Rheumatology | Polymyalgia rheumatica | Polymyalgia rheumatica: MRI of hips

MRI of the pelvis in a 75-year-old patient with pain

- bilateral hips in the context of moderate hip osteoarthritis

- bilateral shoulders


Axial
(fig. A, B, C, D, E) and coronal (fig. 1 and F) fat suppression MRI (figures A, B, C, D, E) 



Figure 1:

Osteoarthritis : narrowed joint space, subchondral geode (green arrow), degenerative labrum (blue arrow) and intra articular effusion (red arrow)

 

Figure A : tendinous and peri-tendinous oedema of indirect tendinous of rectus femoris muscle (blue arrow)

figure B : tendinous and peri-tendinous oedema of direct tendinous of rectus femoris muscle (green arrow)

 

Figure C:

tendinous and peri-tendinous oedema of psoas muscle (red arrow) and of iliacus muscle (orange arrow)

intramuscular oedema between tensor fasciae latae, rectus femoris and vastus lateralis (violet arrow)

      

 

 figure D : bursitis between psoas muscle and iliacus muscle (yellow arrow)

 

Figure E:

tendinous and peri-tendinous oedema of adductors (violet arrow)

thickening and oedema of iliofemoral ligament (blue arrow)

 

 Figure F :

Bursitis of the gluteus minimus (violet arrow)

Superficial trochanteric bursitis (blue arrow)

Tendinous oedema of gluteus minimus (red arrow)

Muscular oedema of glutues minimus (yellow arrow)

 

Improvement of the symptomatology after treatment of corticosteroids, in favor of the diagnosis

Polymyalgia rheumatica (PMR) is an infl ammatory condition of unknown etiology characterized by diffuse pain and morning stiffness involving neck, shoulder, and pelvic girdles ffecting people aged 50 years or
older. (1).

Cantini et all (2) have described in 20 patients with polymyalgia rheumatica who had hupp MRI: trochanteric bursitis in 100% of PMR patients, bilateral in 18/20 (90%), and in 12/40 (30%) controls (p < 0.001). Hip synovitis was detected in 17/20 (85%) by MRI and in 9/20 (45%) by US (p < 0.02) in case-patients and in 18/40 (45%) controls. In PMR, MRI and US showed iliopsoas bursitis in 10/20 (50%) and 6/20 (30%) and ischiogluteal bursitis in 5/20 (25%) and 4/20 (20%)

1. Kermani TA, Warrington KJ. Polymyalgia rheumatica. Lancet. 2013;381(9860): 63–72.

2. Cantini F, Niccoli L, Nannini C et al. Inflammatory changes of hip synovial structures in polymyalgia rheumatica. Clin Exp Rheumatol 2005;23:462[1]-8.