The Role of MR Imaging in Avascular Necrosis of the Femoral Head

Apostolos H Karantanas; Eleni E Drakonaki

doi:10.1055/s-0031-1278427

Seminars in Musculoskeletal Radiology, Table of Contents

Semin Musculoskelet Radiol 2011; 15(3): 281-300
DOI: 10.1055/s-0031-1278427

The Role of MR Imaging in Avascular Necrosis of the Femoral Head

Apostolos H. Karantanas¹ , Eleni E. Drakonaki¹

¹Department of Radiology, University of Crete, Heraklion, Greece

Abstract

ABSTRACT

Due to the pattern of its blood supply, the femoral head is particularly vulnerable to avascular necrosis (AVN). Nontraumatic AVN is a devastating disorder affecting young patients, and despite treatment it normally follows a progressive course toward a destructive osteoarthropathy. Magnetic resonance (MR) imaging is currently used in major classification systems solely for early detection of femoral head AVN when plain radiographs are normal. More recent data have shown that MR imaging may improve staging, investigate radiologically occult collapse, depict other causes of disability and pain, assess prognosis, and evaluate treatment. This article reviews the established and evolving role of MR imaging in patients at risk or with known femoral head AVN.

KEYWORDS

MR imaging/diagnosis - hip joint - osteonecrosis - avascular necrosis - bone marrow/ischemia - vascularized grafts/osteonecrosis

