification at the tendon insertion site when present [4]. Ultrasonography can reveal bursal fluid collections, bursal thickening, gluteal tendon thickening and intratendinous heterogenous echogenicity [5]. MR imaging can well demonstrate the anatomy of the greater trochanter and can accurately diagnose gluteal tendinopathy [5], [6].

Peritrochanteric soft tissue edema surrounding the intact tendons suggesting peritendinitis is a common finding on MR images but this finding is not always associated with hip pain or trochanteric pain syndrome [3]. We have also observed that most patients with peritrochanteric high T2 signal had these changes on both hips.

The aim of this study is to evaluate the incidence of peritrochanteric high T2 signal (peritendinitis, peritrochanteric edema) on routine MR imaging studies and to determine whether reporting peritrochanteric high T2 signal is always clinically relevant depending on the age and gender of the patients.

Section snippets

Materials and methods

We retrospectively evaluated 79 consecutive bilateral hip MR images performed in our department between January 2006 and December 2006. There were 57 female and 22 male patients, with ages ranging from 16 to 88 years old and a mean age of 49 years. The indications for the MR examinations included hip pain, limited range of motion of the hip, groin pain, and buttock pain. Four patients were referred for MRI with suspicion of trochanteric bursitis. MR images were retrospectively reviewed in

Results

In 55 of the 79 patients (70%) peritrochanteric high T2 signal was detected and 52 of the 55 patients (95%) had these changes on both hips (Fig. 1). Only 4 of the 52 patients (8%) with bilateral peritrochanteric edema had bilateral hip pain and the remaining 48 patients had unilateral symptoms. In two of the three patients with unilateral peritrochanteric edema the peritrochanteric high T2 signal was on the symptomatic side (Fig. 2). In three of the four patients with presumed diagnosis of

Discussion

The greater trochanter of the femur demonstrates a consistent topographic anatomy with four facets, specific tendinous attachments and specific nearby bursae. The gluteus medius tendon attaches to the superoposterior and lateral facets, and the gluteus minimus tendon inserts in the anterior facet of the greater trochanter. No tendon insertion is present on the posterior facet, which is covered by the trochanteric bursa [6]. Gluteal tendinopathy with or without associated trochanteric bursitis,

References (14)

  • G.E.D. Howell et al.

    Prevalence of abductor mechanism tears of the hips in patients with osteoarthritis

    J Arthroplasty

    (2001)
  • R.B. Traycoff

    “Pseudotrochanteric bursitis”: the differential diagnosis of lateral hip pain

    J Rheumatol

    (1991)
  • P.A. Bird et al.

    Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome

    Arthritis Rheum

    (2001)
  • D.G. Blankenbaker et al.

    Correlation of MRI findings with clinical findings of trochanteric pain syndrome

    Skeletal Radiol

    (2008)
  • I.K. Yang et al.

    Calcific tendinitis of the gluteus medius tendon with bone marrow edema mimicking metastatic disease

    Skeletal Radiol

    (2002)
  • A. Kong et al.

    MRI and US of gluteal tendinopathy in greater trochanteric pain syndrome

    Eur Radiol

    (2007)
  • C.W.A. Pfirrmann et al.

    Greater trochanter of the hip: attachment of the abductor mechanism and a complex of three bursae—MR imaging and MR bursography in cadavers and MR imaging in asymptomatic volunteers

    Radiology

    (2001)
There are more references available in the full text version of this article.

Cited by (0)

View full text