Current concepts in imaging of the pelvis and hip

Over the past two decades, there have been numerous technologic advances in the field of imaging of the hips and bony pelvis. Conventional radiography remains the initial imaging examination in virtually all cases, but options for second-time imaging have increased considerably. Tomography has been virtually replaced by computed tomography (CT) and magnetic resonance imaging (MRI). Nuclear medicine techniques have been refined. in some instances, technologic advances have occurred so quickly that they have outpaced the ability to adequately evaluate their accuracy and effectiveness. Although the addition of new techniques has made the detection of earlier and more subtle pathology almost routine, it also has led to confusion over the most effective imaging strategies for given situations. Choosing the optimal imaging examination is particularly important in light of today's progressively cost-conscious medical environment. This article reviews the current status of pelvis and hip imaging including trauma, osteonecrosis, arthropathies, tumors, and interventional imaging. We have attempted to focus, whenever possible, on cost-effective imaging for initial diagnosis, treatment planning, and follow-up. We also have reviewed recent technical advances, such as helical CT and dynamic gadolinium-enhanced MR imaging for their current and potential impact on imaging practices.