Radiology Department, Baskent University, Ankara, Turkey.
Orthopedics and Traumatology Department, Baskent University, Ankara, Turkey.
Radiologie (Heidelb). 2024 Nov;64(Suppl 1):145-152. doi: 10.1007/s00117-024-01359-0. Epub 2024 Sep 5.
Predicting the development of collapse in patients with avascular necrosis of the femoral head (ANFH) is critical in determining prognosis and management.
We aimed to evaluate whether MRI findings and parameters based on the Association Research Circulation Osseous (ARCO), Japanese Investigation Committee (JIC), modified Kerboul, and Mitchell classifications can predict prognosis in patients with early-stage ANFH at initial diagnosis.
This study comprises a retrospective analysis of early-stage ANFH patients without femoral head collapse. Hips with ANFH were divided into two groups based on whether they developed collapse during at least 1 year of follow-up or not. MRI findings were assessed by two radiologists and compared between the groups. Interobserver reliability was also evaluated.
Patients who developed collapse had higher measurements in the percentage of midcoronal area, midsagittal area, maximum coronal area, and total necrotic area (p = 0.001, p = 0.001, p < 0.001, p = 0.003, respectively). Although all AUC values were close to each other, the percentage of maximum coronal area showed the highest AUC value (0.857; 95% CI 0.714-1.000; sensitivity 85.7%, specificity 80%) in ROC curve analysis. Interobserver reliability was best for the JIC and worst for the modified Kerboul classification (Kappa values: 0.890 and 0.492, respectively). No statistically significant difference was found among etiological factors, bone marrow edema, cyst-like changes, synovial effusion, and collapse development (p > 0.05). The double-line sign was statistically significantly more frequent in hips without collapse (p = 0.025).
The risk of collapse development is higher with a greater volume of necrosis in the femoral head and when the osteonecrosis is located more laterally.
预测股骨头缺血性坏死（ANFH）患者塌陷的发展对于确定预后和治疗非常重要。
我们旨在评估基于 Association Research Circulation Osseous（ARCO）、Japanese Investigation Committee（JIC）、改良 Kerboul 和 Mitchell 分类的 MRI 表现和参数是否可以预测早期 ANFH 患者初始诊断时的预后。
本研究包括对无股骨头塌陷的早期 ANFH 患者进行回顾性分析。根据至少 1 年随访期间是否发生塌陷，将患有 ANFH 的髋关节分为两组。由两位放射科医生评估 MRI 表现，并比较两组之间的表现。还评估了观察者间的可靠性。
发生塌陷的患者在中冠状面积百分比、中矢状面积百分比、最大冠状面积百分比和总坏死面积方面的测量值较高（p=0.001，p=0.001，p<0.001，p=0.003，分别）。尽管所有 AUC 值都彼此接近，但最大冠状面积百分比在 ROC 曲线分析中显示出最高的 AUC 值（0.857；95%CI 0.714-1.000；敏感性 85.7%，特异性 80%）。观察者间可靠性在 JIC 分类中最好，在改良 Kerboul 分类中最差（Kappa 值分别为 0.890 和 0.492）。病因因素、骨髓水肿、囊状改变、滑膜积液和塌陷发展之间无统计学显著差异（p>0.05）。无塌陷髋关节的双线征更常见，差异有统计学意义（p=0.025）。
股骨头坏死体积越大，坏死越偏外侧，塌陷发展的风险越高。
