Staging avascular necrosis of the femoral head: the role of MRI.

Congress:

ECR 2019

Poster Number:

C-2265

Type:

Educational Exhibit

Keywords:

Education and training, Diagnostic procedure, MR, CT, Conventional radiography, Musculoskeletal bone, Bones

Authors:

A. Cardín Pereda¹, E. Montes Figueroa², Y. Lamprecht², E. Marín Diez², C. González-Carrero Sixto², J. Azcona Saenz², A. Garcia Bolado³, H. Vidal Trueba², R. Garcia Barredo²; ¹SANTANDER, cantabria/ES, ²Santander/ES, ³Soto de la Marina/ES

DOI:

10.26044/ecr2019/C-2265

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-2265

$Fig. 8: T1 and T2 weighted coronal MR images showing subchondral fracture without articular collapse or alterations in the femoral head shape (stage III in Ficat and Arlet, ARCO and Steinberg systems).$

Fig. 8: T1 and T2 weighted coronal MR images showing subchondral fracture without...

Table 1: Classification of Ficat and Arlet.

Table 2: ARCO Classification.

Learning objectives

To teach about limitations, regarding sensitivity and specificity, of different imaging studies when staging hip osteonecrosis.

Background

Avascular necrosis of the hip (AVNH) is an unusual but disabling condition that usually results in a collapse of the femoral head and secondary arthritis, requiring a total hip arthroplasty when is not properly treated in early stages. Early diagnosis is both essential and challenging, as the onset of symptoms and imaging characteristics are insidious and subtle. Magnetic resonance imaging (MRI) is considered the method of choice for its diagnosis, with the highest sensitivity and specificity. In the last decades, different scientific societies have developed...

Findings and procedure details

Despite it is challenging and sometimes confusing, AVNH diagnosis relies on imaging. The most used approach consists of starting the study of the patient with plain radiographs and, when considered, requesting more imaging techniques, like MRI, computerized tomography or bone scan.Lets review some of them beforedeepening in the staging process. Simple X-rays Because of their availability and low cost, plain radiographs are the most appropriate initial test in the management of hip pain, and thus imaging evaluation of AVNH should begin with radiography. Both frontal...

Conclusion

Radiologists should be aware of the pros and cons of every diagnostic tool regarding the classification of femoral head osteonecrosis. MRI is the technique of choice in most cases.

Personal information

References

1-Choi HR, Steinberg ME ,Cheng EY. Osteonecrosis of the femoral head: diagnosis and classification systems. Curr Rev Musculoskelet Med (2015) 8:210–220 2-Karantanas AH. Accuracy and limitations of diagnostic methods for avascular necrosis of the hip. Expert Opin. Med. Diagn. (2013) 7(2):179-187 3-Murphey MD, Foreman KL, Klassen-Fischer MK, Fox MG, Chung EM, Kransdorf MJ. From the radiologic pathology archives imaging of osteonecrosis: radiologic-pathologic correlation. Radiographics. 2014 Jul-Aug;34(4):1003-28. 4-Öner AY, Aggunlu L, Akpek S, Celik A, Le Roux P, Tali T, Gultekin S. Staging of hip avascular...