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Correlation Between Bone Marrow Edema and Collapse of the Femoral Head in Steroid-Induced Osteonecrosis

Satoshi Iida1,2, Yoshitada Harada1, Koh Shimizu1, Masaaki Sakamoto1, Sumio Ikenoue1, Tohru Akita1, Hiroshi Kitahara3 and Hideshige Moriya1

1 Department of Orthopaedic Surgery, Chiba University School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8677, Japan.
2 Department of Orthopaedic Surgery, Matsudo City Hospital, 4005, Kamihongou, Matsudo City, 271-0064, Japan.
3 Department of Radiology, Chiba University School of Medicine, Chiba City, 260-8677, Japan.



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  		Fig. 1A. —Right femoral head of 16-year-old girl who received high-dose steroid therapy for systemic lupus erythematosus. Coronal T1-weighted MR image (TR/TE, 400/30) obtained 6 months after initiation of therapy shows bandlike hypointense zone.

 


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  		Fig. 2A. —Right femoral head of 24-year-old woman who received high-dose steroid therapy for systemic lupus erythematosus. Coronal T1-weighted MR image (TR/TE, 300/18) obtained 10 weeks after initiation of therapy shows bandlike hypointense zone.

 


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  		Fig. 3A. —Bilateral hips of 48-year-old woman who received high-dose steroid therapy for systemic lupus erythematosus. Coronal T1-weighted MR image (TR/TE, 400/30) obtained 3 months after initiation of therapy shows bandlike hypointense zone in bilateral femoral head.

 


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  		Fig. 1B. —Right femoral head of 16-year-old girl who received high-dose steroid therapy for systemic lupus erythematosus. Coronal short tau inversion recovery (STIR) image (2000/30; tau, 100 msec) shows matching hyperintense zone.

 


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  		Fig. 2B. —Right femoral head of 24-year-old woman who received high-dose steroid therapy for systemic lupus erythematosus. Coronal short tau inversion recovery (STIR) image (3000/42; tau, 150 msec) shows matching hyperintense zone.

 


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  		Fig. 3B. —Bilateral hips of 48-year-old woman who received high-dose steroid therapy for systemic lupus erythematosus. Coronal short tau inversion recovery (STIR) image (2000/30; tau, 100 msec) shows matching hyperintense zone.

 


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  		Fig. 1C. —Right femoral head of 16-year-old girl who received high-dose steroid therapy for systemic lupus erythematosus. Anteroposterior radiograph appears to show normal findings. Right hip with osteonecrosis is asymptomatic.

 


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  		Fig. 2C. —Right femoral head of 24-year-old woman who received high-dose steroid therapy for systemic lupus erythematosus. Anteroposterior radiograph appears to show normal findings.

 


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  		Fig. 3C. —Bilateral hips of 48-year-old woman who received high-dose steroid therapy for systemic lupus erythematosus. Radiographic findings appear normal.

 


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  		Fig. 1D. —Right femoral head of 16-year-old girl who received high-dose steroid therapy for systemic lupus erythematosus. Coronal T1-weighted MR image (400/30) obtained 2 months after A-C and 3 weeks after onset of hip pain shows decreased signal intensity in femoral head and neck.

 


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  		Fig. 2D. —Right femoral head of 24-year-old woman who received high-dose steroid therapy for systemic lupus erythematosus. Coronal T1-weighted MR image (300/18) obtained 6 months after A C and 1 week after onset of hip pain shows diffusely decreased signal intensity.

 


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  		Fig. 3D. —Bilateral hips of 48-year-old woman who received high-dose steroid therapy for systemic lupus erythematosus. Coronal T1-weighted image (400/30) obtained 2 years 11 months after A-C and 7 weeks after onset of pain in left hip shows diffusely decreased signal intensity.

 


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  		Fig. 1E. —Right femoral head of 16-year-old girl who received high-dose steroid therapy for systemic lupus erythematosus. Coronal STIR image (2000/30; tau, 100 msec) shows focal hypointense lesion surrounded by diffuse hyperintense area. Note joint effusion.

 


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  		Fig. 2E. —Right femoral head of 24-year-old woman who received high-dose steroid therapy for systemic lupus erythematosus. Coronal STIR image (2000/30; tau, 100 msec) shows increased signal intensity. Note joint effusion.

 


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  		Fig. 3E. —Bilateral hips of 48-year-old woman who received high-dose steroid therapy for systemic lupus erythematosus. Coronal STIR image (2000/30; tau, 100 msec) shows surrounding increased signal intensity with focal lesion and joint effusion in left hip. In right hip, bandlike pattern is evident.

 


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  		Fig. 1F. —Right femoral head of 16-year-old girl who received high-dose steroid therapy for systemic lupus erythematosus. Coronal T2-weighted image (2000/100) reveals diffusely increased signal intensity and fails to show focal hypointense lesion in subchondral area.

 


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  		Fig. 2F. —Right femoral head of 24-year-old woman who received high-dose steroid therapy for systemic lupus erythematosus. T1-weighted image (300/18) of the femoral neck reveals diffusely decreased signal intensity.

 


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  		Fig. 2G. —Right femoral head of 24-year-old woman who received high-dose steroid therapy for systemic lupus erythematosus. T1-weighted fat-saturated contrast-enhanced image (300/18) shows non-enhancing lesion in subchondral area offemoral head surrounded by brightly enhanced marrow in head and neck.

 


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  		Fig. 1G. —Right femoral head of 16-year-old girl who received high-dose steroid therapy for systemic lupus erythematosus. Radiograph shows faint irregularity of articular surface of femoral head.

 


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  		Fig. 2H. —Right femoral head of 24-year-old woman who received high-dose steroid therapy for systemic lupus erythematosus. Radiograph obtained 1 week after D and E reveals faint demarcated sclerosis.

 


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  		Fig. 3F. —Bilateral hips of 48-year-old woman who received high-dose steroid therapy for systemic lupus erythematosus. Radiograph of left hip reveals faint demarcated sclerosis.

 


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  		Fig. 1H. —Right femoral head of 16-year-old girl who received high-dose steroid therapy for systemic lupus erythematosus. Radiograph obtained 3 weeks after D G shows collapse of femoral head.

 


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  		Fig. 2I. —Right femoral head of 24-year-old woman who received high-dose steroid therapy for systemic lupus erythematosus. Anteroposterior radiograph obtained 4 months after F-H shows flattening of femoral head.

 


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  		Fig. 2J. —Right femoral head of 24-year-old woman who received high-dose steroid therapy for systemic lupus erythematosus. Frog-leg lateral radiograph shows flattening of femoral head.

 


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  		Fig. 3G. —Bilateral hips of 48-year-old woman who received high-dose steroid therapy for systemic lupus erythematosus. Radiograph obtained 10 months after D-F reveals collapse of left femoral head. Right hip remains asymptomatic and radiographic findings appear normal.

 


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  		Fig. 1I. —Right femoral head of 16-year-old girl who received high-dose steroid therapy for systemic lupus erythematosus. Photomicrograph of tissue sample in subchondral area obtained from core biopsy shows no osteocytes in lacunae of trabecular bone. (H and E, x316)

 


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  		Fig. 1J. —Right femoral head of 16-year-old girl who received high-dose steroid therapy for systemic lupus erythematosus. Photomicrograph of areas adjacent to necrotic area shows exudates and fibroblastic proliferation in medullary spaces. Note absence of evidence of necrosis of trabecular bone. (H and E, x158)

 

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