Skip to main content

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

  • 1663 Accesses

Abstract

Bone ischemia is a relatively common condition, which may be idiopathic or secondary to a variety of clinical situations. Medullary infarction refers to dia-metaphyseal location whereas osteonecrosis to the epiphyseal and sub-articular involvement. In both situations, the lesions may be radiographically occult. Magnetic resonance imaging (MRI) is very sensitive in identifying and characterizing bone ischemia. Newer treatments on femoral head osteonecrosis require early diagnosis, accurate staging, and estimation of prognosis and assessment of treatment. This chapter reviews the current and evolving knowledge on the various faces of bone ischemia with emphasis on the role of MRI on the clinically most important forms of the disease.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Ahlbäck S, Bauer GC, Bohne WH (1968) Spontaneous osteonecrosis of the knee. Arthr Rheum 11:705–733

    Article  Google Scholar 

  • Arce K, Assael LA, Weissman JL, Markiewitcz MR (2009) Imaging findings in bisphosphonate-related osteonecrosis of jaws. J Oral Maxillofac Surg 67(1):75–84

    Article  PubMed  Google Scholar 

  • Assouline-Dayan Y, Chang C, Greenspan A et al (2002) Pathogenesis and natural history of osteonecrosis. Semin Arthr Rheum 32:94–124

    Google Scholar 

  • Barker DJ, Hall AJ (1986) The epidemiology of Perthes’ disease. Clin Orthop Relat Res 209:89–94

    PubMed  Google Scholar 

  • Bassounas AE, Karantanas AH, Fotiadis DI, Malizos KN (2007) Femoral head osteonecrosis: volumetric MRI assessment and outcome. Eur J Radiol 63:10–15

    Article  PubMed  Google Scholar 

  • Baur A, Stäbler A, Arbogast S, Duerr HR, Bartl R, Reiser M (2002) Acute osteoporotic and neoplastic vertebral compression fractures: fluid sign at MR imaging. Radiology 225:730–735

    Article  PubMed  Google Scholar 

  • Beltran J, Burk JM, Herman LJ et al (1987) Avascular necrosis of the femoral head: early MRI detection and radiological correlation. Magn Reson Imaging 5:431–442

    Article  PubMed  CAS  Google Scholar 

  • Beltran J, Herman LJ, Burk JM et al (1988) Femoral head avascular necrosis: MR imaging with clinical-pathologic and radionuclide correlation. Radiology 166:215–220

    PubMed  CAS  Google Scholar 

  • Bianchi SD, Scoletta M, Cassione FB et al (2007) Computerized tomographic findings in bisphosphonate-associated osteonecrosis of the jaw in patients with cancer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 104:249–258

    Article  PubMed  Google Scholar 

  • Chiandussi S, Biasotto M, Dore F et al (2006) Clinical and diagnostic imaging of bisphosphonate-associated osteonecrosis of the jaws. Dentomaxillofac Radiol 35:236–243

    Article  PubMed  CAS  Google Scholar 

  • Coleman B, Kressel H, Dalinka M et al (1988) Radiographically negative avascular necrosis: detection with MR imaging. Radiology 168:525–528

    PubMed  CAS  Google Scholar 

  • Cooney WP, Dobyns JH, Linscheid RL (1980) Fractures of the scaphoid: a rational approach to management. Clin Orthop 149:90–97

    PubMed  Google Scholar 

  • Dailiana ZH, Zachos V, Varitimidis S et al (2004) Scaphoid nonunions treated with vascularised bone grafts: MRI assessment. Eur Radiol 50:217–224

    Article  CAS  Google Scholar 

  • Dillman JR, Hernandez RJ (2009) MRI of Legg-Calve-Perthes disease. AJR Am J Roentgenol 193:1394–1407

    Article  PubMed  Google Scholar 

  • Duda SH, Laniado M, Schick F, Claussen CD (1993) The double-line sign of osteonecrosis: evaluation on chemical shift MR images. Eur J Radiol 16:233–238