Full Text

References

REFERENCES

1 Steinberg M E, Hayken G D, Steinberg D R. A quantitative system for staging avascular necrosis. J Bone Joint Surg Br. 1995; 77 (1) 34-41
2 Assouline-Dayan Y, Chang C, Greenspan A, Shoenfeld Y, Gershwin M E. Pathogenesis and natural history of osteonecrosis. Semin Arthritis Rheum. 2002; 32 (2) 94-124
3 Saini A, Saifuddin A. MRI of osteonecrosis. Clin Radiol. 2004; 59 (12) 1079-1093
4 Malizos K N, Karantanas A H, Varitimidis S E, Dailiana Z H, Bargiotas K, Maris T. Osteonecrosis of the femoral head: etiology, imaging and treatment. Eur J Radiol. 2007; 63 (1) 16-28
5 Hadjigeorgiou G, Dardiotis E, Dardioti M, Karantanas A, Dimitroulias A, Malizos K. Genetic association studies in osteonecrosis of the femoral head: mini review of the literature. Skeletal Radiol. 2008; 37 (1) 1-7
6 Chang J D, Hur M, Lee S S, Yoo J H, Lee K M. Genetic background of nontraumatic osteonecrosis of the femoral head in the Korean population. Clin Orthop Relat Res. 2008; 466 (5) 1041-1046
7 Mont M A, Hungerford D S. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am. 1995; 77 (3) 459-474
8 Steinberg M E, Brighton C T, Hayken G D, Tooze S E, Steinberg D R. Early results in the treatment of avascular necrosis of the femoral head with electrical stimulation. Orthop Clin North Am. 1984; 15 (1) 163-175
9 Markisz J A, Knowles R J, Altchek D W, Schneider R, Whalen J P, Cahill P T. Segmental patterns of avascular necrosis of the femoral heads: early detection with MR imaging. Radiology. 1987; 162 (3) 717-720
10 Beltran J, Herman L J, Burk J M et al.. Femoral head avascular necrosis: MR imaging with clinical-pathologic and radionuclide correlation. Radiology. 1988; 166 (1 Pt 1) 215-220
11 Genez B M, Wilson M R, Houk R W et al.. Early osteonecrosis of the femoral head: detection in high-risk patients with MR imaging. Radiology. 1988; 168 (2) 521-524
12 Coleman B G, Kressel H Y, Dalinka M K, Scheibler M L, Burk D L, Cohen E K. Radiographically negative avascular necrosis: detection with MR imaging. Radiology. 1988; 168 (2) 525-528
13 Fordyce M J, Solomon L. Early detection of avascular necrosis of the femoral head by MRI. J Bone Joint Surg Br. 1993; 75 (3) 365-367
14 Theodorou D J, Theodorou S J, Haghighi P, Resnick D. Distinct focal lesions of the femoral head: imaging features suggesting an atypical and minimal form of bone necrosis. Skeletal Radiol. 2002; 31 (8) 435-444
15 Saito S, Ohzono K, Ono K. Minimal osteonecrosis as a segmental infarct within the femoral head. Clin Orthop Relat Res. 1988; (231) 35-50
16 Dillman J R, Hernandez R J. MRI of Legg-Calve-Perthes disease. AJR Am J Roentgenol. 2009; 193 (5) 1394-1407
17 Nadel S N, Debatin J F, Richardson W J et al.. Detection of acute avascular necrosis of the femoral head in dogs: dynamic contrast-enhanced MR imaging vs spin-echo and STIR sequences. AJR Am J Roentgenol. 1992; 159 (6) 1255-1261
18 Vande Berg B E, Malghem J J, Labaisse M A, Noel H, Maldague B. Avascular necrosis of the hip: comparison of contrast-enhanced and nonenhanced MR imaging with histologic correlation. Work in progress. Radiology. 1992; 182 (2) 445-450
19 Mitchell D G, Rao V M, Dalinka M K et al.. Femoral head avascular necrosis: correlation of MR imaging, radiographic staging, radionuclide imaging, and clinical findings. Radiology. 1987; 162 (3) 709-715
20 Mitchell D G, Joseph P M, Fallon M et al.. Chemical-shift MR imaging of the femoral head: an in vitro study of normal hips and hips with avascular necrosis. AJR Am J Roentgenol. 1987; 148 (6) 1159-1164
21 Mitchell D G, Steinberg M E, Dalinka M K, Rao V M, Fallon M, Kressel H Y. Magnetic resonance imaging of the ischemic hip. Alterations within the osteonecrotic, viable, and reactive zones. Clin Orthop Relat Res. 1989; 244 (244) 60-77
22 Sugimoto H, Okubo R S, Ohsawa T. Chemical shift and the double-line sign in MRI of early femoral avascular necrosis. J Comput Assist Tomogr. 1992; 16 (5) 727-730
23 Duda S H, Laniado M, Schick F, Claussen C D. The double-line sign of osteonecrosis: evaluation on chemical shift MR images. Eur J Radiol. 1993; 16 (3) 233-238
24 Ikemura S, Yamamoto T, Motomura G, Nakashima Y, Mawatari T, Iwamoto Y. MRI evaluation of collapsed femoral heads in patients 60 years old or older: differentiation of subchondral insufficiency fracture from osteonecrosis of the femoral head. AJR Am J Roentgenol. 2010; 195 (1) W63-8
25 Watson R M, Roach N A, Dalinka M K. Avascular necrosis and bone marrow edema syndrome. Radiol Clin North Am. 2004; 42 (1) 207-219
26 Stevens K, Tao C, Lee S U et al.. Subchondral fractures in osteonecrosis of the femoral head: comparison of radiography, CT, and MR imaging. AJR Am J Roentgenol. 2003; 180 (2) 363-368
27 Mitchell D G. MR of the normal and ischemic hip. Magn Reson Annu. 1988; 37-69
