MRI evaluation of collapsed femoral heads in patients 60 years old or older: Differentiation of subchondral insufficiency fracture from osteonecrosis of the femoral head

Satoshi Ikemura, Takuaki Yamamoto, Goro Motomura, Yasuharu Nakashima, Taro Mawatari, Yukihide Iwamoto

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Abstract

OBJECTIVE. The purpose of this article is to verify the hypothesis that osteonecrosis and subchondral insufficiency fracture of the femoral head can be differentiated on the basis of their appearance on MRI. SUBJECTS AND METHODS. Between May 1998 and February 2009, we reviewed 30 consecutive hips in 30 patients, 60 years old or older at the time of onset of hip pain, with radiologic evidence of subchondral collapse of the femoral head and with both MR images and histologic results available. Both clinical and radiologic appearances were investigated. The patients were divided into two groups according to the shape of low-intensity bands on T1-weighted images. The first group showed concavity of the articular surface, which is characteristic of osteonecrosis, and the second group showed an irregular convexity of the articular surface, which is characteristic of subchondral insufficiency fracture. RESULTS. Sixteen hips (53.3%) showed evidence of osteonecrosis, and 14 (46.7%) showed evidence of subchondral insufficiency fracture, which was consistent with the corresponding histopathologic diagnoses. In all cases of osteonecrosis, the patient had a history of either corticosteroid intake or alcohol abuse. Among patients with subchondral insufficiency fracture, the proportion of women was significantly higher than that among patients with osteonecrosis. A crescent sign (subchondral fracture) was present radiographically in about half of all cases in both groups. CONCLUSION. The results of the present study suggest that the shape of the low-intensity band on MRI is useful for the differentiating subchondral insufficiency fracture from osteonecrosis. In addition, among osteoporotic elderly women without any history of corticosteroid intake or alcohol abuse, a diagnosis of subchondral insufficiency fracture should be considered.

Original languageEnglish
Pages (from-to)W63-W68
JournalAmerican Journal of Roentgenology
Volume195
Issue number1
DOIs
Publication statusPublished - Jul 1 2010

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Stress Fractures
Osteonecrosis
Thigh
Hip
Alcoholism
Adrenal Cortex Hormones
Joints
Pain

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

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title = "MRI evaluation of collapsed femoral heads in patients 60 years old or older: Differentiation of subchondral insufficiency fracture from osteonecrosis of the femoral head",
abstract = "OBJECTIVE. The purpose of this article is to verify the hypothesis that osteonecrosis and subchondral insufficiency fracture of the femoral head can be differentiated on the basis of their appearance on MRI. SUBJECTS AND METHODS. Between May 1998 and February 2009, we reviewed 30 consecutive hips in 30 patients, 60 years old or older at the time of onset of hip pain, with radiologic evidence of subchondral collapse of the femoral head and with both MR images and histologic results available. Both clinical and radiologic appearances were investigated. The patients were divided into two groups according to the shape of low-intensity bands on T1-weighted images. The first group showed concavity of the articular surface, which is characteristic of osteonecrosis, and the second group showed an irregular convexity of the articular surface, which is characteristic of subchondral insufficiency fracture. RESULTS. Sixteen hips (53.3{\%}) showed evidence of osteonecrosis, and 14 (46.7{\%}) showed evidence of subchondral insufficiency fracture, which was consistent with the corresponding histopathologic diagnoses. In all cases of osteonecrosis, the patient had a history of either corticosteroid intake or alcohol abuse. Among patients with subchondral insufficiency fracture, the proportion of women was significantly higher than that among patients with osteonecrosis. A crescent sign (subchondral fracture) was present radiographically in about half of all cases in both groups. CONCLUSION. The results of the present study suggest that the shape of the low-intensity band on MRI is useful for the differentiating subchondral insufficiency fracture from osteonecrosis. In addition, among osteoporotic elderly women without any history of corticosteroid intake or alcohol abuse, a diagnosis of subchondral insufficiency fracture should be considered.",
author = "Satoshi Ikemura and Takuaki Yamamoto and Goro Motomura and Yasuharu Nakashima and Taro Mawatari and Yukihide Iwamoto",
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T1 - MRI evaluation of collapsed femoral heads in patients 60 years old or older

