Skeletal Radiology

, Volume 8, Issue 4, pp 251–258 | Cite as

CT analysis of the upper end of the femur: The asterisk sign and ischaemic bone necrosis of the femoral head

  • W. Dihlmann


In computed tomography (CT) of the head of the femur, a star-shaped structure can be seen which we refer to as theasterisk orasterisk sign. The asterisk is formed by thickened weight-bearing bone trabeculae. It can be shown by CT that the asterisk exhibits a characteristic change in ischaemic bone necrosis of the femoral head, even when the disease is in an early stage. CT of the hip joint is therefore an important examination for early diagnosis of ischaemic disease of the femoral head.

Key words

Asterisk sign Ischaemic necrosis of the femoral head Early diagnosis by computed tomography 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Arlet J, Ficat P (1968) Diagnostic de l'ostéo-nécrose fémorocapitale primitive au state I. (Stade préradiologique). Rev Chir Orthop 54:637PubMedGoogle Scholar
  2. 2.
    Axhausen G, Bergmann E (1937) Die Ernährungsunterbrechungen and Knochen. In: Lubarsch O, Henke F, Rössle RS (eds) Handbuch der speziellen pathologischen Anatomie und Histologie, IX/3. Springer, Berlin, p 118Google Scholar
  3. 3.
    Bessler W (1969) Röntgenologische, autoradiographische und szintigraphische Befunde bei Femurkopfnekrose. ROEFO 110:214Google Scholar
  4. 4.
    Bessler W (1971) Roentgenographic and scintigraphic findings in idiopathic aseptic necrosis of the femoral head. In: Zinn WM (ed) Idiopathic ischemic necrosis of the femoral head in adults. Thieme, StuttgartGoogle Scholar
  5. 5.
    Bobechko WP, Harris WR (1960) The radiographic density of avascular bone. J Bone Joint Surg [Br] 42:626Google Scholar
  6. 6.
    Boettcher WG, Bonfiglio M, Hamilton HH, Sheets RF, Smith K (1970) Non-traumatic necrosis of the femoral head. Part I. Relation of altered hemostasis to etiology. J Bone Joint Surg [Am] 52:312Google Scholar
  7. 7.
    Bouteiller G, Dehais-Goffinet F, Ton That D, Durand D, Suc JM, Arlet J (1980) Bone histopathological contribution to the pathogenesis of the osteonecrosis in renal transplant patients. Rev Rhum Mal Osteoartic 48:38Google Scholar
  8. 8.
    Brailsford JF (1950) Sclerosing conditions of bone. Br J Radiol 23:83PubMedGoogle Scholar
  9. 9.
    Davidson JK (1975) Radiology of aseptic necrosis of bone. J Belge Radiol 58:189PubMedGoogle Scholar
  10. 10.
    Dihlmann W (1982) Gelenke — Wirbelverbindungen, 2. Aufl. Thieme, StuttgartGoogle Scholar
  11. 11.
    Edeiken J, Hodes PJ, Libshitz HI (1967) Bone ischemia. Radiol Clin North Am 5:515Google Scholar
  12. 12.
    Gerhardt P, Van Kaick G, Puhl W, Prawitz R, Jaschke W (1979) Die Computertomographie des Hüftgelenkes. Roentgenpraxis 32:42Google Scholar
  13. 13.
    Hungerford DS (1975) Early diagnosis of ischemic nerosis of the femoral head. Johns Hopkins Med J 137:270PubMedGoogle Scholar
  14. 14.
    Klotz O (1905) Studies upon calcareous degeneration. I. The process of pathological calcification. J Exp Med 7:633CrossRefGoogle Scholar
  15. 15.
    Kölbel R, Bergmann G, Böhm E (1975) Mikroradiographie und “Makroradiographie” mit einem einfachen Röntgendurchleuchtungsgerät. Z Orthop 113:886PubMedGoogle Scholar
  16. 16.
    Lee CK, Hansen HT, Weiss AB (1980) The “silent hip” of idiopathic ischemic necrosis of the femoral head in adults. J Bone Joint Surg [Am] 62:795Google Scholar
