Müller H F, Schedel H, Schneller A, Eisenschenk A, Wicht L, Siekmann R, Felix R
Strahlenklinik und Poliklinik, Virchow-Klinikum Humboldt Universität, Berlin.
Aktuelle Radiol. 1997 Mar;7(2):79-85.
The vascular femoral head necrosis is a serious illness, especially when appearing in patients aged 30 to 50 years. Many etiologic factors cause a femoral head necrosis such as, for example, high-dose steroids, abuse of alcohol, defect of bone marrow and trauma of the hip. Often the X-ray photograph leads to the diagnosis in the second stage (ARCO 1992) or in the third stage, when the femoral head has begun to collapse. The stage IIc and III shows an evident enhancement in contrast media in MRI. Contrast enhancement is demonstrated by STIR, FATSAT, T1-weighted and dynamic screening sequence. The characteristics of the contrast media enhancement argue for an active concomitant process of destruction and regeneration. This stage has the best chances for a drug or a surgical therapy. The evaluation of the signal intensity by the dynamic screening sequence is considered as an objective contribution for the staging of the femoral head necrosis. This enables one to differentiate between the curable stage IIc and the stage III, showing the beginning of breakdown of the femoral head.
股骨头缺血性坏死是一种严重疾病,尤其在30至50岁患者中出现时。许多病因可导致股骨头坏死,例如大剂量使用类固醇、酗酒、骨髓缺陷和髋部创伤。通常,X线照片在第二阶段(ARCO 1992)或第三阶段(此时股骨头已开始塌陷)才能做出诊断。IIc期和III期在MRI中显示造影剂明显增强。通过短TI反转恢复序列(STIR)、脂肪抑制快速自旋回波序列(FATSAT)、T1加权成像和动态扫描序列可显示造影剂增强。造影剂增强的特征表明存在破坏和再生的活跃伴随过程。此阶段进行药物或手术治疗的机会最大。通过动态扫描序列评估信号强度被认为是股骨头坏死分期的客观依据。这有助于区分可治愈的IIc期和显示股骨头开始破坏的III期。