Advertisement

European Radiology

, Volume 15, Issue 2, pp 368–375 | Cite as

Detection of dysbaric osteonecrosis in military divers using magnetic resonance imaging

  • H. BolteEmail author
  • A. Koch
  • K. Tetzlaff
  • E. Bettinghausen
  • M. Heller
  • M. Reuter
Musculoskeletal

Abstract

This was a controlled cross-sectional study to investigate the prevalence of dysbaric osteonecrosis (DON) in military divers. MRI examinations of the large joints and adjacent bones were performed in a cross-sectional group of 32 highly experienced military divers and 28 non-divers matched for age and anthropometric data. Additional plain radiographs and follow-up controls were performed in all persons with signs certain or suspicious of DON. In two subject groups (one of divers and one of non-divers), lesions characteristic of DON were detected. From this controlled study, it may be concluded that MRI is a highly sensitive method to detect signs of osteonecrosis. It could be shown that the prevalence of bone lesions characteristic of osteonecrosis in highly experienced military divers is not higher than in non-diving subjects of comparable age. The outcome of this comparably small study group fits to the results of previous extensive studies performed with radiographs. The detected low incidence of DON in this collective may be due to the fact that military divers follow stricter selection criteria, decompression schemes and medical surveillance than commercial divers.

Keywords

Dybaric osteonecrosis Decompression sickness Caisson disease Diving Magnetic resonance imaging 

References

  1. 1.
    Resnick D (1995) Osteonecrosis. In: Diagnosis of bone and joint disorders, 3rd edn. Saunders, LondonGoogle Scholar
  2. 2.
    Lam TH, Yau KP (1992) Dysbaric osteonecrosis in a compressed air tunneling project in Hong Kong. Occup Med 42:23–29Google Scholar
  3. 3.
    Lehner CE, Adams WM, Dubielzig RR, Palta M, Lanphier EH (1997) Dysbaric osteonecrosis in divers and caisson workers. Clin Orthop 344:320–332CrossRefPubMedGoogle Scholar
  4. 4.
    Brody AS, Strong M, Babikian G, Sweet DE, Seidel FG, Kuhn JP (1991) Avascular necrosis: early MR imaging and histologic findings in a canine model. Am J Roentgenol 157:341–345Google Scholar
  5. 5.
    Reuter M, Tetzlaff K, Steffens JC, Gluer CC, Faeseke KP, Bettinghausen E, Heller M (1999) Functional and high resolution computed tomographic studies of diver’s lungs. Scand J Work Environ Health 25:66–74Google Scholar
  6. 6.
    Cordes P, Keil R, Bartsch T, Tetzlaff K, Reuter M, Hutzelmann A, Friege L, Meyer T, Bettinghausen E, Deuschl G (2002) Neurologic outcome of controlled compressed-air diving. Neurology 55:1743–1745Google Scholar
  7. 7.
    Bartsch T, Cordes, Keil R, Reuter M, Hutzelmann A, Tetzlaff K, Deuschl G (2001) Cervico-thoracic disc protrusions in controlled compressed-air diving: clinical and MRI findings. J Neurol 248:514–516Google Scholar
  8. 8.
    Report from the decompression sickness central registry and radiological panel (1981) Aseptic bone necrosis in commercial divers. Lancet 384–388Google Scholar
  9. 9.
    Stoller DW (1997) Magnetic resonance imaging in orthopaedics and sports medicine, 2nd edn. Lippincot-Raven, PhiladelphiaGoogle Scholar
  10. 10.
    Totty WG, Murphy WA, Ganz WI, Kumar B, Daum WJ, Siegel BA (1984) Magnetic resonance imaging of the normal and ischemic femoral head. Am J Roentgenol 143:1273–1280Google Scholar
  11. 11.
    Shinoda S, Hasegawa Y, Kawasaki S, Tagawa N, Iwata H (1997) Magnetic resonance imaging of osteonecrosis in divers: comparison with plain radiographs. Skeletal Radiol 26:354–359Google Scholar
  12. 12.
    Williams ES, Khreisat S, Ell PJ, King JD (1987) Bone imaging and skeletal radiology in dysbaric osteonecrosis. Clin Radiol 38:589–592Google Scholar
  13. 13.
    Macleod MA, McEwan AJ, Pearson RR, Houston AS (1982) Functional imaging in the early diagnosis of dysbaric osteonecrosis. Br J Radiol 55:497–500Google Scholar
  14. 14.
    Heyer D, Schontag H, Maas R, Beese M (1994) Dysbaric osteonecrosis in professional divers: MRT as a screening method? Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 161:335–340PubMedGoogle Scholar
  15. 15.
    Harrison JAB (1971) Aseptic bone necrosis in naval divers: radiographic findings. Proc R Soc Med 64:24–26Google Scholar
  16. 16.
    Hunter WL Jr, Biersner RJ, Sphar, Harvey CA (1979) Aseptic bone necrosis in US navy divers: prevalence and associated factors. Med Aero Spat Med Subaq Hyp 64:402–404Google Scholar
  17. 17.
    Ohta Y, Matsunaga H (1974) Bone lesions in divers. J Bone Joint Surg 56:3–16Google Scholar
  18. 18.
    Xue HL (1988) Dysbaric osteonecrosis and its radiographic classification in China. Undersea Biomed Res 15:389–395PubMedGoogle Scholar
  19. 19.
    Davidson JK, Harrison JA, Jacobs P, Hilditch TE, Catto M, Hendry WT (1977) The significance of bone islands, cystic areas and sclerotic areas in dysbaric osteonecrosis. Clin Radiol 28:381–393PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • H. Bolte
    • 1
    Email author
  • A. Koch
    • 2
  • K. Tetzlaff
    • 2
  • E. Bettinghausen
    • 2
  • M. Heller
    • 1
  • M. Reuter
    • 1
  1. 1.Klinik fuer Diagnostische RadiologieUniversitaetsklinikum Schleswig-Holstein Campus KielKielGermany
  2. 2.German Naval Medical InstituteKielGermany

Personalised recommendations