MRI Imaging technique for GROIN Injuries

Many groin injuries will be readily apparent on a conventional, noncontrast MRI of the pelvis. Musculoskeletal lesions are such a frequent source of groin pain and pain at other locations about the pelvis, that every pelvis MRI protocol deserves at least two sequences optimized for osseous and tendinous injury. I believe that each pelvis MRI protocol, whether for the visceral structures, the hips, the sacroiliac joints or the pubic symphysis, should include a coronal short TE inversion recovery (STIR) and an axial T2 fast spin echo (FSE) fat suppressed sequence of the entire pelvis. These should cover both anterior superior iliac spines, both ischial tuberosities, the pubic symphysis and the sacrum and coccyx. Adding a traditional non fat suppressed T1 weighted coronal sequence will put to rest any concerns for a marrow infiltrating process such as myeloma or diffuse metastases. From here, protocols can be directed toward the most likely source of pain. A sacroiliac protocol adds smaller field of view sequences angles with the sacrum to display the joints in a coronal oblique plane, and hip protocols should include smaller field of view, higher resolution imaging of the hip in question. For athletic pubalgia, I advocate adding two sequences in an oblique plane prescribed along the anterior ileum from a sagittal localizer, covering the pubic symphysis and extending to the medial acetabulae. These will maximize sensitivity for small tears at the rectus abdominis/adductor aponeuroses. A true sagittal T2 FSE fat suppressed sequence spanning the symphysis often provides the best delineation of injury extent. This noncontrast athletic pubalgia protocol includes three sequences of the entire pelvis and three sequences dedicated to the pubic symphysis, and should require approximately 25 minutes of scanning time at 1.5 Tesla with a phased array torso coil centered over the pubic symphysis 

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