28 Huang G S, Chan W P, Chang Y C, Chang C Y, Chen C Y, Yu J S. MR imaging of bone marrow edema and joint effusion in patients with osteonecrosis of the femoral head: relationship to pain. AJR Am J Roentgenol. 2003; 181 (2) 545-549
29 Mitchell M D, Kundel H L, Steinberg M E, Kressel H Y, Alavi A, Axel L. Avascular necrosis of the hip: comparison of MR, CT, and scintigraphy. AJR Am J Roentgenol. 1986; 147 (1) 67-71
30 Beltran J, Burk J M, Herman L J et al.. Avascular necrosis of the femoral head: early MRI detection and radiological correlation. Magn Reson Imaging. 1987; 5 (6) 431-442
31 Khanna A J, Yoon T R, Mont M A, Hungerford D S, Bluemke D A. Femoral head osteonecrosis: detection and grading by using a rapid MR imaging protocol. Radiology. 2000; 217 (1) 188-192
32 Dreinhöfer K E, Schwarzkopf S R, Haas N P, Tscherne H. Isolated traumatic dislocation of the hip. Long-term results in 50 patients. J Bone Joint Surg Br. 1994; 76 (1) 6-12
33 Poggi J J, Callaghan J J, Spritzer C E, Roark T, Goldner R D. Changes on magnetic resonance images after traumatic hip dislocation. Clin Orthop Relat Res. 1995; 319 (319) 249-259
34 Kaushik A, Sankaran B, Varghese M. Prognostic value of dynamic MRI in assessing post-traumatic femoral head vascularity. Skeletal Radiol. 2009; 38 (6) 565-569
35 Hou C H, Shih T T, Liu C Y, Li Y D, Enright T. Proton MR spectroscopy of the femoral head—evaluation of patients at risk for avascular necrosis. J Magn Reson Imaging. 2006; 24 (2) 409-417
36 Hong N, Du X, Nie Z, Li S. Diffusion-weighted MR study of femoral head avascular necrosis in severe acute respiratory syndrome patients. J Magn Reson Imaging. 2005; 22 (5) 661-664
37 Steinberg M E, Steinberg D R. Classification systems for osteonecrosis: an overview. Orthop Clin North Am. 2004; 35 (3) 273-283 vii-viii
38 Steinberg M E, Brighton C T, Corces A et al.. Osteonecrosis of the femoral head. Results of core decompression and grafting with and without electrical stimulation. Clin Orthop Relat Res. 1989; 249 (249) 199-208
39 Gardeniers J WM. ARCO Committee on Terminology and Staging. Report on the committee meeting at Santiago de Compostella. ARCO Newsletter. 1993; 5 79-82
40 Zibis A H, Karantanas A H, Roidis N T et al.. The role of MR imaging in staging femoral head osteonecrosis. Eur J Radiol. 2007; 63 (1) 3-9
41 Koo K H, Ahn I O, Kim R et al.. Bone marrow edema and associated pain in early stage osteonecrosis of the femoral head: prospective study with serial MR images. Radiology. 1999; 213 (3) 715-722
42 Kim Y M, Oh H C, Kim H J. The pattern of bone marrow oedema on MRI in osteonecrosis of the femoral head. J Bone Joint Surg Br. 2000; 82 (6) 837-841
43 Iida S, Harada Y, Shimizu K et al.. Correlation between bone marrow edema and collapse of the femoral head in steroid-induced osteonecrosis. AJR Am J Roentgenol. 2000; 174 (3) 735-743
44 Vande Berg B C, Malghem J J, Lecouvet F E, Jamart J, Maldague B E. Idiopathic bone marrow edema lesions of the femoral head: predictive value of MR imaging findings. Radiology. 1999; 212 (2) 527-535
45 Malizos K N, Zibis A H, Dailiana Z, Hantes M, Karachalios T, Karantanas A H. MR imaging findings in transient osteoporosis of the hip. Eur J Radiol. 2004; 50 (3) 238-244
46 Meyers M H. Osteonecrosis of the femoral head. Pathogenesis and long-term results of treatment. Clin Orthop Relat Res. 1988; 231 (231) 51-61
47 Vande Berg B E, Malghem J J, Labaisse M A, Noel H M, Maldague B E. MR imaging of avascular necrosis and transient marrow edema of the femoral head. Radiographics. 1993; 13 (3) 501-520
48 Karantanas A H. Acute bone marrow edema of the hip: role of MR imaging. Eur Radiol. 2007; 17 (9) 2225-2236
49 Turner D A, Templeton A C, Selzer P M, Rosenberg A G, Petasnick J P. Femoral capital osteonecrosis: MR finding of diffuse marrow abnormalities without focal lesions. Radiology. 1989; 171 (1) 135-140
50 Kubo T, Yamazoe S, Sugano N et al.. Initial MRI findings of non-traumatic osteonecrosis of the femoral head in renal allograft recipients. Magn Reson Imaging. 1997; 15 (9) 1017-1023
51 Fujioka M, Kubo T, Nakamura F et al.. Initial changes of non-traumatic osteonecrosis of femoral head in fat suppression images: bone marrow edema was not found before the appearance of band patterns. Magn Reson Imaging. 2001; 19 (7) 985-991
52 Ito H, Matsuno T, Minami A. Relationship between bone marrow edema and development of symptoms in patients with osteonecrosis of the femoral head. AJR Am J Roentgenol. 2006; 186 (6) 1761-1770
53 Radke S, Kirschner S, Seipel V, Rader C, Eulert J. Magnetic resonance imaging criteria of successful core decompression in avascular necrosis of the hip. Skeletal Radiol. 2004; 33 (9) 519-523
