Bone marrow edema syndromes of the hip: MRI features in different hip disorders (original) (raw)
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Skeletal Radiology, 2008
Objective To correlate the amount of bone marrow edema (BME) calculated by magnetic resonance imaging(MRI) with clinical findings, histopathology, and radiographic findings, in patients with advanced hip osteoarthritis(OA). Materials and methods The study was approved by The Institutional Human Subject Protection Committee. Coronal MRI of hips was acquired in 19 patients who underwent hip replacement. A spin echo (SE) sequence with four echoes and separate fast spin echo (FSE) proton density (PD)-weighted SE sequences of fat (F) and water (W) were acquired with water and fat suppression, respectively. T2 and water:fat ratio calculations were made for the outlined regions of interest. The calculated MRI values were correlated with the clinical, radiographic, and histopathologic findings. Results Analyses of variance were done on the MRI data for W/(W + F) and for T2 values (total and focal values) for the symptomatic and contralateral hips. The values were significantly higher in the study group. Statistically significant correlations were found between pain and total W/(W + F), pain and focal T2 values, and the number of microfractures and calculated BME for the focal W/(W + F) in the proximal femora. Statistically significant correlations were found between the radiographic findings and MRI values for total W/(W + F), focal W/(W + F) and focal T2 and among the radiographic findings, pain, and hip movement. On histopathology, only a small amount of BME was seen in eight proximal femora. Conclusion The amount of BME in the OA hip, as measured by MRI, correlates with the severity of pain, radiographic findings, and number of microfractures.
Bone marrow edema of the femoral head and transient osteoporosis of the hip
European Journal of Radiology, 2008
The current article of this issue aims at defining the generic term of bone marrow edema of the femoral head as seen at MR imaging. It must be kept in mind that this syndrome should be regarded, not as a specific diagnosis, but rather as a sign of an ongoing abnormal process that involves the femoral head and/or the hip joint. We aim at emphasizing the role of the radiologists in making a specific diagnosis, starting from a non-specific finding on T1-weighted images and by focusing on ancillary findings on T2-weighted SE or fat-saturated proton-density weighted MR images.
MRI of the Hip: Current Concepts on Bone Marrow Oedema
Hip International, 2017
or reactive. The abnormal signal areas within bone marrow, show homogenous enhancement following I.V. contrast administration. However, the low specificity of BME as an imaging finding implicates that it can be related to numerous benign and malignant disorders in symptomatic and asymptomatic patients. Thus, a combination of history, clinical examination and imaging findings is required in order to reach an accurate diagnosis (3, 4). The aim of this paper is to review current literature data on MRI of adult hip BME and to discuss the diagnostic criteria used for the most common clinical entities that it is related to. Moreover, an attempt has been done to clarify longstanding controversies regarding the diagnosis of conditions presenting with BME, such as avascular necrosis of the femoral head (AVN) and transient osteoporosis (TOH). Acute bone marrow oedema syndromes (aBMEs) The term acute bone marrow oedema syndrome (aBMEs) includes 2 clinical entities: TOH and regional migratory osteoporosis (RMO). The 3 basic characteristics common to both entities are the history of acute onset pain in middle aged men and women during the 3 rd trimester of pregnancy, the fact that symptoms subsequently settle down only with conservative treatment and the presence of BME on hip MRI examinations. In the vast majority of cases, the combination of the above can narrow the differential diagnosis and point towards aBMEs (5-7). TOH is characterised by acute onset of symptoms and hip BME (Fig. 1). It can affect both the proximal femur and rarely the acetabulum and the gold standard for the diagnosis is MRI
Radiology, 1999
PURPOSE: To determine whether the marrow edema around focal osteonecrosis on magnetic resonance (MR) images is associated with clinical symptoms. MATERIALS AND METHODS: Thirty-three patients with 37 hips showing early stage osteonecrosis of the femoral head were followed up at 3-month intervals with clinical evaluation, conventional radiography, and serial MR imaging. RESULTS: Seven (50%) of 14 symptomatic hips showed marrow edema around focal osteonecrosis on initial MR images, whereas only one (4%) of 23 asymptomatic hips showed edema (P Ͻ .01). Six (86%) of seven hips that were moderately to severely painful were associated with surrounding marrow edema. All eight hips showing osteonecrosis with marrow edema at the initial MR examination had joint effusion and exhibited intense radionuclide uptake in the proximal femur, which corresponded to the extent of edema on MR images. In all eight hips, the marrow edema resolved on follow-up MR images, and the pain subsided with the resolution of edema. CONCLUSION: The results of this study suggest that the combination of marrow edema of the proximal femur and focal osteonecrosis of the femoral head are strongly associated with hip pain in early stage osteonecrosis, even prior to collapse. Pain improvement usually parallels the resolution of edema.
MR imaging findings in transient osteoporosis of the hip
European Journal of Radiology, 2004
The authors sought to describe the magnetic resonance (MR) imaging findings including perfusion imaging, in association with the course of acute bone marrow oedema syndrome (aBMEs), in a group of patients with acute hip pain and a final diagnosis of transient osteoporosis of the hip (TOH). Materials and methods: From 217 patients referred with a probable diagnosis of avascular necrosis (AVN) of the femoral head, we identified 42 patients who had clinical and radiographic findings not relevant to AVN. MR imaging examinations were performed on a 1.0T scanner. Perfusion imaging was performed in 20 patients. The bone marrow oedema (BME) was classified in four stages. In addition, the presence or absence of oedema in the subchondral area and the presence of other subchondral lesions were recorded. Acetabular bone marrow was also assessed for the presence of oedema. The quantitative measurements included: maximum size of the effusion, percentage of enhancement (PE) and time of peak enhancement of abnormal marrow compared to the first pass, on the perfusion images. Results: Osteopenia was present on plain radiographs in 87% of cases. The most common pattern of BME was extending to the femoral head and neck. Acetabulum was involved in 16.6%. In 22.6% the BME spared the subchondral region of the femoral head. There were two cases (4.7%) with subchondral changes. A joint effusion was noted in 33 of the 42 patients. On perfusion imaging, a delayed peak enhancement was noted in 20 patients between 40 and 65 s after the first pass of contrast. No patient had any evidence of femoral head collapse or change in sphericity on follow-up MRI. None of the patients developed avascular necrosis in a time frame of 18 months from the onset of the acute hip pain. Conclusion: The aBMEs MR imaging pattern varies and is most commonly appearing on X-rays as osteopenia. Absence of subcondral lesions, delayed peak enhancement of the abnormal marrow on perfusion images, and sparing of subchondral zone from marrow oedema are MR imaging findings highly correlated to TOH.
UTILITY OF MRI IN THE EARLY AND ACCURATE DIAGNOSIS OF AVASCULAR NECROSIS OF HIP JOINT
Introduction: Avascular necrosis (also referred to as osteonecrosis, bone infarction, aseptic necrosis, ischemic bone necrosis, and AVN) is a disease where there is cellular death (necrosis) of bone components due to interruption of the blood supply. The term "avascular necrosis" is used to refer to these changes when they occur in epiphyseal region or subchondral bone 1. In clinical practice, AVN is most commonly encountered in the femoral head. It has also been called "the coronary disease of the hip" by Chandler as the disease simulates the ischemic condition in the heart. 2 Aims: 1) To evaluate Avascular Necrosis of Femoral Head by Plain radiograph and correlate by Magnetic Resonance Imaging (MRI). 2) To assess the importance of MRI in radiographically negative cases and those with high level of clinical suspicion. 3) To assess the importance of MRI in determination of clinically occult contralateral disease. Materials and method: This prospective study was conducted in the Department of Radiodiagnosis at J.L.N. Hospital & Research Centre, Bhilai (C.G.). Sixty-one hips (40 patients) that underwent preliminary conventional radiography followed by MRI study of the hip were studied. Result: A total of 40 patients (61 hip joints) were evaluated by Plain Radiographs and MRI. Of the 61 hips, plain radiographs could identify avascular necrosis in 44 hips (72%) and could not detect it in 17 hips (28%). In our study of 40 patients with AVN of femoral head, 40% of the patients (n=16) were suffering from sickle cell disease; 22.5% of the patients (n=9) had history of trauma/fracture of neck of femur; 20% (n=8) were on steroids for various reasons which included asthma, connective tissue disorders, skin disorders, immunological disorders, ITP and IgA nephropathy; 10% (n=4) suffered from infectious and inflammatory conditions. The other causes in our study were idiopathic (n=2) and chronic alcoholic (n=1). Conclusion: The evaluation of an osteonecrosis lesion based only on plain radiographs could miss important information in stages II and III according to the Ficat and Arlet classification system. Magnetic Resonance Imaging (MRI) with its multi-planar capability and good tissue characterization property is very sensitive in early detection of radiographically negative as well as clinically unsuspected cases of avascular necrosis of femoral head.
Oman medical journal, 2011
Transient osteoporosis of the hip (TOH) is a rare condition mainly affecting pregnant women in their third trimester and middle aged men. We report a case of TOH/Bone marrow edema syndrome in pregnancy with involvement of the surrounding soft tissues on magnetic resonance image, which has not been previously reported. The presence of such edema in the soft tissues may help to differentiate this condition from early avascular necrosis of the hip, and may also provide an insight into the pathogenesis of the condition. The reported patient was treated conservatively and fully recovered.