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Bone marrow oedema on MR imaging indicates ARCO stage 3 disease in patients with AVN of the femoral head

  • Musculoskeletal
  • Published:
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Abstract

Objectives

To test the hypothesis that bone marrow oedema (BME) observed on MRI in patients with avascular necrosis (AVN) of the femoral head represents an indicator of subchondral fracture.

Methods

Thirty-seven symptomatic hips of 27 consecutive patients (53 % women, mean age 49.2) with AVN of the femoral head and associated BME on magnetic resonance (MR) imaging were included. MR findings were correlated with computed tomography (CT) of the hip and confirmed by histopathological examination of the resected femoral head. Imaging studies were analysed by two radiologists with use of the ARCO classification.

Results

On MR imaging a fracture line could be identified in 19/37 (51 %) cases, which were classified as ARCO stage 3 (n = 15) and stage 4 (n = 4). The remaining 18/37 (49 %) cases were classified as ARCO stage 2. However, in all 37/37 (100 %) cases a subchondral fracture was identified on CT, indicating ARCO stage 3/4 disease. The extent of subchondral fractures and the femoral head collapse was graded higher on CT as compared to MRI (P < 0.05). Histopathological analysis confirmed bone necrosis and subchondral fractures.

Conclusions

In patients with AVN, BME of the femoral head represents a secondary sign of subchondral fracture and thus indicates ARCO stage 3 disease.

Key Points

• BME on MRI in AVN of femoral head indicates a subchondral fracture.

• BME in AVN of the femoral head represents ARCO stage 3/4 disease.

• CT identifies subchondral fractures and femoral head collapse better than MR imaging.

• This knowledge helps to avoid understaging and to trigger adequate treatment.

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Acknowledgements

The scientific guarantors of this publication are R.M. and K.W. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors (B.H.) has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, observational, performed at one institution.

The authors Reinhard Meier and Tobias M Kraus contributed equally and therefore share the first authorship.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany

    Reinhard Meier, Christoph Schaeffeler, Simone Waldt, Ernst J. Rummeny & Klaus Woertler

  2. Department of Orthopaedics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Tobias M. Kraus, Sebastian Torka & Hans Rechl

  3. Institute of Pathology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Anna Melissa Schlitter & Katja Specht

  4. Institute of Medical Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Bernhard Haller

  5. Department of Trauma and Orthopaedics, Berufsgenossenschaftliche Unfallklinik Tübingen, Tübingen, Germany

    Tobias M. Kraus

  6. Department of Trauma and Orthopaedics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany

    Sebastian Torka

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  1. Reinhard Meier
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Correspondence to Reinhard Meier.

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Meier, R., Kraus, T.M., Schaeffeler, C. et al. Bone marrow oedema on MR imaging indicates ARCO stage 3 disease in patients with AVN of the femoral head. Eur Radiol 24, 2271–2278 (2014). https://doi.org/10.1007/s00330-014-3216-8

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  • DOI: https://doi.org/10.1007/s00330-014-3216-8

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