Pediatric Radiology

, Volume 38, Issue 11, pp 1195–1200 | Cite as

Importance of sagittal MR imaging in nontraumatic femoral head osteonecrosis in children

Original Article
First Online:
Received:
Revised:
Accepted:

Abstract

Background

In nontraumatic femoral head osteonecrosis, characterization of femoral head collapse is important in staging disease progression and planning treatment. Few prior studies have quantitatively compared the ability of sagittal and coronal MR images to detect femoral head collapse.

Objective

We hypothesized that sagittal MR images show a greater degree and angular span of femoral head collapse than coronal images.

Materials and methods

We reviewed 38 hip MRI scans of nontraumatic femoral head osteonecrosis from 34 pediatric patients. In both sagittal and coronal images, the maximal extent and angular location along with the angular span of the femoral head collapse were measured. Differences were evaluated using a paired t-test. The extent of bone and cartilage loss from the femoral head was evaluated.

Results

Sagittal MR images showed 29% maximal femoral head radius collapse, whereas coronal images showed 16% collapse (P<0.001). Sagittal images showed a larger angular span of collapse (115°) than coronal images (55°, P<0.001). Sagittal images showed greater epiphyseal bone loss in the anterior than in the posterior portion (P<0.001), whereas coronal images did not show a significant difference in bone loss between the medial and lateral portion (P=0.32).

Conclusion

Sagittal images show greater femoral head collapse than coronal images in nontraumatic femoral head osteonecrosis.

Keywords

Femoral Osteonecrosis Sagittal MRI Children 
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References

  1. 1.
    Steinberg ME, Hayken GD, Steinberg DR (1995) A quantitative system for staging avascular necrosis. J Bone Joint Surg Br 77:34–41PubMedGoogle Scholar
  2. 2.
    Arlet J, Ficat P (1968) Diagnosis of primary femur head osteonecrosis at stage 1 (preradiologic stage). Rev Chir Orthop Reparatrice Appar Mot 54:637–648PubMedGoogle Scholar
  3. 3.
    Mont MA, Jones LC, Hungerford DS (2006) Nontraumatic osteonecrosis of the femoral head: ten years later. J Bone Joint Surg Am 88:1117–1132PubMedCrossRefGoogle Scholar
  4. 4.
    Mont MA, Fairbank AC, Krackow KA et al (1996) Corrective osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg Am 78:1032–1038PubMedGoogle Scholar
  5. 5.
    Saini A, Saifuddin A (2004) MRI of osteonecrosis. Clin Radiol 59:1079–1093PubMedCrossRefGoogle Scholar
  6. 6.
    Waldenström H (1938) The first stages of coxa plana. J Bone Joint Surg Am 20:559–566Google Scholar
  7. 7.
    Jaramillo D, Galen TA, Winalski CS et al (1999) Legg-Calve-Perthes disease: MR imaging evaluation during manual positioning of the hip – comparison with conventional arthrography. Radiology 212:519–525PubMedGoogle Scholar
  8. 8.
    Zibis AH, Karantanas AH, Roidis NT et al (2007) The role of MR imaging in staging femoral head osteonecrosis. Eur J Radiol 63:3–9PubMedCrossRefGoogle Scholar
  9. 9.
    Cherian SF, Laorr A, Saleh KJ et al (2003) Quantifying the extent of femoral head involvement in osteonecrosis. J Bone Joint Surg Am 85A:309–315Google Scholar
  10. 10.
    Ha YC, Jung WH, Kim JR et al (2006) Prediction of collapse in femoral head osteonecrosis: a modified Kerboul method with use of magnetic resonance images. J Bone Joint Surg Am 88 [Suppl 3]:35–40PubMedCrossRefGoogle Scholar
  11. 11.
    Cho TJ, Lee SH, Choi IH et al (2002) Femoral head deformity in Catterall groups III and IV Legg-Calve-Perthes disease: magnetic resonance image analysis in coronal and sagittal planes. J Pediatr Orthop 22:601–606PubMedCrossRefGoogle Scholar
  12. 12.
    Yazici M, Aydingoz U, Aksoy MC et al (2002) Bipositional MR imaging vs. arthrography for the evaluation of femoral head sphericity and containment in Legg-Calve-Perthes disease. Clin Imaging 26:342–346PubMedCrossRefGoogle Scholar
  13. 13.
    Snow SW, Keret D, Scarangella S et al (1993) Anterior impingement of the femoral head: a late phenomenon of Legg-Calve-Perthes’ disease. J Pediatr Orthop 13:286–289PubMedGoogle Scholar
  14. 14.
    Herring JA, Kim HT, Browne R (2004) Legg-Calve-Perthes disease. Part I: classification of radiographs with use of the modified lateral pillar and Stulberg classifications. J Bone Joint Surg Am 86A:2103–2120Google Scholar
  15. 15.
    Bassounas AE, Karantanas AH, Fotiadis DI et al (2007) Femoral head osteonecrosis: volumetric MRI assessment and outcome. Eur J Radiol 63:10–15PubMedCrossRefGoogle Scholar
  16. 16.
    Atsumi T, Kajiwara T, Hiranuma Y et al (2006) Posterior rotational osteotomy for nontraumatic osteonecrosis with extensive collapsed lesions in young patients. J Bone Joint Surg Am 88 [Suppl 3]:42–47PubMedCrossRefGoogle Scholar
  17. 17.
    Rush BH, Bramson RT, Ogden JA (1988) Legg-Calve-Perthes disease: detection of cartilaginous and synovial change with MR imaging. Radiology 167:473–476PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Department of RadiologyHospital of the University of PennsylvaniaPhiladelphiaUSA
  2. 2.Department of Orthopedic SurgeryChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  3. 3.Department of RadiologyChildren’s Hospital of PhiladelphiaPhiladelphiaUSA

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