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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

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Abstract

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.

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Acknowledgments

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).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Yusuke Kubo, Takuaki Yamamoto, Goro Motomura, Kazuyuki Karasuyama, Kazuhiko Sonoda, Hiroyuki Hatanaka, Takeshi Utsunomiya & Yukihide Iwamoto

  2. Department of Orthopaedic Surgery, Saga Prefectural Medical Center Koseikan, 400 Kase-Town, Saga City, 840-8571, Japan

    Nobuaki Tsukamoto

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  1. Yusuke Kubo
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  2. Takuaki Yamamoto
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  3. Goro Motomura
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  5. Kazuyuki Karasuyama
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  6. Kazuhiko Sonoda
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  7. Hiroyuki Hatanaka
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  8. Takeshi Utsunomiya
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  9. Yukihide Iwamoto
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Correspondence to Takuaki Yamamoto.

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Kubo, Y., Yamamoto, T., Motomura, G. et al. 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. Rheumatol Int 35, 1909–1912 (2015). https://doi.org/10.1007/s00296-015-3346-6

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  • DOI: https://doi.org/10.1007/s00296-015-3346-6

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