Meier Reinhard, Kraus Tobias M, Schaeffeler Christoph, Torka Sebastian, Schlitter Anna Melissa, Specht Katja, Haller Bernhard, Waldt Simone, Rechl Hans, Rummeny Ernst J, Woertler Klaus
Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany,
Eur Radiol. 2014 Sep;24(9):2271-8. doi: 10.1007/s00330-014-3216-8. Epub 2014 May 28.
To test the hypothesis that bone marrow oedema (BME) observed on MRI in patients with avascular necrosis (AVN) of the femoral head represents an indicator of subchondral fracture.
Thirty-seven symptomatic hips of 27 consecutive patients (53% women, mean age 49.2) with AVN of the femoral head and associated BME on magnetic resonance (MR) imaging were included. MR findings were correlated with computed tomography (CT) of the hip and confirmed by histopathological examination of the resected femoral head. Imaging studies were analysed by two radiologists with use of the ARCO classification.
On MR imaging a fracture line could be identified in 19/37 (51%) cases, which were classified as ARCO stage 3 (n = 15) and stage 4 (n = 4). The remaining 18/37 (49%) cases were classified as ARCO stage 2. However, in all 37/37 (100%) cases a subchondral fracture was identified on CT, indicating ARCO stage 3/4 disease. The extent of subchondral fractures and the femoral head collapse was graded higher on CT as compared to MRI (P < 0.05). Histopathological analysis confirmed bone necrosis and subchondral fractures.
In patients with AVN, BME of the femoral head represents a secondary sign of subchondral fracture and thus indicates ARCO stage 3 disease.
BME on MRI in AVN of femoral head indicates a subchondral fracture. BME in AVN of the femoral head represents ARCO stage 3/4 disease. CT identifies subchondral fractures and femoral head collapse better than MR imaging. This knowledge helps to avoid understaging and to trigger adequate treatment.
验证股骨头缺血性坏死（AVN）患者磁共振成像（MRI）上观察到的骨髓水肿（BME）是软骨下骨折指标的假说。
纳入27例连续患者的37个有症状的髋关节（女性占53%，平均年龄49.2岁），这些患者患有股骨头缺血性坏死且磁共振成像（MR）显示有相关骨髓水肿。将MR表现与髋关节计算机断层扫描（CT）结果进行关联，并通过对切除的股骨头进行组织病理学检查加以证实。两名放射科医生采用ARCO分类法对影像学研究进行分析。
在MR成像上，19/37（51%）例可识别出骨折线，这些病例被分类为ARCO 3期（n = 15）和4期（n = 4）。其余18/37（49%）例被分类为ARCO 2期。然而，在所有37/37（100%）例中，CT均显示有软骨下骨折，表明为ARCO 3/4期疾病。与MRI相比，CT上软骨下骨折的范围和股骨头塌陷程度分级更高（P < 0.05）。组织病理学分析证实存在骨坏死和软骨下骨折。
在股骨头缺血性坏死患者中，股骨头骨髓水肿是软骨下骨折的次要征象，因此提示为ARCO 3期疾病。
股骨头缺血性坏死患者MRI上的骨髓水肿提示软骨下骨折。股骨头缺血性坏死患者的骨髓水肿代表ARCO 3/4期疾病。CT比MR成像能更好地识别软骨下骨折和股骨头塌陷。这一认识有助于避免分期过低并促使采取适当治疗。
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