54 Tervonen O, Mueller D M, Matteson E L, Velosa J A, Ginsburg W W, Ehman R L. Clinically occult avascular necrosis of the hip: prevalence in an asymptomatic population at risk. Radiology. 1992; 182 (3) 845-847
55 Ohzono K, Saito M, Sugano N, Takaoka K, Ono K. The fate of nontraumatic avascular necrosis of the femoral head. A radiologic classification to formulate prognosis. Clin Orthop Relat Res. 1992; 277 (277) 73-78
56 Koo K-H, Kim R. Quantifying the extent of osteonecrosis of the femoral head. A new method using MRI. J Bone Joint Surg Br. 1995; 77 (6) 875-880
57 Kim Y M, Ahn J H, Kang H S, Kim H J. Estimation of the extent of osteonecrosis of the femoral head using MRI. J Bone Joint Surg Br. 1998; 80 (6) 954-958
58 Steinberg M E, Bands R E, Parry S, Hoffman E, Chan T, Hartman K M. Does lesion size affect the outcome in avascular necrosis?. Clin Orthop Relat Res. 1999; 367 (367) 262-271
59 Malizos K N, Siafakas M S, Fotiadis D I, Karachalios T S, Soucacos P N. An MRI-based semiautomated volumetric quantification of hip osteonecrosis. Skeletal Radiol. 2001; 30 (12) 686-693
60 Cherian S F, Laorr A, Saleh K J, Kuskowski M A, Bailey R F, Cheng E Y. Quantifying the extent of femoral head involvement in osteonecrosis. J Bone Joint Surg Am. 2003; 85-A (2) 309-315
61 Bassounas A E, Karantanas A H, Fotiadis D I, Malizos K N. Femoral head osteonecrosis: volumetric MRI assessment and outcome. Eur J Radiol. 2007; 63 (1) 10-15
62 Min B W, Song K S, Cho C H, Lee S M, Lee K J. Untreated asymptomatic hips in patients with osteonecrosis of the femoral head. Clin Orthop Relat Res. 2008; 466 (5) 1087-1092
63 Beltran J, Knight C T, Zuelzer W A et al.. Core decompression for avascular necrosis of the femoral head: correlation between long-term results and preoperative MR staging. Radiology. 1990; 175 (2) 533-536
64 Kopecky K K, Braunstein E M, Brandt K D et al.. Apparent avascular necrosis of the hip: appearance and spontaneous resolution of MR findings in renal allograft recipients. Radiology. 1991; 179 (2) 523-527
65 Zhao F C, Li Z R, Zhang N F et al.. Lesion size changes in osteonecrosis of the femoral head: a long-term prospective study using MRI. Int Orthop. 2010; 34 (6) 799-804
66 Takao M, Nishii T, Sakai T, Yoshikawa H, Sugano N. Repair in osteonecrosis of the femoral head: MR imaging features at long-term follow-up. Clin Rheumatol. 2010; 29 (8) 841-848
67 Fujisawa K, Hirata H, Inada H, Morita A, Takeda K, Hibasami H. Value of a dynamic MR scan in predicting vascular ingrowth from free vascularized scapular transplant used for treatment of avascular femoral head necrosis. Microsurgery. 1995; 16 (10) 673-678
68 May D A, Disler D G. Screening for avascular necrosis of the hip with rapid MRI: preliminary experience. J Comput Assist Tomogr. 2000; 24 (2) 284-287
69 Schmidt G P, Reiser M F, Baur-Melnyk A. Whole-body imaging of bone marrow. Semin Musculoskelet Radiol. 2009; 13 (2) 120-133
70 Beer M, Stenzel M, Girschick H, Schlegel P G, Darge K. Whole-body MR imaging in children with suspected osteonecrosis after intensive chemotherapy: preliminary results. Rofo. 2008; 180 (3) 238-245
71 Castro T C, Lederman H, Terreri M T, Kaste S C, Hilario M O. Detection of multifocal osteonecrosis in an adolescent with dermatomyositis using whole-body MRI. Pediatr Radiol. 2010; 40 (9) 1566-1568
72 Hadjigeorgiou G M, Karantanas A H, Zibis A et al.. Increased frequency of white matter lesions in patients with osteonecrosis (WMLeOn) of the femoral head. Eur J Radiol. 2004; 50 (3) 278-284
73 Hadjigeorgiou G M, Malizos K, Dardiotis E et al.. Paraoxonase 1 gene polymorphisms in patients with osteonecrosis of the femoral head with and without cerebral white matter lesions. J Orthop Res. 2007; 25 (8) 1087-1093
74 Barker D J, Hall A J. The epidemiology of Perthes' disease. Clin Orthop Relat Res. 1986; 209 (209) 89-94
75 Lamer S, Dorgeret S, Khairouni A et al.. Femoral head vascularisation in Legg-Calvé-Perthes disease: comparison of dynamic gadolinium-enhanced subtraction MRI with bone scintigraphy. Pediatr Radiol. 2002; 32 (8) 580-585
76 Merlini L, Combescure C, De Rosa V, Anooshiravani M, Hanquinet S. Diffusion-weighted imaging findings in Perthes disease with dynamic gadolinium-enhanced subtracted (DGS) MR correlation: a preliminary study. Pediatr Radiol. 2010; 40 (3) 318-325
77 Jaramillo D, Kasser J R, Villegas-Medina O L, Gaary E, Zurakowski D. Cartilaginous abnormalities and growth disturbances in Legg-Calvé-Perthes disease: evaluation with MR imaging. Radiology. 1995; 197 (3) 767-773
78 Jaramillo D, Galen T A, Winalski C S et al.. Legg-Calvé-Perthes disease: MR imaging evaluation during manual positioning of the hip—comparison with conventional arthrography. Radiology. 1999; 212 (2) 519-525

Apostolos H KarantanasM.D. Ph.D.

Department of Radiology, University Hospital

Stavrakia 711 10, Heraklion, Greece

Email: akarantanas@gmail.com