title: Abbreviated MRI for patients presenting to the emergency department with hip pain.
abstract: OBJECTIVE
  The objective of our study was to assess the diagnostic performance of two abbreviated hip MRI protocols--coronal STIR images only and coronal STIR with coronal T1-weighted images--as compared with a full hip MRI protocol in patients presenting to the emergency department (ED) with hip pain and negative radiographic findings.
  
  
  METHODS
  The cohort included 385 patients (277 females, 108 males; mean age, 61 years; age range, 16-99 years) who underwent MRI within 1 month of negative radiographs obtained for ED evaluation of hip pain between January 2000 and March 2009. MR examinations were graded independently by two musculoskeletal fellowship-trained emergency radiologists for detection of fracture, avascular necrosis (AVN), and muscle injury in three subsets: coronal STIR images only; coronal STIR images and coronal T1-weighted images; and the full examination.
  
  
  RESULTS
  MRI detected findings suspicious for fracture in 42% (162/385) of patients, for AVN in 9% (33/385), and for muscle injury in 35% (134/385). The sensitivity and specificity of STIR alone in raising concern for fracture was 99% (220/223) for both readers, with small incremental benefits of adding coronal T1-weighted images. For AVN, specificity was 100% (28/28) with STIR alone, but the addition of coronal T1-weighted images provided substantial benefit by increasing sensitivity from 85% (28/33) to 97% (32/33). For muscle injury, sensitivity and specificity exceeded 95% (128/134) for both abbreviated examinations.
  
  
  CONCLUSIONS
  An abbreviated MRI protocol including coronal STIR and coronal T1-weighted images has high sensitivity and specificity for fracture, AVN, and muscle injury in ED patients presenting with hip pain and negative radiographs.
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA. bkhurana@partners.org
authors.forename: Bharti
authors.initials: B
authors.lastname: Khurana
authors.forename: Heitor
authors.initials: H
authors.lastname: Okanobo
authors.forename: Mohamad
authors.initials: M
authors.lastname: Ossiani
authors.forename: Stephen
authors.initials: S
authors.lastname: Ledbetter
authors.forename: Khaldoon
authors.initials: K
authors.lastname: Al Dulaimy
authors.forename: Aaron
authors.initials: A
authors.lastname: Sodickson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000175:diagnosis* / Q000209:etiology; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006621:Hip Joint; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity