Correlation between bone marrow edema and collapse of the femoral head in steroid-induced osteonecrosis
Correlation between bone marrow edema and collapse of the femoral head in steroid-induced osteonecrosis
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DOI：
10.2214/ajr.174.3.1740735
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发表时间：
2000-03-01
影响因子：
5
通讯作者：
Moriya, H
中科院分区：
文献类型：
--
作者：
Iida, S;Harada, Y;Moriya, H
OBJECTIVE.本研究的目的是为了阐明是否骨髓水肿是检测激素诱导的股骨头坏死的初始MR成像。本文对48个髋关节骨坏死患者进行了MRI和X线检查。在既往报道的骨坏死筛查中，当软骨下出现异常信号时，MRI诊断为骨坏死。在开始类固醇治疗后平均14周，在48个髋关节中检测到软骨下带。在随访的47个髋关节（不包括髋关节）的MR成像中，在髋关节疼痛发作后最初观察到13个髋关节骨髓水肿。其余34个髋关节的MR成像也未显示骨髓水肿，患者均无症状。34个髋关节中的31个髋关节的MR成像继续显示软骨下带，另外3个髋关节的MR成像显示软骨下带消失。当检测到骨髓水肿时，X线检查异常结果轻微，但13个髋关节中有11个（85%）进展为晚期骨坏死。骨髓水肿与随后的股骨头塌陷高度相关（p < 0.0001）。在骨坏死的初始MR成像中不存在骨髓水肿，骨髓水肿应被认为是潜在进展为晚期骨坏死的标志物，当观察到骨髓水肿时，有必要仔细检查骨坏死。
OBJECTIVE. The purpose of this study was to clarify whether bone marrow edema is detectable on initial MR imaging of steroid-induced osteonecrosis of the femoral head.SUBJECTS AND METHODS. Forty-eight hips with osteonecrosis were examined consecutively with MR imaging and radiography, In a previously reported screening program, osteonecrosis was diagnosed on MR imaging when subchondral bands of abnormal signals were present, In the screening program, the MR images of 200 hips of 100 patients receiving high-dose steroid therapy were examined prospectively. Subchondral bands were detected in 48 hips at a mean of 14 weeks after the initiation of steroid therapy.RESULTS. On follow-up MR imaging of 47 hips tone hip excluded) bone marrow edema was initially observed in 13 hips after the onset of hip pain. MR imaging of the remaining 34 hips did nor reveal bone marrow edema and the patients were all asymptomatic. MR imaging of 31 of the 34 hips continued to show subchondral bands and MR imaging of the other three hips indicated that the subchondral bands had disappeared. When bone marrow edema was detectable, abnormal findings on radiography were slight but 11 (85%) of the 13 hips progressed to advanced osteonecrosis. Bone marrow edema was highly correlated with the subsequent collapse of the femoral head (p < 0.0001).CONCLUSION. Bone marrow edema was not present on initial MR imaging of osteonecrosis, Bone marrow edema should be considered a marker for potential progression to advanced osteonecrosis, and careful examinations for osteonecrosis are necessary when bone marrow edema is seen.