MRI Hip Without Contrast — Dictation, Appropriateness, and Dose for Residents

Your Go-To Guide for MRI of the Hip Without Contrast

You get the read: 34-year-old, persistent groin pain, negative X-rays. The orthopod suspects early avascular necrosis (AVN) or a labral tear. Your attending is going to want a definitive answer on the femoral head, a comment on the labrum, and a mention of any femoroacetabular impingement (FAI) morphology. Getting the key findings for AVN—the T1 serpentine line and the T2 double-line sign—is non-negotiable. This is a classic case where a non-contrast hip MRI shines, and a structured report is your best friend.

As a resident or fellow, you’re constantly juggling a high-volume worklist with the need for precision. This guide is built for you—a practical, high-yield template for dictating a non-contrast hip MRI, backed by the details attendings expect. For more tools like this, check out the free residents and fellows resource hub we’ve put together.

What an MRI of the Hip Without Contrast Covers and What Attendings Look For

A non-contrast hip MRI is the workhorse for evaluating bone marrow and soft tissue pathology without the need for gadolinium. It’s the primary modality for diagnosing and staging Avascular Necrosis (AVN) and is incredibly sensitive for detecting occult or stress fractures that are invisible on plain films. While an MR arthrogram is superior for labral tears, this non-invasive study provides a robust initial assessment.

Your attending expects a systematic evaluation covering:

• Femoral Heads: The key area for AVN. Look for the pathognomonic T1 low-signal serpentine line and the T2 “double-line sign.” If present, stage it using Steinberg or ARCO classifications.
• Bone Marrow Signal: Diffuse edema in a geriatric patient with a fall is an occult fracture until proven otherwise. In other contexts, it could be transient osteoporosis or a stress reaction.

* Articular Cartilage and Labrum: Assess for thinning, defects, or tears. Note that evaluation is limited without an arthrogram.

• Osseous Morphology: Comment on cam-type (femoral head-neck asphericity) or pincer-type (acetabular over-coverage) FAI.
• Supporting Structures: Evaluate the surrounding muscles for tears or atrophy, check the bursae for fluid (especially iliopsoas), and screen for tendinopathy.
• Sacrum and Pelvis: In elderly patients, look for insufficiency fractures, which often present with an H-shaped or “tuning fork” pattern of edema.

Radiology Report Template for MRI of the Hip Without Contrast

Use this template as a starting point for your macros. It’s structured to ensure you don’t miss the key findings that matter for clinical management.

Technique

Multiplanar, multisequence magnetic resonance imaging of the hip was performed without the administration of intravenous contrast. Sequences include: large field-of-view coronal T1, coronal T2/PD with fat saturation, coronal STIR, axial T1, axial T2/PD with fat saturation, and sagittal T2/PD with fat saturation.

Findings

Bones:
Femoral Heads: No evidence of avascular necrosis. Normal morphology and marrow signal. [IF AVN: Describe the serpentine T1 low signal line and T2 double-line sign. Specify location and size of the lesion. Stage the AVN, e.g., “Subchondral collapse is present, consistent with Steinberg Stage III.”]
Femoral Necks: No fracture or abnormal marrow signal.
Acetabulum: Normal morphology. No pincer-type FAI deformity noted.
Femoroacetabular Articulation: No cam-type FAI deformity noted. The alpha angle is within normal limits.
Pubic Symphysis: Unremarkable.
Sacroiliac Joints: Unremarkable.

Joints:
Hip Joints: No joint effusion.
Articular Cartilage: The articular cartilage is preserved in thickness and signal intensity.
Acetabular Labrum: The anterior, superior, and posterior labra are intact. [IF TEAR: Describe location and morphology of the tear, e.g., “High signal extending to the articular surface of the superior labrum is consistent with a tear.”]

Soft Tissues:
Muscles and Tendons: The gluteal, iliopsoas, and adductor muscles and tendons are unremarkable.
Bursae: No trochanteric or iliopsoas bursitis.
Neurovascular Structures: The visualized sciatic nerve and femoral neurovascular bundle are unremarkable.

Other:
The visualized portions of the pelvis and urinary bladder are unremarkable.

Impression

1. No evidence of avascular necrosis of the femoral heads.
2. No acute fracture or dislocation.
3. Mild degenerative changes of the hip joints, as described above.
[OR, for a positive study:]
1. Findings consistent with avascular necrosis of the [right/left] femoral head, Steinberg Stage [e.g., III], with subchondral collapse.
2. Occult, non-displaced fracture of the [right/left] femoral neck with associated marrow edema.

Free Template Sources for Your Practice

Building a personal library of high-quality templates is a career-long project. While you develop your own, two great free repositories exist that are worth bookmarking. They are maintained by radiologists for radiologists, offering a solid foundation for nearly any study you’ll encounter.

• RadReport.org: Curated by the RSNA, this is one of the most comprehensive free libraries available, with templates for almost every modality and subspecialty. (https://radreport.org/)
• Radiology Templates (AU): An excellent, well-organized collection maintained by Australian radiologists, offering a slightly different perspective and formatting. (https://www.radiologytemplates.com.au/home-page/)

The Next-Level Move: From Free-Form Dictation to Structured Report

Templates are a great start, but the real friction on call isn’t finding the template—it’s populating it accurately under pressure. When you see positive findings, you often just want to dictate what you see naturally: “Serpentine low signal line on T1 in the superior right femoral head with a double-line sign on T2, looks like stage 3 AVN with some early subchondral collapse.”

