Sakai T, Sugano N, Nishii T, Haraguchi K, Ochi T, Ohzono K
Department of Orthopedic Surgery, Osaka University Medical School, Suita, Japan.
Skeletal Radiol. 2000 Mar;29(3):133-41. doi: 10.1007/s002560050583.
To investigate the MR findings of necrotic lesions and the extralesional area of osteonecrosis of the femoral head (ONFH) for each of the radiological stages.
Forty-nine hips in 29 patients (15 female, 14 male; mean age 38 years, range 17-59 years) were imaged using a 1.0-T superconducting magnet. T2-weighted spin echo pulse sequences (T2WI), spoiled gradient recalled echo pulse sequences (SPGR) and fat suppression SPGR (FS-SPGR), followed by Gd-DTPA enhanced fat suppression SPGR (Gd-FS-SPGR), were all obtained with the aid of a TORSO surface coil.
While a normal fat intensity area with a low-intensity band on SPGR (band pattern) was seen in 16 of 16 stage 1 (100%), nine of 11 stage 2 (82%), four of 17 stage 3 (24%), and none of five stage 4 hips, all hips showed peripheral rim enhancement on Gd-FS-SPGR (100%). This enhancement band on Gd-FS-SPGR corresponded to histological findings of necrotic trabecular bone, repaired marrow, and fibrous reparative tissue. Bone marrow edema was also clearly demonstrated as a diffuse, high-intensity area outside this enhancement band on Gd-FS-SPGR in two stage 2 (18%), 12 stage 3 (71%), and one stage 4 hip (20%). In cases at stage 2 or more advanced stages with homogeneous or inhomogeneous low intensity on nonenhanced MRI, the reparative process both inside and outside the necrotic lesion, including bone marrow edema, was detected clearly on contrast-enhanced MRI.
研究股骨头坏死（ONFH）各放射学分期的坏死灶及病灶外区域的磁共振成像（MR）表现。
对29例患者（15例女性，14例男性；平均年龄38岁，范围17 - 59岁）的49个髋关节采用1.0-T超导磁体进行成像。借助TORSO表面线圈获取T2加权自旋回波脉冲序列（T2WI）、扰相梯度回波脉冲序列（SPGR）和脂肪抑制SPGR（FS-SPGR），随后进行钆喷替酸葡甲胺增强脂肪抑制SPGR（Gd-FS-SPGR）。
16例1期患者中的16个髋关节（100%）、11例2期患者中的9个髋关节（82%）、17例3期患者中的4个髋关节（24%）在SPGR上可见正常脂肪信号区域伴低信号带（带状模式），而5例4期患者的髋关节均未出现此表现。所有髋关节在Gd-FS-SPGR上均显示周边环形强化（100%）。Gd-FS-SPGR上的这种强化带与坏死小梁骨、修复的骨髓和纤维修复组织的组织学表现相对应。在2例2期（18%）、12例3期（71%）和1例4期髋关节（20%）的Gd-FS-SPGR上，骨髓水肿也清晰显示为该强化带外的弥漫性高信号区域。在2期或更晚期且未增强MRI表现为均匀或不均匀低信号的病例中，对比增强MRI能清晰检测到坏死灶内外包括骨髓水肿在内的修复过程。