  17. 17.
    Lequesne M, Bensasson M (1970) Ätiologie der nichttraumatischen Nekrose des Femurkopfes. Dtsch Med Wochenschr 95:698PubMedGoogle Scholar
  18. 18.
    Marcus ND, Enneking WF, Massam RA (1973) The silent hip in idiopathic aseptic necrosis. Treatment by bone-grafting. J Bone Joint Surg [Am] 55:1351Google Scholar
  19. 19.
    Martel W, Sitterley BH (1969) Roentgenologic manifestations of osteonecrosis. AJR 106:509Google Scholar
  20. 20.
    Merle d'Aubigné R, Postel M, Mazabraud A, Massias P, Gueguen J (1965) Idiopathic necrosis of the femoral head in adults. J Bone Joint Surg [Br] 47:612Google Scholar
  21. 21.
    Nebel G (1982) Die Wertigkeit der Computertomographie bei der Diagnose der avaskulären Hüftkopfnekrose des Erwachsenen. Aktuel Rheumatol 7:5Google Scholar
  22. 22.
    Phemister DB (1915) Necrotic bone and the subsequent changes which it undergoes. JAMA 64:211Google Scholar
  23. 23.
    Phemister DB (1930) Repair of bone in the presence of aseptic necrosis resulting from fractures, transplantations, and vascular obstruction. J Bone Joint Surg 12:769Google Scholar
  24. 24.
    Phemister DB (1940) Changes in bones and joints resulting from interruption of circulation. I. General considerations and changes resulting from injuries. Arch Surg 41:436Google Scholar
  25. 25.
    Rutishauser E, Rohner A, Held D (1960) Experimentelle Untersuchungen über die Wirkung der Ischämie auf den Knochen und das Mark. Virchows Arch [Pathol Anat] 333:101CrossRefGoogle Scholar
  26. 26.
    Serre H, Simon L (1961) L'ostéonécrose primitive de la tête fémorale chez l'adulte. Acta Rheumatol Scand 7:265PubMedGoogle Scholar
  27. 27.
    Sherman MS, Selakovich WG (1957) Bone changes in chronic circulatory insufficiency. A histopathological study. J Bone Joint Surg [Am] 39:892Google Scholar
  28. 28.
    Singh M, Magrath AR, Maini PS (1970) Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg [Am] 52:457Google Scholar
  29. 29.
    Springfield DS, Enneking EF (1976) Idiopathic aseptic necrosis. In: Ackerman LV, Spjut HJ (eds) Bones and joints. International Academy of Pathology Monograph No. 17, Williams and Wilkins, Baltimore, p 61Google Scholar
  30. 30.
    Storey GO (1968) Bone necrosis in joint disease. Proc R Soc Med 61:961PubMedGoogle Scholar
  31. 31.
    Todd RC, Freeman MAP, Pirie CJ (1972) Isolated trabecular fatigue fractures in the femoral head. J Bone Joint Surg [Br] 54:723Google Scholar
  32. 32.
    Trueta J, Harrison MHM (1953) The normal vascular anatomy of the femoral head in adult man. J Bone Joint Surg [Br] 35:442Google Scholar
  33. 33.
    Watson Jones R, Roberts RE (1933) Calcification, decalcification, and ossification. Br J Surg 21:461Google Scholar
  34. 34.
    Weber MM, Wagner J, Cragin MD (1977) Radionuclide pattern of femoral head disease. Int J Nucl Med Biol 4:167CrossRefPubMedGoogle Scholar
  35. 35.
    Wright P, Symmers WStC (1966) Systemic pathology II. Longmans Green and Co, LondonGoogle Scholar
  36. 36.
    Zizic TM, Hungerford DS, Stevens MB (1980) Ischemic bone necrosis in systemic lupus erythematosus. I. The early diagnosis of ischemic necrosis of bone. Medicine (Baltimore) 59:134Google Scholar

Copyright information

© International Skeletal Society 1982

Authors and Affiliations

  • W. Dihlmann
    • 1
  1. 1.A.K. BarmbekInstitute of RoentgenologyHamburg 60Federal Republic of Germany

Personalised recommendations