Semin Musculoskelet Radiol 2011; 15(3): 281-300
DOI: 10.1055/s-0031-1278427
© Thieme Medical Publishers

The Role of MR Imaging in Avascular Necrosis of the Femoral Head

Apostolos H. Karantanas1 , Eleni E. Drakonaki1
  • 1Department of Radiology, University of Crete, Heraklion, Greece
Further Information

Publication History

Publication Date:
03 June 2011 (online)

ABSTRACT

Due to the pattern of its blood supply, the femoral head is particularly vulnerable to avascular necrosis (AVN). Nontraumatic AVN is a devastating disorder affecting young patients, and despite treatment it normally follows a progressive course toward a destructive osteoarthropathy. Magnetic resonance (MR) imaging is currently used in major classification systems solely for early detection of femoral head AVN when plain radiographs are normal. More recent data have shown that MR imaging may improve staging, investigate radiologically occult collapse, depict other causes of disability and pain, assess prognosis, and evaluate treatment. This article reviews the established and evolving role of MR imaging in patients at risk or with known femoral head AVN.

REFERENCES

  • 1 Steinberg M E, Hayken G D, Steinberg D R. A quantitative system for staging avascular necrosis.  J Bone Joint Surg Br. 1995;  77 (1) 34-41
  • 2 Assouline-Dayan Y, Chang C, Greenspan A, Shoenfeld Y, Gershwin M E. Pathogenesis and natural history of osteonecrosis.  Semin Arthritis Rheum. 2002;  32 (2) 94-124
  • 3 Saini A, Saifuddin A. MRI of osteonecrosis.  Clin Radiol. 2004;  59 (12) 1079-1093
  • 4 Malizos K N, Karantanas A H, Varitimidis S E, Dailiana Z H, Bargiotas K, Maris T. Osteonecrosis of the femoral head: etiology, imaging and treatment.  Eur J Radiol. 2007;  63 (1) 16-28
  • 5 Hadjigeorgiou G, Dardiotis E, Dardioti M, Karantanas A, Dimitroulias A, Malizos K. Genetic association studies in osteonecrosis of the femoral head: mini review of the literature.  Skeletal Radiol. 2008;  37 (1) 1-7
  • 6 Chang J D, Hur M, Lee S S, Yoo J H, Lee K M. Genetic background of nontraumatic osteonecrosis of the femoral head in the Korean population.  Clin Orthop Relat Res. 2008;  466 (5) 1041-1046
  • 7 Mont M A, Hungerford D S. Non-traumatic avascular necrosis of the femoral head.  J Bone Joint Surg Am. 1995;  77 (3) 459-474
  • 8 Steinberg M E, Brighton C T, Hayken G D, Tooze S E, Steinberg D R. Early results in the treatment of avascular necrosis of the femoral head with electrical stimulation.  Orthop Clin North Am. 1984;  15 (1) 163-175
  • 9 Markisz J A, Knowles R J, Altchek D W, Schneider R, Whalen J P, Cahill P T. Segmental patterns of avascular necrosis of the femoral heads: early detection with MR imaging.  Radiology. 1987;  162 (3) 717-720
  • 10 Beltran J, Herman L J, Burk J M et al.. Femoral head avascular necrosis: MR imaging with clinical-pathologic and radionuclide correlation.  Radiology. 1988;  166 (1 Pt 1) 215-220
  • 11 Genez B M, Wilson M R, Houk R W et al.. Early osteonecrosis of the femoral head: detection in high-risk patients with MR imaging.  Radiology. 1988;  168 (2) 521-524
  • 12 Coleman B G, Kressel H Y, Dalinka M K, Scheibler M L, Burk D L, Cohen E K. Radiographically negative avascular necrosis: detection with MR imaging.  Radiology. 1988;  168 (2) 525-528
  • 13 Fordyce M J, Solomon L. Early detection of avascular necrosis of the femoral head by MRI.  J Bone Joint Surg Br. 1993;  75 (3) 365-367
  • 14 Theodorou D J, Theodorou S J, Haghighi P, Resnick D. Distinct focal lesions of the femoral head: imaging features suggesting an atypical and minimal form of bone necrosis.  Skeletal Radiol. 2002;  31 (8) 435-444
  • 15 Saito S, Ohzono K, Ono K. Minimal osteonecrosis as a segmental infarct within the femoral head.  Clin Orthop Relat Res. 1988;  (231) 35-50
  • 16 Dillman J R, Hernandez R J. MRI of Legg-Calve-Perthes disease.  AJR Am J Roentgenol. 2009;  193 (5) 1394-1407
  • 17 Nadel S N, Debatin J F, Richardson W J et al.. Detection of acute avascular necrosis of the femoral head in dogs: dynamic contrast-enhanced MR imaging vs spin-echo and STIR sequences.  AJR Am J Roentgenol. 1992;  159 (6) 1255-1261
  • 18 Vande Berg B E, Malghem J J, Labaisse M A, Noel H, Maldague B. Avascular necrosis of the hip: comparison of contrast-enhanced and nonenhanced MR imaging with histologic correlation. Work in progress.  Radiology. 1992;  182 (2) 445-450
  • 19 Mitchell D G, Rao V M, Dalinka M K et al.. Femoral head avascular necrosis: correlation of MR imaging, radiographic staging, radionuclide imaging, and clinical findings.  Radiology. 1987;  162 (3) 709-715
  • 20 Mitchell D G, Joseph P M, Fallon M et al.. Chemical-shift MR imaging of the femoral head: an in vitro study of normal hips and hips with avascular necrosis.  AJR Am J Roentgenol. 1987;  148 (6) 1159-1164
  • 21 Mitchell D G, Steinberg M E, Dalinka M K, Rao V M, Fallon M, Kressel H Y. Magnetic resonance imaging of the ischemic hip. Alterations within the osteonecrotic, viable, and reactive zones.  Clin Orthop Relat Res. 1989;  244 (244) 60-77
  • 22 Sugimoto H, Okubo R S, Ohsawa T. Chemical shift and the double-line sign in MRI of early femoral avascular necrosis.  J Comput Assist Tomogr. 1992;  16 (5) 727-730
  • 23 Duda S H, Laniado M, Schick F, Claussen C D. The double-line sign of osteonecrosis: evaluation on chemical shift MR images.  Eur J Radiol. 1993;  16 (3) 233-238
  • 24 Ikemura S, Yamamoto T, Motomura G, Nakashima Y, Mawatari T, Iwamoto Y. MRI evaluation of collapsed femoral heads in patients 60 years old or older: differentiation of subchondral insufficiency fracture from osteonecrosis of the femoral head.  AJR Am J Roentgenol. 2010;  195 (1) W63-8
  • 25 Watson R M, Roach N A, Dalinka M K. Avascular necrosis and bone marrow edema syndrome.  Radiol Clin North Am. 2004;  42 (1) 207-219
  • 26 Stevens K, Tao C, Lee S U et al.. Subchondral fractures in osteonecrosis of the femoral head: comparison of radiography, CT, and MR imaging.  AJR Am J Roentgenol. 2003;  180 (2) 363-368
  • 27 Mitchell D G. MR of the normal and ischemic hip.  Magn Reson Annu. 1988;  37-69
  • 28 Huang G S, Chan W P, Chang Y C, Chang C Y, Chen C Y, Yu J S. MR imaging of bone marrow edema and joint effusion in patients with osteonecrosis of the femoral head: relationship to pain.  AJR Am J Roentgenol. 2003;  181 (2) 545-549
