Jordan Eric, Varady Nathan H, Hosseinzadeh Shayan, Smith Stacy, Chen Antonia F, Mont Michael, Iorio Richard
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
Arthroplast Today. 2023 Oct 14;24:101244. doi: 10.1016/j.artd.2023.101244. eCollection 2023 Dec.
The 2019 Revised Association Research Circulation Osseous (ARCO) Staging Criteria for Osteonecrosis of the Femoral Head (ONFH) only requires plain radiographs and magnetic resonance imaging (MRI) to diagnose and stage ONFH; however, the effectiveness of the 2019 ARCO criteria in the absence of computed tomography (CT) scans has not been investigated. Therefore, the purpose of this study was to evaluate whether CT scanning is a necessary modality for diagnosing/staging ONFH using the ARCO staging system. More specifically, do CT scans help differentiate pre- and post-collapse lesions more than MRI scans?
A study was conducted on 228 ONFH patients diagnosed between January 1, 2008, and December 31, 2018, at a single academic medical center. CT and MRI scans were reviewed by the senior author and other contributors. The ONFH classification was compared between the 2 scans to determine if CT scans were able to further differentiate staging of collapsed lesions vs MRI scans.
A diagnosis of ONFH was made by MRI first in 57% (129/228) while 21% (48/228) used MRI and CT simultaneously. Only 22% (51/228) of cases were diagnosed by CT scans first. There were no cases where collapse was found by a CT scan that were not diagnosed by standard x-rays and/or MRIs.
CT scans are not a useful adjunct for diagnosing or treating ONFH and are not necessary if MRI is ordered when using the Revised ARCO Staging System for ONFH diagnosis.
2019年修订的股骨头坏死（ONFH）协会研究循环骨（ARCO）分期标准仅要求通过X线平片和磁共振成像（MRI）对ONFH进行诊断和分期；然而，尚未研究在没有计算机断层扫描（CT）的情况下2019年ARCO标准的有效性。因此，本研究的目的是评估使用ARCO分期系统时CT扫描是否是诊断/分期ONFH的必要手段。更具体地说，CT扫描在区分塌陷前和塌陷后病变方面是否比MRI扫描更有帮助？
对2008年1月1日至2018年12月31日期间在单一学术医学中心诊断的228例ONFH患者进行了一项研究。资深作者和其他研究人员对CT和MRI扫描进行了评估。比较两种扫描的ONFH分类，以确定CT扫描是否能够进一步区分塌陷病变与MRI扫描的分期。
57%（129/228）的患者首先通过MRI确诊为ONFH，而21%（48/228）的患者同时使用了MRI和CT。只有22%（51/228）的病例首先通过CT扫描确诊。没有出现CT扫描发现塌陷但标准X线和/或MRI未诊断出的病例。
CT扫描对ONFH的诊断或治疗没有帮助，在使用修订后的ARCO分期系统进行ONFH诊断时，如果已开具MRI检查，则CT扫描并非必需。
