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The history was a young female with anterior and lateral right hip pain,

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decreased range of motion, no injury reported. Patient plays soccer,

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no history of surgery. Again,

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a young patient with hip pain looking at couple things.

0:14

You're looking at muscle tendon injuries, and you're looking at labral tears.

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So one of the things that we need to make sure when we are looking at these MR

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images, is like, what sequence are we looking at?

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So here we see a lot of, uh, bright signal in the, in the joint.

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And I know when I was correcting the reports,

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I saw a lot of people said there is a big joint effusion,

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but this is actually an RR program study.

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And how do we tell it's an MRR program Studies by looking what sequence this is.

0:42

I mean, I'm not asking you to look at like the annotation has been labeled as,

0:46

um, uh, T one,

0:49

what you need to look at the te and t image of the sequence. Let me see.

0:54

I think I was able to see it on the images where they mentioned the

0:59

TE and dr. Let's see if we go to another sequence,

1:03

if they have that annotation.

1:10

It's the same sequence.

1:19

This is, um, center with slice thickness.

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This is series. Okay? This one doesn't, uh, mention the TE and T of the image,

1:28

but I mean, it is labeled here. So we know this is AT two FAT set. Um,

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this is AT one fat set image. So anytime,

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uh, there's something that is bright on T one fat set image in a joint space,

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that means there is gadolinium involved. So this would be, uh,

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this is your radicular gadolinium. So that means it's an rogram study. Uh,

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if it was just simple fluid, it'll look bright on T twos,

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mitered sequences on T one.

1:55

There's no reason for the joint fluid to look that bright, right?

1:59

So that's how we tell it's an ROGRAM study. And if, uh,

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the best way to tell how, what a sequences by looking at its te and tr timings,

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if the TE and tr are on the lower side, it's AT one weighted sequence.

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So typically your tes will be less than 30 and tr would be around 800,

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uh, and or less than 800. That's your T one weighted sequence.

2:19

So if on that sequence, if your fluid is looking bright,

2:22

that means it's an arthrogram. Okay, now let's, let's review this.

2:25

The way we look at just your, uh, other images,

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we can look at the labrum. And again,

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there's some important things. Again, it should look like a black triangle.

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So coronal images are best to evaluate the superior labrum.

2:45

So the superior labrum is looking normal, really normal here.

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And you start seeing little signal in the post superior labrum, which extends,

2:52

but this signal, the the margins are pretty clean, right?

2:56

This mar these margins are pretty clean.

2:59

Um, and it doesn't go all the way in the,

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in like to the base of the labrum, neither it extends into the, the substance.

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So this is what your sulcus will look like.

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Now moving on to oblique axial T one fat set.

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This is what you're catching a little bit of the sulcus,

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which was there in this case, posteriorly and posteriorly.

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And look at this anterior aspect. You should see a nice black triangle.

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And here it's all gray signal, not seeing a,

3:29

like a clear fluid cleft, but at the same time,

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I'm not seeing like a normal black triangle that would suggest a labrum too

3:38

abnormal here, here, very attenuated.

3:41

There's hardly any labrum there.

3:43

And now I start to get a little bit of normal labrum and then it becomes normal.

3:48

You see that how the, the, the volume of that thing changes here,

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you see that triangle? I'm going more inferior. You see this triangle,

3:57

that's your labrum. And I'm now moving up

4:03

here very attenuated. I don't see a black triangle here.

4:07

That black triangle is missing here. Again,

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very small black, not a black triangle, but that gray signal,

4:17

again, a little gray signal here. So again, it looks very subtle. We can, uh,

4:21

look at other sequences if we can see that better. But looks like there's,

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there in this case is a small intra superior labral tear.

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So those, uh, uh, oblique images are best to see the,

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the intra superior quadrant of the hip, which, uh, um,

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and it's often like done, um,

4:38

to look for any cam morphology of the hip that's best seen on those oblique

4:42

axial images. And this, these are your, uh, true axial images. Again,

4:47

we can start looking at the labrum.

4:51

So this is your black triangle here, anterior,

4:54

and you start seeing some signal at the base of it.

4:58

You see that signal here.

4:59

And then see the change in the size of the labrum significantly.

5:03

It's really nice and robust here with little signal at the base. And as we,

5:07

again, no signal more medially here,

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but when I'm coming more lateral little signal,

5:17

then you get a much deeper signal.

