Gondim Teixeira Pedro Augusto, Dubois Lauriane, Hossu Gabriela, Gillet Romain, Badr Sammy, Cotten Anne, Blum Alain
Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France.
Université de Lorraine, Inserm, IADI, F-54000, Nancy, France.
Eur Radiol. 2023 Apr;33(4):2340-2349. doi: 10.1007/s00330-022-09250-z. Epub 2022 Nov 17.
To evaluate the MRI perfusion changes in patients with risk factors for osteonecrosis and normally appearing femoral heads prior to overt femoral head osteonecrosis.
Fifty-eight patients (105 hips) were prospectively included in this ethics committee-approved study. There were 46 hips with no image anomalies and no risk factors for osteonecrosis of the femoral head (ONFH) risk factors, 38 with ONFH risk factors and no image abnormalities, and 21 with overt ONFH. All patients underwent DCE-MRI. Semi-quantitative (peak enhancement [PE], area under the curve [AUC], time to maximum enhancement [TME]) and quantitative perfusion parameters (volume plasma, KTRANS, and KEP) were calculated. Excessive alcohol consumption, corticosteroid use, and trauma were considered major risk factors for osteonecrosis of the femoral head.
Measured at the femoral neck and compared to the healthy hips without OFNH risk factors, PE was significantly lower in the hips of patients with OFNH risk factors. Moreover, the difference was greater in females with risk factors, who presented significantly lower PE values (p = 0.0096). A PE threshold of 1.4% yielded a 92% sensitivity and 54% specificity for the presence of associated ONFH risk factors. The hips with overt OFNH compared to those with normally appearing showed an increase of PE of 45% in the neck (p < 0.014). Various epiphyseal femoral head perfusion parameters (PE, TME, AUC, and K) presented statistically significant differences in hips with ONFH and those without (p < 0.0001).
DCE-MRI can identify perfusion marrow changes related to the presence of ONFH risk factors and adjacent to osteonecrosis areas.
• Bone marrow perfusion changes may occur prior to overt ONFH and extend beyond the osteonecrosis area to the entire femoral head and neck. • Peak enhancement values were significantly reduced in patients with ONFH risk factors, compared to those without. • The presence of ONFH led to a significant increase in marrow perfusion adjacent to the osteonecrosis area.
评估在股骨头明显坏死之前，具有股骨头坏死风险因素且股骨头外观正常的患者的MRI灌注变化。
本研究经伦理委员会批准，前瞻性纳入了58例患者（105髋）。其中46髋无影像异常且无股骨头坏死（ONFH）风险因素，38髋有ONFH风险因素但无影像异常，21髋有明显的ONFH。所有患者均接受了动态对比增强磁共振成像（DCE-MRI）检查。计算了半定量参数（峰值增强[PE]、曲线下面积[AUC]、达到最大增强的时间[TME]）和定量灌注参数（血容量、传递常数[KTRANS]和 Kep）。过度饮酒、使用皮质类固醇和创伤被视为股骨头坏死的主要风险因素。
在股骨颈测量时，与无OFNH风险因素的健康髋关节相比，有OFNH风险因素患者的髋关节PE显著降低。此外，有风险因素的女性差异更大，其PE值显著更低（p = 0.0096）。PE阈值为1.4%时，对于存在相关ONFH风险因素的敏感性为92%，特异性为54%。与外观正常的髋关节相比，明显OFNH的髋关节在颈部的PE增加了45%（p < 0.014）。在有ONFH和无ONFH的髋关节中，各种股骨头骨骺灌注参数（PE、TME、AUC和 K）存在统计学显著差异（p < 0.0001）。
DCE-MRI可以识别与ONFH风险因素存在相关且邻近坏死区域的骨髓灌注变化。
• 在明显的ONFH之前可能会发生骨髓灌注变化，且这种变化会超出坏死区域，延伸至整个股骨头和颈部。• 与无ONFH风险因素的患者相比，有ONFH风险因素的患者峰值增强值显著降低。• ONFH的存在导致坏死区域邻近的骨髓灌注显著增加。