    Article  PubMed  CAS  Google Scholar 

  • Fordyce M, Solomon L (1993) Early detection of avascular necrosis of the femoral head by MRI. J Bone Jt Surg Br 75:365–367

    CAS  Google Scholar 

  • Fujioka M, Kubo T, Nakamura F et al (2001) 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 19:985–991

    Article  PubMed  CAS  Google Scholar 

  • Gardeniers JWM (1993) ARCO Committee on terminology and staging. Report on the committee meeting at Santiago de Compostella. ARCO Newsletter 5:79–82

    Google Scholar 

  • Genez BM, Wilson MR, Houk RW et al (1988) Early osteonecrosis of the femoral head: detection in high-risk patients with MR imaging. Radiology 168:521–524

    PubMed  CAS  Google Scholar 

  • Hawkins LG (1970) Fractures of the neck of the talus. J Bone Jt Surg 52A:991–1002

    Google Scholar 

  • Hadjigeorgiou GM, Karantanas AH, Zibis A et al (2004) Increased frequency of white matter lesions in patients with osteonecrosis (WMLeOn) of the femoral head. Eur J Radiol 50:278–284

    Article  PubMed  Google Scholar 

  • Hermann G, Singson R, Bromley M et al (2004) Cystic degeneration of medullary bone infarction evaluated with magnetic resonance imaging correlated with pathologic examination. Can Assoc Radiol J 55:321–325

    PubMed  Google Scholar 

  • Huang GS, Chan WP, Chang YC et al (2003) MR imaging of bone marrow edema and joint effusion in patients with osteonecrosis of the femoral head: relationship to pain. AJR Am J Roentgenol 181:545–549

    PubMed  Google Scholar 

  • Iida S, Harada Y, Shimizu K, Sakamoto M, Ikenoue S, Akita T, Kitahara H, Moriya H (2000) Correlation between bone marrow edema and collapse of the femoral head in steroid-induced osteonecrosis. AJR Am J Roentgenol 174:735–743

    PubMed  CAS  Google Scholar 

  • Ito H, Matsuno T, Minami A (2006) Relationship between bone marrow edema and development of symptoms in patients with osteonecrosis of the femoral head. AJR Am J Roentgenol 186:1761–1770

    Article  Google Scholar 

  • Karantanas AH (2007) Acute bone marrow edema of the hip: role of MR imaging. Eur Radiol 17:2225–2236

    Article  PubMed  Google Scholar 

  • Karantanas A, Dailiana Z, Malizos K (2007) The role of MR imaging in scaphoid disorders. Eur Radiol 17:2860–2871

    Article  PubMed  Google Scholar 

  • Karantanas AH, Drakonaki E, Karachalios T, Korompilias AV, Malizos K (2008) Acute non-traumatic marrow edema syndrome in the knee: MRI findings at presentation, correlation with spinal DEXA and outcome. Eur J Radiol 67:22–33

    Article  PubMed  Google Scholar 

  • Karantanas AH, Drakonaki EE (2011) The role of MR imaging in avascular necrosis of the femoral head. Semin Musculoskelet Radiol 15:281–300

    Article  PubMed  Google Scholar 

  • Kattapuram TM, Kattapuram SV (2008) Spontaneous osteonecrosis of the knee. Eur J Radiol 67:42–48

    Article  PubMed  Google Scholar 

  • Kim YM, Ahn JH, Kang HS, Kim HJ (1998) Estimation of the extent of osteonecrosis of the femoral head using MRI. J Bone Jt Surg Br 80B:954–958

    Article  Google Scholar 

  • Kim YM, Oh HC, Kim HJ (2000) The pattern of bone marrow oedema on MRI in osteonecrosis of the femoral head. J Bone Jt Surg Br 82:837–841

    Article  CAS  Google Scholar 

  • Koo K-H, Kim R (1995) Quantifying the extent of osteonecrosis of the femoral head. A new method using MRI. J Bone Jt Surg Br 77B:875–880