5:23

And then this is, this is your intra superior labrum.

5:26

You see that how gray signal it is,

5:27

but it gets more normal when we move posteriorly. So as we saw, uh,

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the superior labrum looked normal,

5:36

and this is the posterior labrums. Posterior labrum, um,

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looks little bit bulkier than the anterior labrum.

5:43

And the sulcus in the hip is more common than posterior superiorly, sorry,

5:48

posteriorly. And this labrum is only from like,

5:52

from anterior superior and posterior. It's absent inferiorly

5:56

Because it joins the transverse ebor ligament.

6:02

Like if you see, it'll continue as a ligament here. So that's not your labrum.

6:06

This one, this is your transverse ebor ligament.

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The labrum is only in the anterior superior,

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superior posterosuperior and posterior quadrants. It's absent inferiorly.

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That's where we have the transverse asab ligament.

6:23

Let's, let's look at this image again, carefully. Another, like,

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that's the reason why we look at, uh, everything else. Uh,

6:31

there's a nice incidental finding where the uterus has two, uh,

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endometrial cavities, but as we go modestly, it's just, uh,

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one single cervix. So this will be your, um, uh,

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either a septate or a bicornuate.

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Let's look at on other projections and see if the difference between the two is

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how is the external fundal contour of the uterus.

6:53

So the external fundal contour is maintained. So this will be a septate uterus,

6:58

and it's a complete septate uterus because it divides the,

7:01

the endometrial cavity into two halves along the entire uterine body.

7:05

And the cervix is okay. If this was a bicornuate, you will get a dip here. The,

7:10

there'll be a dip in the fundal contour and the delphis, even when the,

7:15

uh,

7:15

they're completely separated and even the cervix is separated in those cases.

7:19

So, uh, nice incidental finding of a complete separate uterus.

7:24

Okay, that's all about the findings. Let's see if I have any,

7:29

yeah, teaching files. I mean, um, the points, uh, this is how your labrum is.

7:34

It is a, uh,

7:35

a triangular fibrocartilage that's seen all along the ebor, uh,

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margin. Um,

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and has this chondral labral junction starts at the periphery where the

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cartilage ends. This is how it looks on imaging.

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You should have a nice black triangle with no abnormal signal at the base or

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getting into the substance.

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And that just smoothly continues into that gray articular cartilage more

7:58

medially. So again, uh, with more and more, uh, uh,

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a better quality Mr. Images, it's, um, we're diagnosing more and more lab tears.

8:07

And, uh,

8:07

the incidence of labral tears in patients who have hip groin pain is actually

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very high from 22 to 55% active. And it's very, um,

8:16

like almost every hip exam that we do,

8:19

they probably have a lab tear if this, it's done for hip pain. Um,

8:24

and lab tears are subtle as we saw in this case. Um,

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there's sometimes difficult to diagnose, especially because of,

8:30

of normal variants like you have sulcus and, um, um,

8:35

that we need to differentiate those from tears. So,

8:40

uh, what are the features of a recess? It's a shallow depth,

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less than one half of the labral thickness. Uh, it has a linear shape,

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it has smooth borders, location at the chondrolabral junction,

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not accompanied by per labral or ular

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Abnormalities.

8:55

And there's only partial separation of the labrum from the ebor attachment.

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So, uh, a recess, uh, and actually they're in hip there,

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like it's more common in shoulder and hip.

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There are a lot of like debate in literature itself.

9:08

A lot of people say that in hip these things don't even exist.

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And these are just residual changes from prior labral tear.

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And there's another group that, like two schools of thought,

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the other one supports that these are just recesses.

9:21

So anytime it's really smooth, uh,

9:24

and it doesn't go all the way to the depth of the labrum or into the substance

9:28

of the labrum, that's probably anatomic variation or not significant.

9:32

And if it's has ratty margins deep, has a paralabral cyst, then,

9:36

then that's a definite tear. So in this case, we had labral tear.

9:41

This was an rogram study, uh, because the fluid was hyper intense on T one, fat,

9:45

fat images. Uh, key findings in this case, uh,

9:50

I mean obviously we talked about this and another important finding was this

9:53

Malian duplication anomaly.

9:55

And I'm just mentioning how to differentiate the two.