Imaging

Tronchanteric Bursitis

Preliminary Diagnosis: Trochanteric bursitis

I. What imaging technique is first-line for this diagnosis

  • MR imaging.

II. Describe the advantages and disadvantages of this technique for diagnosis of trochanteric bursitis.

Advantages

  • MR imaging is able to detect other causes of pain or weakness in the joint such as tendonitis, tenosynovitis or tears.

  • MR imaging does not make use of ionizing radiation.

Disadvantages

  • MR imaging is an expensive and time-consuming imaging modality that requires marked patient cooperation to limit motion artifact.

  • MR imaging with intravenous contrast requires that the patient have good renal function with a GFR greater than 60. Administration of intravenous contrast is decided individually on a case-by-case basis with a GFR > 30 and < 60.

III. What are the contraindications for the first-line imaging technique?

  • Patients with non-MR compatible metallic hardware or foreign bodies.

IV. What alternative imaging techniques are available?

  • Ultrasound

  • CT with or without contrast

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of trochanteric bursitis.

Ultrasound

Advantages

  • Ultrasound is able to detect fluid collection and whether fluid is simple or complex.

  • Optimal modality for concomitant detection and aspiration of fluid if indicated.

  • Ultrasound imaging is a relatively inexpensive and portable imaging modality that does not use ionizing radiation.

Disadvantages

  • Ultrasound evaluation of joints requires a skilled technician trained in musculoskeletal imaging with a high index of suspicion for detection of pathology.

  • Limited evaluation in obese patients.

CT with or without contrast

Advantages

  • Able to see fluid-filled bursa in its typical location.

  • Further detail of bone if fracture or osseous lesion suspected.

  • CT imaging is performed much quicker than MR imaging, requires less patient cooperation, and is associated with less motion artifact compared with MR imaging.

Disadvantages

  • Soft tissue structures and tendons better evaluated with MRI.

  • CT scan expose the patient to a large amount of ionizing radiation.

  • Imaging with intravenous contrast requires that the patient have good renal function with a creatinine of 0.6-1.2 mg/dl for an adult.

VI. What are the contraindications for the alternative imaging techniques?

Ultrasound

  • No significant contraindications exist.

CT with or without contrast

  • Contraindicated in a pregnant patient, especially within the first two trimesters.

  • Documented history of multiple prior significant reactions to contrast.

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