Relationship Between Bone Marrow Edema and Development of Symptoms in Patients With Osteonecrosis of the Femoral Head
Hiroshi Ito1,
Takeo Matsuno1 and
Akio Minami2
1 Department of Orthopedic Surgery, Asahikawa Medical College, Midorigaoka
Higashi 2-1-1-1, Asahikawa 078-8510, Japan.
2 Hokkaido University School of Medicine, Hokkaido, Japan.
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Fig. 1A —Right femoral head in 48-year-old woman who received high-dose
steroid therapy for dermatomyositis. Coronal T1-weighted MR image (TR/TE,
450/17) obtained 12 months after initiation of therapy and 4 weeks after onset
of hip pain shows decreased signal intensity in femoral head and neck.
Necrotic volume is 29.8%.
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Fig. 1B —Right femoral head in 48-year-old woman who received high-dose
steroid therapy for dermatomyositis. Coronal T2-weighted MR image (3,000/102)
shows high-signal-intensity bone marrow edema in femoral head and neck.
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Fig. 1C —Right femoral head in 48-year-old woman who received high-dose
steroid therapy for dermatomyositis. Anteroposterior radiograph shows minimum
collapse of femoral head. Harris hip score
[20] is 93 points.
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Fig. 1D —Right femoral head in 48-year-old woman who received high-dose
steroid therapy for dermatomyositis. Anteroposterior radiograph 3 months after
A-C shows radiolucent zone and clear demarcation line.
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Fig. 1E —Right femoral head in 48-year-old woman who received high-dose
steroid therapy for dermatomyositis. Frog-leg lateral radiograph shows
progression of collapse. Patient reports right hip pain but refuses surgery.
Harris hip score is 48 points.
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Fig. 2A —Left femoral head of 25-year-old woman who received high-dose
steroid therapy for systemic lupus erythematosus. Coronal T1-weighted MR image
(TR/TE, 500/17) obtained 18 months after initiation of therapy and 2 weeks
after onset of hip pain shows decreased signal intensity in femoral head.
Necrotic volume calculated on sequential T1-weighted images is 24.5%.
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Fig. 2B —Left femoral head of 25-year-old woman who received high-dose
steroid therapy for systemic lupus erythematosus. Coronal T2-weighted MR image
(3,000/102) shows high-signal-intensity bone marrow edema in femoral head and
neck.
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Fig. 2C —Left femoral head of 25-year-old woman who received high-dose
steroid therapy for systemic lupus erythematosus. Frog-leg lateral radiograph
appears to show normal findings. Harris hip score
[20] is 96 points.
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Fig. 2D —Left femoral head of 25-year-old woman who received high-dose
steroid therapy for systemic lupus erythematosus. Anteroposterior radiograph
12 months after A-C shows radiolucent zone and sclerotic changes
in femoral head.
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Fig. 2E —Left femoral head of 25-year-old woman who received high-dose
steroid therapy for systemic lupus erythematosus. Frog-leg lateral radiograph
shows progressive collapse of femoral head. Patient reports left hip pain, and
femoral transtrochanteric rotational osteotomy is being considered. Harris hip
score is 66 points.
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Fig. 3A —Measuring necrotic volume of femoral head using NIH Image software
(National Institutes of Health). Initially, circumference of femoral head
(dotted line) as seen on each sequential T1-weighted coronal image is
outlined using a nonpermanent fine-tip marker.
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Fig. 3B —Measuring necrotic volume of femoral head using NIH Image software
(National Institutes of Health). Then circumference of necrotic area
(dotted line) is outlined.
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Fig. 4 —Classification of necrotic locations according to criteria of Sugano
et al. [1]: lesions occupying
medial one third or less (type A), two thirds or less (type B), or more than
two thirds (type C) of weight-bearing portion.
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Fig. 5 —Line graph shows cumulative rate of survival comparing hips with
(dotted line) and those without (solid line) bone marrow
edema on diagnostic MR images in which osteonecrosis was initially
identified.
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Fig. 6A —Left femoral head of 16-year-old girl who received steroid therapy
for systemic lupus erythematosus. Coronal T1-weighted MR image (TR/TE, 360/9)
obtained 12 months after initiation of therapy and 4 weeks after onset of hip
pain shows a bandlike hypointense zone in femoral head. Necrotic volume is
38.5%.
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Fig. 6B —Left femoral head of 16-year-old girl who received steroid therapy
for systemic lupus erythematosus. Coronal T2-weighted MR image (3,800/102)
shows bandlike hypointense zone in femoral head. Bone marrow edema is not
found. Harris hip score [20]
is 88 points.
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Fig. 6C —Left femoral head of 16-year-old girl who received steroid therapy
for systemic lupus erythematosus. Coronal T1-weighted MR image (500/20)
obtained 5 years after A and B shows almost same necrotic area
in femoral head. No collapse is found. Bone marrow edema was not found during
this period.
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Fig. 6D —Left femoral head of 16-year-old girl who received steroid therapy
for systemic lupus erythematosus. Frog-leg lateral radiograph 5 years after
A and B appears to show normal findings. Patient reports no
worsening of hip pain during this period. Harris hip score is 91 points.
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Copyright © 2006 by the American Roentgen Ray Society.