  • 29 Mitchell M D, Kundel H L, Steinberg M E, Kressel H Y, Alavi A, Axel L. Avascular necrosis of the hip: comparison of MR, CT, and scintigraphy.  AJR Am J Roentgenol. 1986;  147 (1) 67-71
  • 30 Beltran J, Burk J M, Herman L J et al.. Avascular necrosis of the femoral head: early MRI detection and radiological correlation.  Magn Reson Imaging. 1987;  5 (6) 431-442
  • 31 Khanna A J, Yoon T R, Mont M A, Hungerford D S, Bluemke D A. Femoral head osteonecrosis: detection and grading by using a rapid MR imaging protocol.  Radiology. 2000;  217 (1) 188-192
  • 32 Dreinhöfer K E, Schwarzkopf S R, Haas N P, Tscherne H. Isolated traumatic dislocation of the hip. Long-term results in 50 patients.  J Bone Joint Surg Br. 1994;  76 (1) 6-12
  • 33 Poggi J J, Callaghan J J, Spritzer C E, Roark T, Goldner R D. Changes on magnetic resonance images after traumatic hip dislocation.  Clin Orthop Relat Res. 1995;  319 (319) 249-259
  • 34 Kaushik A, Sankaran B, Varghese M. Prognostic value of dynamic MRI in assessing post-traumatic femoral head vascularity.  Skeletal Radiol. 2009;  38 (6) 565-569
  • 35 Hou C H, Shih T T, Liu C Y, Li Y D, Enright T. Proton MR spectroscopy of the femoral head—evaluation of patients at risk for avascular necrosis.  J Magn Reson Imaging. 2006;  24 (2) 409-417
  • 36 Hong N, Du X, Nie Z, Li S. Diffusion-weighted MR study of femoral head avascular necrosis in severe acute respiratory syndrome patients.  J Magn Reson Imaging. 2005;  22 (5) 661-664
  • 37 Steinberg M E, Steinberg D R. Classification systems for osteonecrosis: an overview.  Orthop Clin North Am. 2004;  35 (3) 273-283 vii-viii
  • 38 Steinberg M E, Brighton C T, Corces A et al.. Osteonecrosis of the femoral head. Results of core decompression and grafting with and without electrical stimulation.  Clin Orthop Relat Res. 1989;  249 (249) 199-208
  • 39 Gardeniers J WM. ARCO Committee on Terminology and Staging. Report on the committee meeting at Santiago de Compostella.  ARCO Newsletter. 1993;  5 79-82
  • 40 Zibis A H, Karantanas A H, Roidis N T et al.. The role of MR imaging in staging femoral head osteonecrosis.  Eur J Radiol. 2007;  63 (1) 3-9
  • 41 Koo K H, Ahn I O, Kim R et al.. Bone marrow edema and associated pain in early stage osteonecrosis of the femoral head: prospective study with serial MR images.  Radiology. 1999;  213 (3) 715-722
  • 42 Kim Y M, Oh H C, Kim H J. The pattern of bone marrow oedema on MRI in osteonecrosis of the femoral head.  J Bone Joint Surg Br. 2000;  82 (6) 837-841
  • 43 Iida S, Harada Y, Shimizu K et al.. Correlation between bone marrow edema and collapse of the femoral head in steroid-induced osteonecrosis.  AJR Am J Roentgenol. 2000;  174 (3) 735-743
  • 44 Vande Berg B C, Malghem J J, Lecouvet F E, Jamart J, Maldague B E. Idiopathic bone marrow edema lesions of the femoral head: predictive value of MR imaging findings.  Radiology. 1999;  212 (2) 527-535
  • 45 Malizos K N, Zibis A H, Dailiana Z, Hantes M, Karachalios T, Karantanas A H. MR imaging findings in transient osteoporosis of the hip.  Eur J Radiol. 2004;  50 (3) 238-244
  • 46 Meyers M H. Osteonecrosis of the femoral head. Pathogenesis and long-term results of treatment.  Clin Orthop Relat Res. 1988;  231 (231) 51-61
