Transitorische Osteoporose oder Femurkopfnekrose? Frühdiagnose mit der MRT

Abstract

Transient osteoporosis of the hip is a syndrome that does not seem to be widely known; this is also true for its radiological appearance. It is often mistaken for avascular necrosis of the femoral head, metastatic or inflammatory disease. These differential diagnoses lead to more or less invasive procedures, although transient osteoporosis does not require more than immobilisation for complete remission. MRI was done in 38 patients with acute hip pain, 13 had femoral head necrosis and 8 transient osteoporosis. Follow-up studies via MRI in patients with transient osteoporosis revealed 3 stages (diffuse, focal, residual) during the clinical course of which stage II is similar to femoral head necrosis but always without the typical sclerotic rim.

Idiopathic Bone Marrow Edema Lesions of the Femoral Head: Predictive Value of MR Imaging Findings

“…In this popularly known bone marrow edema pattern, there is no evidence of a reactive interface, which is considered to be specific for osteonecrosis (3,13). The bone marrow edema pattern has been described (3,12,13,(15)(16)(17)(18)(19)(20)(21)(22) in association with a number of conditions, including transient osteoporosis of the hip, transient bone marrow edema syndrome, epiphyseal stress fracture, and epiphyseal osteonecrosis. The distinction between these conditions is crucial because of considerable differences in treatment and prognosis (1).…”

“…Because of previously reported (12,17,19,26) additional subchondral findings, we studied three parameters to determine their prognostic significance: lowsignal-intensity subchondral areas, epiphyseal lines, and contour deformities (Fig 1).…”

“…This lesion pattern differs from the bone marrow edema pattern that is characterized by an ill-defined epiphyseal marrow area of low signal intensity on T1-weighted MR images and of intermediate to high signal intensity on T2-weighted images (11)(12)(13)(14). The bone marrow edema pattern is nonspecific and can be observed in association with several conditions, including transient osteoporosis (12,(15)(16)(17), transient bone marrow edema syndrome (12,13,16), and epiphyseal stress fracture (18,19). These conditions are self-limiting disorders that necessitate no specific therapy other than palliative measures.…”

“…On T2-weighted and contrast materialenhanced T1-weighted MR images of bone marrow edema lesions of the femoral head, several discrete features can occasionally be observed in the subchondral area of the femoral head (12,17,19,26). In hypothetical terms, assessment of the presence of these subchondral changes and precise determination of their spatial characteristics on MR images could help differentiate irreversible from transient epiphyseal lesions.…”

Das transitorische Knochenmarködemsyndrom der Hüfte

“…Daher schlugen Hunder und Kelly [28] ebenso wie Leqesne [38] vor, den Ausdruck transitorische Hüftosteoporose zu verwenden. Vom Jahr 1988 an, als Folge des immer verbreiteteren Gebrauchs der Magnetresonanztomographie, häuften sich Publikationen, in denen berichtet wurde, dass diese weltweit vorkommende Krankheit durch ein charakteristisches Bild in den MRT-Aufnahmen gekennzeichnet sei [5,17,22,50,53]. Diese typischen Signalveränderungen konnten durch eine Flüssigkeitsansammlung im Knochenmark des proximalen Femurs erklärt werden.…”