From the Guidelines
For chronic groin pain, an MRI of the hip and pelvis should typically be performed without contrast, as this approach is often sufficient for visualizing bone marrow abnormalities, labral tears, muscle strains, tendon injuries, and bursitis, which are common causes of chronic groin pain 1.
Key Considerations
- The use of contrast is rarely needed for MRI in the evaluation of chronic hip pain, according to the American College of Radiology (ACR) Appropriateness Criteria 1.
- MRI without IV contrast is appropriate for patients with chronic hip pain when radiographs are negative, equivocal, or nondiagnostic, and there is a suspicion for an extra-articular noninfectious soft tissue abnormality such as tendonitis 1.
- In cases where the suspected diagnosis primarily involves bone or cartilage structures, a non-contrast study may be sufficient 1.
Additional Imaging Modalities
- Ultrasound (US) can be used to evaluate soft tissue structures around the hip for specific diagnoses such as trochanteric bursitis 1.
- CT arthrography or MR arthrography may be considered in patients with chronic hip pain when radiographs are negative, equivocal, or nondiagnostic, and there is a suspicion for impingement or a labral tear 1.
Clinical Decision Making
The final decision on whether to use contrast or not should be made by the ordering physician in consultation with the radiologist, taking into account the patient's clinical presentation, suspected pathology, and any contraindications to contrast such as severe kidney disease or previous allergic reactions to contrast agents 1.
From the Research
MRI of the Hip and Pelvis for Chronic Groin Pain
- The decision to perform an MRI of the hip and pelvis with or without contrast for a patient with chronic groin pain depends on various factors, including the specific clinical presentation and the suspected underlying cause of the pain.
- A study published in 2011 2 highlights the importance of comprehensive evaluation of all anatomical locations prone to injury, including the hip joint, sacrum, ilium, and proximal femora, pelvic tendon attachments, and pelvic musculature.
- Another study published in 2018 3 found that MRI has a high diagnostic accuracy in evaluating chronic groin pain, with a combination of coronal T1, axial PDFS, sagittal PDFS, and axial T1 VM sequences providing the best diagnostic performance.
Use of Contrast in MRI
- The use of contrast in MRI for chronic groin pain is not universally recommended, and the decision to use contrast should be based on the specific clinical scenario and the suspected underlying cause of the pain.
- A study published in 2018 3 found that the use of gadolinium enhancement (FSGE) improved the diagnostic accuracy of MRI in evaluating chronic groin pain, particularly in the assessment of pubic symphysis and adductor longus tendon injuries.
Alternative Imaging Modalities
- Other imaging modalities, such as computed tomography (CT), may also be useful in evaluating chronic groin pain, particularly in patients with suspected occult hernias or other abdominal wall injuries 4.
- A study published in 2019 5 found that CT may be adequate to rule out hip and pelvic fractures in elderly patients with low-energy trauma, and may be preferable to MRI due to decreased time spent in the ED and the large percentage of elderly patients with contraindications to MRI.
Clinical Correlation
- Ultimately, the choice of imaging modality and the use of contrast should be based on a thorough clinical evaluation and correlation with the patient's symptoms and physical examination findings.
- A study published in 2024 6 highlights the importance of correlating MRI findings with clinical symptoms and outcomes, particularly in patients 45 years old and older with hip or knee pain.