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

Stevens, Kathryn J.; Tao, Caroline; Lee, Shi-Uk; Salem, Natalie; Vandevenne, Jan; Cheng, Calise; Neumann, G.; Valentin‐Opran, Alexandre; Lang, Philipp

doi:10.2214/ajr.180.2.1800363

Cited by 124 publications

(55 citation statements)

References 30 publications

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“…CT is superior to radiography and MRI in identifying subchondral femoral head fracture. 15,16 Therefore, CT can play an important role in predicting the prognosis of ONFH.…”

Section: Discussionmentioning

confidence: 99%

Osteonecrosis of the femoral head: using CT, MRI and gross specimen to characterize the location, shape and size of the lesion

Hu¹,

Huang²,

Wei³

et al. 2015

BJR

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of the femoral head: using CT, MRI and gross specimen to characterize the location, shape and size of the lesion. Br J Radiol 2015;88:20140508. FULL PAPER Osteonecrosis of the femoral head: using CT, MRI and gross specimen to characterize the location, shape and size of the lesion The results were compared with findings from coronal sectional gross specimens. Two radiologists independently measured the volume of necrotic lesions from CT and MR images using computer software, and the results were averaged. The volume of specimens' necrotic lesion was measured using the water displacement method.Results: There was a high degree of consistency between CT, MRI and the coronal sectional gross specimen on the location, shape and spatial structure of lesions.Differences of the lesion volume measured from CT and MR images were not statistically significant between two radiologists. The necrotic lesion volumes measured from CT and MR images and gross specimens were 22.07 6 5. Osteonecrosis of the femoral head (ONFH) is a common disease of the hip joint. If untreated, 80% of patients with ONFH will suffer the collapse of femoral head articular surface in a few years of disease progression.1 Once the femoral head collapses, osteoarthritis becomes inevitable and function of the hip joint will be seriously affected, which eventually will lead to artificial joint replacement. 2,3Although hip replacement is an effective approach to relieve pain and improve hip function in the short term, its long-term performance remains unsatisfactory.4,5 Furthermore, non-traumatic ONFH typically occurs in young adults and involves both hips. On the other hand, not all ONFH will progress to femoral head collapse.6 Therefore, being able to accurately predict the risk of femoral head collapse according to the disease severity and to take appropriate therapeutic measures are critical to preserve the hip joint and improve the prognosis of ONFH. 7 Studies have shown that the size and location of necrotic lesions are major factors associated with femoral head collapse.6-9 Although various approaches have been reported to illustrate the lesion location and size, all were based on MRI and/or radiographs.6-11 As a main imaging modality for diagnosis of ONFH, CT can clearly display ONFH that is in Association Research Circulation Osseous (ARCO) stage II or above. Multislice CT can achieve isotropic resolution. Volume data acquired from axial scans can be used to reconstruct in any direction to observe lesions. But so far, there has been no study that reports the feasibility and accuracy of using CT to measure the size of ONFH lesions. We hypothesized that CT and MRI could achieve highly consistent results in illustrating the size, shape and location of ONFH lesions in ARCO stage II and above, and both methods can be used to assess the risk of necrotic femoral head collapse.The objectives of this study are (1) to investigate the accuracy of using CT to capture the size, location, shape and spatial structural relationship of the necrotic lesion by com...

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“…CT is superior to radiography and MRI in identifying subchondral femoral head fracture. 15,16 Therefore, CT can play an important role in predicting the prognosis of ONFH.…”

Section: Discussionmentioning

confidence: 99%

Osteonecrosis of the femoral head: using CT, MRI and gross specimen to characterize the location, shape and size of the lesion

Hu¹,

Huang²,

Wei³

et al. 2015

BJR

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“…MR images and radiographs were used to determine the presence of subchondral collapse. Stevens et al investigated the sensitivity and specificity of MRI and plain radiography in comparison to CT for detecting the presence of collapse in the capital femoral epiphysis and found MRI to have sensitivity and specificity of 38% and 100%, respectively, and radiography had sensitivity and specificity of 71% and 97%, respectively [12].…”

Section: Methodsmentioning

confidence: 99%

How Does Osteonecrosis About the Knee Progress in Young Patients with Leukemia?: A 2- to 7-year Study

Karimova¹,

Wozniak

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Osteonecrosis is a major treatment complication of pediatric leukemias owing to its potential to cause joint deterioration. Because of potential long-term effects of osteonecrosis on joints, information regarding its progression and collapse in different patients can be used to identify high-risk groups, advise the patients and parents of this complication, and potentially consider the risk for development of osteonecrosis in planning primary treatment. Questions/purposes We therefore determined: (1) the incidence of joint collapse and/or pain in young patients with hematologic malignancies diagnosed with ON of the knee; (2) risk factors associated with collapse; and (3) the relationship between size and location of osteonecrotic knee lesions and the likelihood of joint collapse. Patients and Methods We retrospectively reviewed 109 patients with hematologic malignancies and MRI-confirmed knee osteonecrosis. The median age was 11.5 years (range, 2.3-18.8 years) at primary diagnosis of hematologic malignancy and a median age of 13.4 years (range, 2.7-23.3 years) at diagnosis of osteonecrosis of the knee. For analyses, we used the first and last MR images. Minimum clinical followup was 2.3 years after diagnosis of knee osteonecrosis (median, 6 years; range, 2.3-7.17 years).

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“…Computerized tomography (CT) is considered the most sensitive test for detecting subchondral fracture of the femoral head [50]. While radiographs and MR are useful, a CT delineates the outline of the subchondral bone most clearly (Fig.…”

Section: Computerized Tomographymentioning

confidence: 99%

Osteonecrosis of the femoral head: diagnosis and classification systems

Choi

Steinberg

Cheng

2015

Curr Rev Musculoskelet Med

103

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Osteonecrosis of femoral head is a rare but disabling condition that usually results in progressive femoral head collapse and secondary arthritis necessitating total hip arthroplasty if not treated appropriately in early stages. However, early diagnosis is challenging as the onset of disease is insidious and the symptoms and signs are usually minimal and nonspecific until it becomes advanced. Of several diagnostic modalities, magnetic resonance imaging (MRI) is considered the imaging method of choice with the highest sensitivity and specificity, while detection of potential risk factors is very important as well. Many investigators have developed several different classification systems; however, there still is controversy regarding the optimal classification system. Diagnostic methods and the evolution of different classification systems will be reviewed in this paper.

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

Cited by 124 publications

References 30 publications

Osteonecrosis of the femoral head: using CT, MRI and gross specimen to characterize the location, shape and size of the lesion

Osteonecrosis of the femoral head: using CT, MRI and gross specimen to characterize the location, shape and size of the lesion

How Does Osteonecrosis About the Knee Progress in Young Patients with Leukemia?: A 2- to 7-year Study

Osteonecrosis of the femoral head: diagnosis and classification systems

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