    Google Scholar 

  • Koo KH, Ahn IO, Kim R et al (1999) Bone marrow edema and associated pain in early stage osteonecrosis of the femoral head: prospective study with serial MR images. Radiology 213:715–722

    PubMed  CAS  Google Scholar 

  • Kopecky KK, Braunstein EM, Brandt KD et al (1991) Apparent avascular necrosis of the hip: appearance and spontaneous resolution of MR findings in renal allograft recipients. Radiology 179:523–527

    PubMed  CAS  Google Scholar 

  • Koren A, Garty I, Katzuni E (1984) Bone infarction in children with sickle cell disease: early diagnosis and differentiation from osteomyelitis. Eur J Pediatr 142:93–97

    Article  PubMed  CAS  Google Scholar 

  • Kubo T, Yamazoe S, Sugano N et al (1997) Initial MRI findings of non-traumatic osteonecrosis of the femoral head in renal allograft recipients. Magn Reson Imaging 15:1017–1023

    Article  PubMed  CAS  Google Scholar 

  • Lamer S, Dorgeret S, Khairouni A et al (2002) Femoral head vascularisation in Legg-Calvé-Perthes disease: comparison of dynamic gadolinium-enhanced subtraction MRI with bone scintigraphy. Pediatr Radiol 32:580–585

    Article  PubMed  Google Scholar 

  • Libicher M, Appelt A, Berger I et al (2007) The intravertebral vacuum phenomen as specific sign of osteonecrosis in vertebral compression fractures: results from a radiological and histological study. Eur Radiol 17:2248–2252

    Article  PubMed  Google Scholar 

  • Malizos KN, Siafakas MS, Fotiadis DI, Karachalios TS, Soucacos PN (2001) An MRI-based semiautomated volumetric quantification of hip osteonecrosis. Skeletal Radiol 30:686–693

    Article  PubMed  CAS  Google Scholar 

  • Malizos KN, Zibis AH, Dailiana Z, Hantes M, Karachalios T, Karantanas AH (2004) MR imaging findings in transient osteoporosis of the hip. Eur J Radiol 50:238–244

    Article  PubMed  Google Scholar 

  • Malizos KN, Karantanas AH, Varitimidis SE et al (2007a) Osteonecrosis of the femoral head: etiology, imaging and treatment. Eur J Radiol 63:16–28

    Article  PubMed  Google Scholar 

  • Malizos KN, Zachos V, Dailiana ZH, Zalavras C, Varitimidis S, Hantes M, Karantanas A (2007b) Scaphoid nonunions: management with vascularized bone grafts from the distal radius: a clinical and functional outcome study. Plast Reconstr Surg 119:1513–1525

    Article  PubMed  CAS  Google Scholar 

  • Matsuno T, Kaneda K, Takeda N (1996) Development of angiosarcoma at the site of a bone infarct. Clin Orthop Relat Res 327:259–263

    Article  PubMed  Google Scholar 

  • McKiernan F, Faciszewski T (2003) Intravertebral clefts in osteoporotic vertebral compression fractures. Arthr Rheum 48:14149

    Article  Google Scholar 

  • Merlini L, Combescure C, De Rosa V, Anooshiravani M, Hanquinet S (2010) Diffusion-weighted imaging findings in Perthes disease with dynamic gadolinium-enhanced subtracted (DGS) MR correlation: a preliminary study. Pediatr Radiol 40:318–325

    Article  PubMed  Google Scholar 

  • Min BW, Song KS, Cho CH, Lee SM, Lee KJ (2008) Untreated asymptomatic hips in patients with osteonecrosis of the femoral head. Clin Orthop Relat Res 466:1087–1092

    Article  PubMed  Google Scholar 

  • Mirra MJ, Gold RH, Marafiote R (1977) Malignant (fibrous) histiocytoma arising in association with a bone infarct in sickle cell disease: coincidence or cause-and -effect? Cancer 39:186–194