This is where AI-powered dictation tools can streamline your workflow. Instead of manually slotting your findings into a macro, you dictate the positives in free form. GigHz Precision AI then parses your language and generates a complete, structured report using pre-loaded ACR and SIR templates. It’s designed to help you create clean, attending-ready reports faster, without sacrificing the detail and nuance of your diagnostic interpretation.

When Should You Order an MRI of the Hip Without Contrast? American College of Radiology (ACR) Appropriateness Criteria

The decision to order a non-contrast hip MRI is guided by specific clinical scenarios. The ACR provides evidence-based guidelines to help clinicians choose the right test for the right patient. For hip pain, MRI is often the problem-solver after initial radiographs are negative or inconclusive.

According to the ACR Appropriateness Criteria for Acute Hip Pain, an MRI of the hip is Usually Appropriate as the next imaging study when a fracture is suspected in an adult with negative or indeterminate radiographs. It is also Usually Appropriate for evaluating suspected tendon, muscle, or ligament injuries after negative X-rays, and for follow-up imaging after the reduction of a hip dislocation to assess for complications like AVN.

For suspected Stress (Fatigue/Insufficiency) Fracture, MRI is again rated Usually Appropriate as the next step when radiographs are negative or indeterminate. This holds true for the general adult population, pregnant patients (due to the lack of ionizing radiation), and high-risk patients where a definitive diagnosis is needed urgently. MRI is considered the first-line imaging modality for suspected Osteonecrosis (AVN).

Key alternatives include CT for better osseous detail in complex fractures or hardware evaluation, and MR arthrogram with traction for definitive assessment of the labrum and articular cartilage.

MRI of the Hip Without Contrast Imaging Protocol — Sequences and Technical Parameters

A standard non-contrast hip MRI protocol is designed to provide both anatomical detail and high sensitivity for fluid and marrow pathology. The scan typically takes 25-30 minutes. A key technical point is to obtain a large field-of-view (FOV) coronal T1 sequence to include both hips, allowing for side-to-side comparison, which is invaluable for subtle marrow signal changes or early AVN.

The following table outlines a typical sequence protocol:

Common protocol pitfalls:

• Forgetting the Large FOV Coronal: The initial Coronal T1 should have an FOV of at least 320 mm to include both hips. Asymmetry is often the first clue to pathology.
• Slice Thickness: Thinner coronal slices (3-4 mm) are preferred for a better overview of the cartilage and labrum, even on a non-arthrographic study.
• Inadequate Sacral Coverage: When a sacral insufficiency fracture is on the differential, ensure the coronal and axial sequences extend superiorly to cover the entire sacrum and sacroiliac joints.

The 3-Months-Free Offer for Radiology Residents and Fellows

3+ months free for radiology residents and fellows

Look like a rockstar on your reports — dictate positive findings in free form, and the AI generates a structured report using ACR + SIR templates with the appropriate clinical decision support firing automatically. All we ask in return is feedback so we can keep improving the product for trainees.

To get set up, we just need three things:

1. Your PGY year (e.g., PGY-2, PGY-4)
2. Your training type (radiology residency or specific fellowship — IR, body, MSK, neuro, peds, breast, nucs)
3. Your training program / hospital name
4. (Optional) Your institutional email

It’s that simple. No credit card, no long forms. Just reply to the application with those three items. You can apply for the residents free-access program here and get started.

Frequently Asked Questions (FAQ)

Is GigHz Precision AI HIPAA-compliant?

Yes. The platform is designed for de-identified workflows by default. It processes the clinical content of your dictation without requiring Protected Health Information (PHI), ensuring compliance with HIPAA privacy and security rules.

Do I need my hospital’s IT department to set this up?

No. GigHz Precision AI is browser-based and requires no local software installation or IT involvement. It works on any modern web browser, including the one on your call-room workstation or personal iPad.

How does this work with PowerScribe or other dictation systems?

It works alongside your existing system. You can dictate your findings into the GigHz web interface, let the AI generate the structured report, and then copy/paste the final, clean text into PowerScribe or your EMR. It’s a workflow enhancement, not a replacement for your PACS-integrated dictation microphone.

Can I use this on my phone or iPad?

Yes, the platform is fully responsive and works on mobile devices and tablets, making it easy to review templates or draft reports away from your primary workstation.

Can I customize the templates?

Yes. While the system comes pre-loaded with standard ACR and society-based templates, you can create, modify, and save your own templates to match your personal preferences or your institution’s specific formatting requirements.

What happens after I finish residency or fellowship?

The free access program is specifically for trainees. After you graduate, you can transition to a standard subscription for practicing radiologists. We aim to provide a tool that grows with you throughout your career.

Free GigHz Tools That Pair With This Article

Three free tools that complement the material above:

• ACR Appropriateness Criteria Lookup — Type an indication or clinical scenario in plain language and get the imaging studies the ACR rates for it, with adult and pediatric radiation levels. Built directly from 297 ACR topics, 1,336 clinical variants, and 15,823 procedure ratings.
• GigHz Imaging Protocol Library — A searchable library of 131 imaging protocols with the physics specs surfaced and the matching ACR Appropriateness Criteria alongside. Plain-English narratives readable in 60 seconds, organized by modality.
• GigHz Radiation Dose Calculator — Pick the imaging studies a patient has had and see total dose in millisieverts (mSv) with comparisons to natural background radiation, transatlantic flights, and chest X-rays. Useful for shared decision-making.

Reviewed by Pouyan Golshani, MD, Interventional Radiologist — May 7, 2026