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Quantitative dynamic contrast-enhanced MRI of bone marrow perfusion at the proximal femur: influence of femoral head osteonecrosis risk factor and overt osteonecrosis

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To evaluate the MRI perfusion changes in patients with risk factors for osteonecrosis and normally appearing femoral heads prior to overt femoral head osteonecrosis.

Methods

Fifty-eight patients (105 hips) were prospectively included in this ethics committee–approved study. There were 46 hips with no image anomalies and no risk factors for osteonecrosis of the femoral head (ONFH) risk factors, 38 with ONFH risk factors and no image abnormalities, and 21 with overt ONFH. All patients underwent DCE-MRI. Semi-quantitative (peak enhancement [PE], area under the curve [AUC], time to maximum enhancement [TME]) and quantitative perfusion parameters (volume plasma, KTRANS, and KEP) were calculated. Excessive alcohol consumption, corticosteroid use, and trauma were considered major risk factors for osteonecrosis of the femoral head.

Results

Measured at the femoral neck and compared to the healthy hips without OFNH risk factors, PE was significantly lower in the hips of patients with OFNH risk factors. Moreover, the difference was greater in females with risk factors, who presented significantly lower PE values (p = 0.0096). A PE threshold of 1.4% yielded a 92% sensitivity and 54% specificity for the presence of associated ONFH risk factors. The hips with overt OFNH compared to those with normally appearing showed an increase of PE of 45% in the neck (p < 0.014). Various epiphyseal femoral head perfusion parameters (PE, TME, AUC, and Ktrans) presented statistically significant differences in hips with ONFH and those without (p < 0.0001).

Conclusion

DCE-MRI can identify perfusion marrow changes related to the presence of ONFH risk factors and adjacent to osteonecrosis areas.

Key Points

• Bone marrow perfusion changes may occur prior to overt ONFH and extend beyond the osteonecrosis area to the entire femoral head and neck.

• Peak enhancement values were significantly reduced in patients with ONFH risk factors, compared to those without.

• The presence of ONFH led to a significant increase in marrow perfusion adjacent to the osteonecrosis area.

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Abbreviations

AIF :

Arterial input function

AUC :

Area under the curve

DCE-MRI :

Dynamic contrast-enhanced MRI

ONFH :

Osteonecrosis of the femoral head

PE :

Peak enhancement

TME :

Time to maximum enhancement

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Acknowledgements

We express our gratitude for the support provided by Ms. Demange-Viardin J, in the data collection patient inclusion processes.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France

    Pedro Augusto Gondim Teixeira, Lauriane Dubois, Romain Gillet & Alain Blum

  2. Université de Lorraine, Inserm, IADI, F-54000, Nancy, France

    Pedro Augusto Gondim Teixeira & Gabriela Hossu

  3. CHU Lille, Department of Radiology and Musculoskeletal Imaging, Centre de Consultations et Imagerie de l’Appareil Locomoteur, F-59000, Lille, France

    Sammy Badr & Anne Cotten

Authors
  1. Pedro Augusto Gondim Teixeira
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  4. Romain Gillet
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Corresponding author

Correspondence to Pedro Augusto Gondim Teixeira.

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Guarantor

The scientific guarantor of this publication is Professor Alain Blum.

Conflict of interest

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.

Statistics and biometry

One of the authors (Dr. Hossu, Gabriela PhD) has significant statistical expertise.

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Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

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• Prospective

• Observational

• performed at one institution

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Gondim Teixeira, P.A., Dubois, L., Hossu, G. et al. Quantitative dynamic contrast-enhanced MRI of bone marrow perfusion at the proximal femur: influence of femoral head osteonecrosis risk factor and overt osteonecrosis. Eur Radiol 33, 2340–2349 (2023). https://doi.org/10.1007/s00330-022-09250-z

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  • DOI: https://doi.org/10.1007/s00330-022-09250-z

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