    Article  PubMed  CAS  Google Scholar 

  • Mitchell DG, Rao VM, Dalinka MK et al (1987) Femoral head avascular necrosis: correlation of MR imaging, radiographic staging, radionuclide imaging, and clinical findings. Radiology 162:709–715

    PubMed  CAS  Google Scholar 

  • Mont MA, Hungerford DS (1995) Non-traumatic avascular necrosis of the femoral head. J Bone Jt Surg Am 77:459–474

    CAS  Google Scholar 

  • Morag Y, Morag-Hezroni M, Jamadar DA et al (2009) Bisphospnonate-related osteonecrosis of the jaw: a pictorial review. Radiographics 29:1971–1986

    Article  PubMed  Google Scholar 

  • Norman A, Steiner GC (1983) Radiographic and morphological features of cyst formation in idiopathic bone infarction. Radiology 146:335–338

    PubMed  CAS  Google Scholar 

  • Ohzono K, Saito M, Sugano N et al (1992) The fate of nontraumatic avascular necrosis of the femoral head: a radiologic classification to formulate prognosis. Clin Orthop Relat Res 277:73–78

    PubMed  Google Scholar 

  • Pape D, Seil R, Anagnostakos K, Kohn D (2007) Postarthroscopic osteonecrosis of the knee. Arthroscopy 23:428–438

    Article  PubMed  Google Scholar 

  • Pearce DH, Mongiardi CN, Fornasier VL, Daniels TR (2005) Avascular necrosis of the talus: a pictorial essay. Radiographics 25:399–410

    Article  PubMed  Google Scholar 

  • Radke S, Kirschner S, Seipel V, Rader C, Eulert J (2004) Magnetic resonance imaging criteria of successful core decompression in avascular necrosis of the hip. Skeletal Radiol 33:519–523

    Article  PubMed  CAS  Google Scholar 

  • Rao VM, Fishman M, Mitchell DG et al (1986) Painful sickle cell crisis: bone marrow patterns observed with MR imaging. Radiology 161:211–215

    PubMed  CAS  Google Scholar 

  • Sagar P, Shailam R, Nimkin K (2010) Avascular necrosis of the metacarpal head: a report of two cases and review of literature. Pediatr Radiol 40:1895–1901

    Article  PubMed  Google Scholar 

  • Saini A, Saifuddin A (2004) MRI of osteonecrosis. Clin Radiol 59:1079–1093

    Article  PubMed  CAS  Google Scholar 

  • Saito S, Ohzono K, Ono K (1988) Minimal osteonecrosis as a segmental infarct within the femoral head. Clin Orthop Relat Res 231:35–50

    PubMed  Google Scholar 

  • Schmidt GP, Reiser MF, Baur-Melnyk A (2009) Whole-body imaging of bone marrow. Semin Musculoskelet Radiol 13:120–133

    Article  PubMed  Google Scholar 

  • Schmitt R, Heinze A, Fellner F et al (1997) Imaging and staging of avascular osteonecroses at the wrist and hand. Eur J Radiol 25:92–103

    Article  PubMed  CAS  Google Scholar 

  • Schmitt R, Christopoulos G, Wagner M et al (2011a) Avascular necrosis (AVN) of the proximal fragment in scaphoid nonunion: Is intravenous contrast agent necessary in MRI? Eur J Radiol 77:222–227

    Article  PubMed  CAS  Google Scholar 

  • Schmitt R, Frohner S, van Schoonhovenb J et al (2011b) Idiopathic osteonecrosis of the scaphoid (Preiser’s disease)—MRI gives new insights into etiology and pathology. Eur J Radiol 77:228–234

    Article  PubMed  CAS  Google Scholar 

  • States LJ (2001) Imaging of metabolic bone disease and marrow disorders in children. Radiol Clin North Am 39:749–772

