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Subchondral Fractures in Osteonecrosis of the Femoral Head: Comparison of Radiography, CT, and MR Imaging

Kathryn Stevens1, Caroline Tao1, Shi-Uk Lee1, Natalie Salem1, Jan Vandevenne1, Calise Cheng1, Gesa Neumann2, Alexandre Valentin-Opran3 and Philipp Lang2

1 Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr., Stanford, CA 94305.
2 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115.
3 Genetics Institute, 87 Cambridge Park Dr., Cambridge, MA 02140.



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  		Fig. 1A. —Patient with osteonecrosis of left femoral head at 6-month follow-up. Anteroposterior radiograph shows subchondral fracture (arrows).

 


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  		Fig. 1B. —Patient with osteonecrosis of left femoral head at 6-month follow-up. Subchondral fracture (arrows) is best seen on this frogleg lateral radiograph.

 


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  		Fig. 2A. —Patient with osteonecrosis of left hip at 12-month follow-up. Frogleg lateral radiograph shows crescent sign (arrows).

 


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  		Fig. 2B. —Patient with osteonecrosis of left hip at 12-month follow-up. Fat-saturated T2-weighted MR image shows crescentic high-signal-intensity line (arrow).

 


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  		Fig. 2C. —Patient with osteonecrosis of left hip at 12-month follow-up. Coronal (C) and sagittal (D) reformatted CT scans show subchondral fracture (black arrows, D), with associated collapse of articular surface (white arrows).

 


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  		Fig. 2D. —Patient with osteonecrosis of left hip at 12-month follow-up. Coronal (C) and sagittal (D) reformatted CT scans show subchondral fracture (black arrows, D), with associated collapse of articular surface (white arrows).

 


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  		Fig. 3. —Patient with osteonecrosis of right femoral head at 12-month follow-up. Coronal reformatted CT scan shows subchondral fracture breaching articular surface of femoral head (arrows).

 


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  		Fig. 4A. —Patient with osteonecrosis of right femoral head at 6-month follow-up. Coronal T1-weighted spin-echo MR image shows crescentic low-signal-intensity line corresponding to subchondral fracture.

 


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  		Fig. 4B. —Patient with osteonecrosis of right femoral head at 6-month follow-up. Coronal fast spin-echo T2-weighted MR image obtained with fat-saturation shows crescentic high-signal-intensity line.

 


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  		Fig. 4C. —Patient with osteonecrosis of right femoral head at 6-month follow-up. Coronal reformatted CT scan shows subchondral fracture breaching articular surface (arrows).

 


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  		Fig. 5A. —Patient with osteonecrosis of right femoral head at 6-month follow-up. Axial CT scan shows subchondral fracture breaching articular surface of femoral head (arrows).

 


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  		Fig. 5B. —Patient with osteonecrosis of right femoral head at 6-month follow-up. Subchondral fracture is not seen on this anteroposterior radiograph.

 


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  		Fig. 5C. —Patient with osteonecrosis of right femoral head at 6-month follow-up. Frogleg lateral radiograph does not show subchondral fracture.

 


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  		Fig. 5D. —Patient with osteonecrosis of right femoral head at 6-month follow-up. Coronal T1-weighted spin-echo MR image does not show subchondral fracture.

 


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  		Fig. 5E. —Patient with osteonecrosis of right femoral head at 6-month follow-up. Coronal T2-weighted MR image obtained with fat-saturation does not show subchondral fracture.

 

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