  • 47 Vande Berg B E, Malghem J J, Labaisse M A, Noel H M, Maldague B E. MR imaging of avascular necrosis and transient marrow edema of the femoral head.  Radiographics. 1993;  13 (3) 501-520
  • 48 Karantanas A H. Acute bone marrow edema of the hip: role of MR imaging.  Eur Radiol. 2007;  17 (9) 2225-2236
  • 49 Turner D A, Templeton A C, Selzer P M, Rosenberg A G, Petasnick J P. Femoral capital osteonecrosis: MR finding of diffuse marrow abnormalities without focal lesions.  Radiology. 1989;  171 (1) 135-140
  • 50 Kubo T, Yamazoe S, Sugano N et al.. Initial MRI findings of non-traumatic osteonecrosis of the femoral head in renal allograft recipients.  Magn Reson Imaging. 1997;  15 (9) 1017-1023
  • 51 Fujioka M, Kubo T, Nakamura F et al.. Initial changes of non-traumatic osteonecrosis of femoral head in fat suppression images: bone marrow edema was not found before the appearance of band patterns.  Magn Reson Imaging. 2001;  19 (7) 985-991
  • 52 Ito H, Matsuno T, Minami A. Relationship between bone marrow edema and development of symptoms in patients with osteonecrosis of the femoral head.  AJR Am J Roentgenol. 2006;  186 (6) 1761-1770
  • 53 Radke S, Kirschner S, Seipel V, Rader C, Eulert J. Magnetic resonance imaging criteria of successful core decompression in avascular necrosis of the hip.  Skeletal Radiol. 2004;  33 (9) 519-523
  • 54 Tervonen O, Mueller D M, Matteson E L, Velosa J A, Ginsburg W W, Ehman R L. Clinically occult avascular necrosis of the hip: prevalence in an asymptomatic population at risk.  Radiology. 1992;  182 (3) 845-847
  • 55 Ohzono K, Saito M, Sugano N, Takaoka K, Ono K. The fate of nontraumatic avascular necrosis of the femoral head. A radiologic classification to formulate prognosis.  Clin Orthop Relat Res. 1992;  277 (277) 73-78
  • 56 Koo K-H, Kim R. Quantifying the extent of osteonecrosis of the femoral head. A new method using MRI.  J Bone Joint Surg Br. 1995;  77 (6) 875-880
  • 57 Kim Y M, Ahn J H, Kang H S, Kim H J. Estimation of the extent of osteonecrosis of the femoral head using MRI.  J Bone Joint Surg Br. 1998;  80 (6) 954-958
  • 58 Steinberg M E, Bands R E, Parry S, Hoffman E, Chan T, Hartman K M. Does lesion size affect the outcome in avascular necrosis?.  Clin Orthop Relat Res. 1999;  367 (367) 262-271
  • 59 Malizos K N, Siafakas M S, Fotiadis D I, Karachalios T S, Soucacos P N. An MRI-based semiautomated volumetric quantification of hip osteonecrosis.  Skeletal Radiol. 2001;  30 (12) 686-693
  • 60 Cherian S F, Laorr A, Saleh K J, Kuskowski M A, Bailey R F, Cheng E Y. Quantifying the extent of femoral head involvement in osteonecrosis.  J Bone Joint Surg Am. 2003;  85-A (2) 309-315
  • 61 Bassounas A E, Karantanas A H, Fotiadis D I, Malizos K N. Femoral head osteonecrosis: volumetric MRI assessment and outcome.  Eur J Radiol. 2007;  63 (1) 10-15
  • 62 Min B W, Song K S, Cho C H, Lee S M, Lee K J. Untreated asymptomatic hips in patients with osteonecrosis of the femoral head.  Clin Orthop Relat Res. 2008;  466 (5) 1087-1092
  • 63 Beltran J, Knight C T, Zuelzer W A et al.. Core decompression for avascular necrosis of the femoral head: correlation between long-term results and preoperative MR staging.  Radiology. 1990;  175 (2) 533-536
