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Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017)

24.10. - 27.10.2017, Berlin

The utility of contrast-enhanced MR imaging for precise assessment of necrotic area in patients with osteonecrosis of the femoral head

Meeting Abstract

  • presenting/speaker Satoshi Ikemura - Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  • Takeshi Utsunomiya - Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  • Goro Motomura - Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  • Jun-ichi Fukushi - Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  • Satoshi Hamai - Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  • Takuaki Yamamoto - Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
  • Yasuharu Nakashima - Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocIN12-969

doi: 10.3205/17dkou013, urn:nbn:de:0183-17dkou0134

Veröffentlicht: 23. Oktober 2017

© 2017 Ikemura et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: The T1 low-intensity band on the MR images is generally used to evaluate the necrotic area, however, it is difficult to do for some cases of osteonecrosis of the femoral head (ON) due to the diffuse bone marrow edema. Therefore, a contrast-enhanced MR imaging is performed for cases in which the definition of the necrotic area was difficult based on the non-enhanced MR imaging at our institution. The purpose of this study is to investigate whether a contrast-enhanced MR imaging is useful for precise assessment of necrotic area in patients with ON.

Methods: This retrospective study was approved by our institutional review board. We reviewed 23 hips in 14 patients (6 males and 8 females) with ON who underwent the contrast-enhanced MRI between January 2014 and April 2016. According to the classification of the Japanese Investigation Committee of Health and Welfare, 18 hips were classified as stage 3A, which means the collapse of the femoral heads was less than 3 mm and 5 were as stage 3B (3 mm or more). The localization of the affected lesion in 2 hips was type B, which means the necrotic area occupied less than two-thirds of the weight-bearing portion, 10 hips was type C1 (more than two-thirds of the weight-bearing portion but did not extend to the acetabular edge) and 11 hips was type C2 (necrotic area occupied more than two-thirds and extended the acetabular edge). The necrotic area (boundary of necrotic- and living-bone) was evaluated on both mid-coronal and -axial slices using the contrast-enhanced MR images. Clinically, the history of corticosteroid usage or alcohol consumption, body mass index (BMI) and duration from the onset of hip pain to MRI examination, were investigated.

Results and Conclusion: The precise necrotic area (boundary of necrotic- and living-bone) was detected by a contrast-enhanced MR imaging on both mid-coronal and -axial slices in all 23 hips. Regarding the necrotic area, eight of 23 hips (35%) in the mid-coronal contrast-enhanced images showed the difference compared with mid-coronal non-enhanced T1 images. Among them, 5 hips of necrotic area in the mid-coronal contrast-enhanced images were larger than mid-coronal non-enhanced T1 images. Similarly, nine of 23 hips (39%) in the mid-axial contrast-enhanced images showed the difference compared with mid-axial non-enhanced T1 images. Among them, 5 hips of necrotic area in the mid-axial contrast-enhanced images were larger than mid-axial non-enhanced T1 images. Clinical findings were compared between Difference [non-enhanced T1 vs. contrast-enhanced T1] (+) and (-) groups The mean duration from the onset of hip pain to MRI examination in the Difference (+) group (2.5 months) was significantly shorter than that in the Difference (-) group (5.3 months) in the mid-coronal slices (P=0.0389).

A contrast-enhanced MR imaging is useful for precise assessment of necrotic area in patients with osteonecrosis of the femoral head.