Magnetic Resonance Imagery Of Hip Avascular Necrosis

在HIV感染的背景下，髋部的缺血性坏死(AVN)偶尔会被报道。1999年5月我们在两名患者中诊断出AVN后，我们开始担心HIV感染的患者发生AVN的风险可能比以前认识到的更高。为了验证这一点，我们对无症状的HIV感染患者进行了一项基于磁共振成像(MRI)的研究，以确定髋部动静脉肾炎在临床人群中的患病率。339例患者中有15例(4.4%)有动静脉络膜结节的MRI证据，其中6例为双侧受累，9例为单侧受累。在118名HIV阴性的志愿者中，没有一人有AVN的MRI证据。前瞻性的体检没有区分患有动静脉炎的HIV感染患者和没有的患者。有骨坏死的患者比没有骨坏死的患者更有可能使用皮质类固醇、降脂剂和睾酮，并且更有可能通过健身来进行常规锻炼。因此，HIV-1感染应该被包括在容易发生骨坏死的医疗条件中。这一队列的长期随访正在进行中，以确定有症状和无症状病变的自然病史，以及新病变的发生率。

Avascular necrosis (AVN) of the hip has occasionally been reported in the setting of HIV infection. After we diagnosed AVN in two patients in May 1999, we became concerned that HIV-infected patients may be at higher risk for developing AVN than previously recognized. To examine this, we undertook a magnetic resonance imaging (MRI)-based study of asymptomatic HIV-infected patients to determine the prevalence of hip AVN in our clinic population. 15 of 339 (4.4 percent) patients had evidence of AVN by MRI: six had bilateral and nine had unilateral involvement. None of 118 HIV-negative volunteers had MRI evidence of AVN. Prospectively performed physical examinations did not distinguish HIV-infected patients with AVN from those without. Patients with osteonecrosis were more likely than patients without osteonecrosis to have used corticosteroids, lipid-lowering agents, and testosterone, and were more likely to routinely exercise by bodybuilding. Thus, HIV-1 infection should be included among medical conditions that predispose to the development of osteonecrosis. Long-term followup of this cohort is underway to determine the natural history of symptomatic and asymptomatic lesions, and the incidence of new lesions.