Relationship of Idiopathic Osteonecrosis of the Femoral Head to Perfusion Changes in the Proximal Femur by Dynamic Contrast-Enhanced MRI

• Published in: American journal of roentgenology (1976) Vol. 196; no. 3; pp. 637 - 643
• Main Authors: Chan, Wing P., Liu, Yi-Jui, Huang, Guo-Shu, Lin, Min-Fang, Huang, Sydney, Chang, Yue-Cune, Jiang, Ching-Chuan
• Format: Journal Article
• Language: English
• Published: Reston, VA American Roentgen Ray Society 01.03.2011
• Subjects: Biological and medical sciences; Case-Control Studies; Contrast Media - pharmacokinetics; Diseases of the osteoarticular system; Female; Femur Head - blood supply; Femur Head - pathology; Femur Head Necrosis - pathology; Gadolinium DTPA - pharmacokinetics; Humans; Magnetic Resonance Imaging - methods; Male; Medical sciences; Middle Aged; Severity of Illness Index; Statistics, Nonparametric; Vascular bone diseases; Femur; perfusion; Femoral head; dynamic contrast-enhanced MRI; Diseases of the osteoarticular system; Bone marrow; Medical imagery; Osteonecrosis; Nuclear magnetic resonance imaging
• ISSN: 0361-803X; 1546-3141; 1546-3141
• DOI: 10.2214/AJR.10.4322

The purpose of this article is to relate intramedullary perfusion of the proximal femur to severity of osteonecrosis of the femoral head by using dynamic contrast-enhanced MRI (DCE-MRI). Twelve patients (14 symptomatic hips) who underwent DCE-MRI and had subsequent core decompression of the femoral head were examined. Hips were graded for severity according to MRI findings and were assigned scores of 0 (negative findings), 1 (focal marrow abnormalities), and 2 (subchondral collapse). Thirteen asymptomatic hips acted as controls. The DCE-MRI data were analyzed by use of a pharmacokinetic two-compartment model. Compared with control hips, there was significantly greater peak enhancement in the femoral head in hips of all grades (p < 0.001) and in the femoral neck (p = 0.001) and intertrochanteric area (p = 0.001) in grade 2 hips. The time to peak was significantly delayed in the femoral head in grade 0 hips (p = 0.02) and in the intertrochanteric area in grade 2 hips (p = 0.003) compared with the controls. As evaluated by DCE-MRI, intramedullary peak enhancement in the femoral head increased with progression of idiopathic osteonecrosis of the femoral head, whereas there was delayed peak enhancement in the femoral head in hips with negative findings and intertrochanteric stasis in advanced osteonecrosis of the femoral head. Such perfusion changes as shown on MRI can occur with early osteonecrosis in the absence of other MRI abnormalities.