Rheumatology International

, Volume 35, Issue 11, pp 1909–1912 | Cite as

MRI-detected bone marrow changes within 3 weeks after initiation of high-dose corticosteroid therapy: a possible change preceding the subsequent appearance of low-intensity band in femoral head osteonecrosis

  • Yusuke Kubo
  • Takuaki Yamamoto
  • Goro Motomura
  • Nobuaki Tsukamoto
  • Kazuyuki Karasuyama
  • Kazuhiko Sonoda
  • Hiroyuki Hatanaka
  • Takeshi Utsunomiya
  • Yukihide Iwamoto
Case Based Review - Food for Thought


Osteonecrosis of the femoral head is considered to occur early during the course of corticosteroid treatment. However, it remains unclear exactly how early it can develop after initiation of corticosteroid treatment. We report a case of osteonecrosis of the femoral head in which abnormal findings were observed on short-tau inversion recovery (STIR) sequence image performed 2 weeks and 4 days after initiation of high-dose corticosteroid therapy. A 45-year-old man with hemophagocytic syndrome was started on prednisolone, with a maximum dose of 40 mg/day. On day 13 after initiation of this corticosteroid therapy, he transiently experienced left hip pain with no apparent cause. STIR sequence image 5 days after the onset of pain revealed high-intensity bone marrow lesions at the femoral neck of both hips. At 3 months after initiation of corticosteroid therapy, T1-weighted magnetic resonance imaging revealed concave-shaped low-intensity bands, which corresponded to the preceding high-intensity lesions on both hips. Because of the subsequent progression to collapse of the left femoral head, he underwent prosthetic replacement surgery. The high-intensity lesions on STIR sequence image indicate the possibility that osteonecrosis can occur within 3 weeks after initiation of high-dose corticosteroid therapy.


Osteonecrosis of the femoral head Corticosteroid treatment Short-tau inversion recovery (STIR) sequence image Hemophagocytic syndrome 



This work was partially supported by a Research Grant for Intractable Diseases from Japan Agency for Medical Research and Development, AMED (H26-Itaku(Nan)-Ippan-031).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Informed consent

The patient was fully informed that his data would be submitted for publication, and he gave his consent.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Yusuke Kubo
    • 1
  • Takuaki Yamamoto
    • 1
  • Goro Motomura
    • 1
  • Nobuaki Tsukamoto
    • 2
  • Kazuyuki Karasuyama
    • 1
  • Kazuhiko Sonoda
    • 1
  • Hiroyuki Hatanaka
    • 1
  • Takeshi Utsunomiya
    • 1
  • Yukihide Iwamoto
    • 1
  1. 1.Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  2. 2.Department of Orthopaedic SurgerySaga Prefectural Medical Center KoseikanSaga CityJapan

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