    Article  PubMed  CAS  Google Scholar 

  • Steinberg ME, Brighton CT, Hayken GD, Tooze SE, Steinberg DR (1984) Early results in the treatment of avascular necrosis of the femoral head with electrical stimulation. Orthop Clin North Am 15:163–175

    PubMed  CAS  Google Scholar 

  • Steinberg ME, Bands RE, Parry S, Hoffman E, Chan T, Hartman KM (1999) Does lesion size affect the outcome in avascular necrosis? Clin Orthop Relat Res 367:262–271

    Article  PubMed  Google Scholar 

  • Steinberg ME, Steinberg DR (2004) Classification systems for osteonecrosis: an overview. Orthop Clin North Am 35:273–283 vii–viii

    Article  PubMed  Google Scholar 

  • Steinberg ME, Hayken GD, Steinberg DR (1995) A quantitative system for staging avascular necrosis. J Bone Jt Surg Am 77B:34–41

    Google Scholar 

  • Steiner RM, Mitchell DG, Rao VM et al (1990) Magnetic resonance imaging of bone marrow: diagnostic value in diffuse hematologic disorders. Magn Reson Q 6:17–34

    PubMed  CAS  Google Scholar 

  • Stevens K, Tao C, Lee SU et al (2003) Subchondral fractures in osteonecrosis of the femoral head: comparison of radiography, CT, and MR imaging. AJR Am J Roentgenol 180:363–368

    PubMed  Google Scholar 

  • Sugimoto H, Okubo RS, Ohsawa T (1992) Chemical shift and the double-line sign in MRI of early femoral avascular necrosis. J Comput Assist Tomogr 16:727–730

    Article  PubMed  CAS  Google Scholar 

  • Theodorou DJ, Theodorou SJ, Haghighi P, Resnick D (2002) Distinct focal lesions of the femoral head: imaging features suggesting an atypical and minimal form of bone necrosis. Skeletal Radiol 31:435–444

    Article  PubMed  Google Scholar 

  • Torres FX, Kyriakos M (1992) Bone infarct-associated osteosarcoma. Cancer 70:2418–2430

    Article  PubMed  CAS  Google Scholar 

  • Tosun B, Al F, Tosun A (2011) Spontaneous osteonecrosis of the tarsal navicular in an adult: Mueller-Weiss syndrome. J Foot Ankle Surg 50:221–224

    Article  PubMed  Google Scholar 

  • Turner DA, Templeton AC, Selzer PM, Rosenberg AG, Petasnick JP (1989) Femoral capital osteonecrosis: MR finding of diffuse marrow abnormalities without focal lesions. Radiology 171:135–140

    PubMed  CAS  Google Scholar 

  • Umans H, Haramati N, Flusser G (2000) The diagnostic role of gadolinium enhanced MRI in distinguishing between acute medullary bone infarct and osteomyelitis. Magn Reson Imaging 18:255–262

    Article  PubMed  CAS  Google Scholar 

  • Yamamoto T, Bullough PG (2000) Spontaneous osteonecrosis of the knee: the result of subchondral insufficiency fracture. J Bone Jt Surg Am 82:858–866

    Article  CAS  Google Scholar 

  • Zhao FC, Li ZR, Zhang NF et al (2010) Lesion size changes in osteonecrosis of the femoral head: a long-term prospective study using MRI. Int Orthop 34:799–804

    Article  PubMed  Google Scholar 

  • Zibis AH, Karantanas AH, Roidis NT et al (2007) The role of MR imaging in staging femoral head osteonecrosis. Eur J Radiol 63:3–9

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Apostolos Karantanas .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Fotiadou, A., Karantanas, A. (2013). Osteonecrosis and Bone Infarction. In: Baur-Melnyk, A. (eds) Magnetic Resonance Imaging of the Bone Marrow. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2011_496

Download citation

  • DOI: https://doi.org/10.1007/174_2011_496

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-17859-7

  • Online ISBN: 978-3-642-17860-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics