Imaging Guidelines for Anterior Hip Pain

Initial Imaging Recommendations

The American College of Radiology recommends plain radiographs, including an anteroposterior pelvis view and a frog-leg lateral view of the symptomatic hip, as the initial imaging modality for anterior hip pain, providing excellent screening for common disorders like osteoarthritis, fractures, dysplasia, femoroacetabular impingement, and bone tumors 1, 2
Specialized views, such as false profile or Dunn view, can provide additional detail for suspected dysplasia or femoroacetabular impingement, with a strength of evidence rated as appropriate for initial evaluation 1

For suspected intra-articular pathology, such as labral tears or impingement, MR arthrography is the gold standard, rated 9/9 "usually appropriate", according to the American College of Radiology 3, 4, 2
For suspected extra-articular soft tissue pathology, such as tendonitis, bursitis, or muscle injuries, MRI without IV contrast is the preferred test, rated 9/9, as recommended by the American College of Radiology 4, 2
For articular cartilage evaluation, both MRI without IV contrast and MR arthrography are equally appropriate, rated 9/9, according to the American College of Radiology 3, 4

When referred pain is suspected, MRI of the hip without IV contrast should be performed to exclude hip pathology as the source, rated 9/9, as recommended by the American College of Radiology 2
Image-guided diagnostic hip injection can definitively determine if the hip joint is the pain source when multiple potential etiologies exist, rated 8/9, according to the American College of Radiology 2