T2 - Differentiation of subchondral insufficiency fracture from osteonecrosis of the femoral head

AU - Ikemura, Satoshi

AU - Yamamoto, Takuaki

AU - Motomura, Goro

AU - Nakashima, Yasuharu

AU - Mawatari, Taro

AU - Iwamoto, Yukihide

PY - 2010/7/1

Y1 - 2010/7/1

N2 - OBJECTIVE. The purpose of this article is to verify the hypothesis that osteonecrosis and subchondral insufficiency fracture of the femoral head can be differentiated on the basis of their appearance on MRI. SUBJECTS AND METHODS. Between May 1998 and February 2009, we reviewed 30 consecutive hips in 30 patients, 60 years old or older at the time of onset of hip pain, with radiologic evidence of subchondral collapse of the femoral head and with both MR images and histologic results available. Both clinical and radiologic appearances were investigated. The patients were divided into two groups according to the shape of low-intensity bands on T1-weighted images. The first group showed concavity of the articular surface, which is characteristic of osteonecrosis, and the second group showed an irregular convexity of the articular surface, which is characteristic of subchondral insufficiency fracture. RESULTS. Sixteen hips (53.3%) showed evidence of osteonecrosis, and 14 (46.7%) showed evidence of subchondral insufficiency fracture, which was consistent with the corresponding histopathologic diagnoses. In all cases of osteonecrosis, the patient had a history of either corticosteroid intake or alcohol abuse. Among patients with subchondral insufficiency fracture, the proportion of women was significantly higher than that among patients with osteonecrosis. A crescent sign (subchondral fracture) was present radiographically in about half of all cases in both groups. CONCLUSION. The results of the present study suggest that the shape of the low-intensity band on MRI is useful for the differentiating subchondral insufficiency fracture from osteonecrosis. In addition, among osteoporotic elderly women without any history of corticosteroid intake or alcohol abuse, a diagnosis of subchondral insufficiency fracture should be considered.

AB - OBJECTIVE. The purpose of this article is to verify the hypothesis that osteonecrosis and subchondral insufficiency fracture of the femoral head can be differentiated on the basis of their appearance on MRI. SUBJECTS AND METHODS. Between May 1998 and February 2009, we reviewed 30 consecutive hips in 30 patients, 60 years old or older at the time of onset of hip pain, with radiologic evidence of subchondral collapse of the femoral head and with both MR images and histologic results available. Both clinical and radiologic appearances were investigated. The patients were divided into two groups according to the shape of low-intensity bands on T1-weighted images. The first group showed concavity of the articular surface, which is characteristic of osteonecrosis, and the second group showed an irregular convexity of the articular surface, which is characteristic of subchondral insufficiency fracture. RESULTS. Sixteen hips (53.3%) showed evidence of osteonecrosis, and 14 (46.7%) showed evidence of subchondral insufficiency fracture, which was consistent with the corresponding histopathologic diagnoses. In all cases of osteonecrosis, the patient had a history of either corticosteroid intake or alcohol abuse. Among patients with subchondral insufficiency fracture, the proportion of women was significantly higher than that among patients with osteonecrosis. A crescent sign (subchondral fracture) was present radiographically in about half of all cases in both groups. CONCLUSION. The results of the present study suggest that the shape of the low-intensity band on MRI is useful for the differentiating subchondral insufficiency fracture from osteonecrosis. In addition, among osteoporotic elderly women without any history of corticosteroid intake or alcohol abuse, a diagnosis of subchondral insufficiency fracture should be considered.

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