  • 64 Kopecky K K, Braunstein E M, Brandt K D et al.. Apparent avascular necrosis of the hip: appearance and spontaneous resolution of MR findings in renal allograft recipients.  Radiology. 1991;  179 (2) 523-527
  • 65 Zhao F C, Li Z R, Zhang N F et al.. Lesion size changes in osteonecrosis of the femoral head: a long-term prospective study using MRI.  Int Orthop. 2010;  34 (6) 799-804
  • 66 Takao M, Nishii T, Sakai T, Yoshikawa H, Sugano N. Repair in osteonecrosis of the femoral head: MR imaging features at long-term follow-up.  Clin Rheumatol. 2010;  29 (8) 841-848
  • 67 Fujisawa K, Hirata H, Inada H, Morita A, Takeda K, Hibasami H. Value of a dynamic MR scan in predicting vascular ingrowth from free vascularized scapular transplant used for treatment of avascular femoral head necrosis.  Microsurgery. 1995;  16 (10) 673-678
  • 68 May D A, Disler D G. Screening for avascular necrosis of the hip with rapid MRI: preliminary experience.  J Comput Assist Tomogr. 2000;  24 (2) 284-287
  • 69 Schmidt G P, Reiser M F, Baur-Melnyk A. Whole-body imaging of bone marrow.  Semin Musculoskelet Radiol. 2009;  13 (2) 120-133
  • 70 Beer M, Stenzel M, Girschick H, Schlegel P G, Darge K. Whole-body MR imaging in children with suspected osteonecrosis after intensive chemotherapy: preliminary results.  Rofo. 2008;  180 (3) 238-245
  • 71 Castro T C, Lederman H, Terreri M T, Kaste S C, Hilario M O. Detection of multifocal osteonecrosis in an adolescent with dermatomyositis using whole-body MRI.  Pediatr Radiol. 2010;  40 (9) 1566-1568
  • 72 Hadjigeorgiou G M, Karantanas A H, Zibis A et al.. Increased frequency of white matter lesions in patients with osteonecrosis (WMLeOn) of the femoral head.  Eur J Radiol. 2004;  50 (3) 278-284
  • 73 Hadjigeorgiou G M, Malizos K, Dardiotis E et al.. Paraoxonase 1 gene polymorphisms in patients with osteonecrosis of the femoral head with and without cerebral white matter lesions.  J Orthop Res. 2007;  25 (8) 1087-1093
  • 74 Barker D J, Hall A J. The epidemiology of Perthes' disease.  Clin Orthop Relat Res. 1986;  209 (209) 89-94
  • 75 Lamer S, Dorgeret S, Khairouni A et al.. Femoral head vascularisation in Legg-Calvé-Perthes disease: comparison of dynamic gadolinium-enhanced subtraction MRI with bone scintigraphy.  Pediatr Radiol. 2002;  32 (8) 580-585
  • 76 Merlini L, Combescure C, De Rosa V, Anooshiravani M, Hanquinet S. Diffusion-weighted imaging findings in Perthes disease with dynamic gadolinium-enhanced subtracted (DGS) MR correlation: a preliminary study.  Pediatr Radiol. 2010;  40 (3) 318-325
  • 77 Jaramillo D, Kasser J R, Villegas-Medina O L, Gaary E, Zurakowski D. Cartilaginous abnormalities and growth disturbances in Legg-Calvé-Perthes disease: evaluation with MR imaging.  Radiology. 1995;  197 (3) 767-773
  • 78 Jaramillo D, Galen T A, Winalski C S et al.. Legg-Calvé-Perthes disease: MR imaging evaluation during manual positioning of the hip—comparison with conventional arthrography.  Radiology. 1999;  212 (2) 519-525

Apostolos H KarantanasM.D. Ph.D. 

Department of Radiology, University Hospital

Stavrakia 711 10, Heraklion, Greece

Email: akarantanas@gmail.com

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