Quantitative dynamic contrast-enhanced MRI of bone marrow perfusion at the proximal femur: influence of femoral head osteonecrosis risk factor and overt osteonecrosis.
Bone
Femoral head necrosis
Magnetic resonance imaging
Perfusion imaging
Risk factors
Journal
European radiology
ISSN: 1432-1084
Titre abrégé: Eur Radiol
Pays: Germany
ID NLM: 9114774
Informations de publication
Date de publication:
Apr 2023
Apr 2023
Historique:
received:
22
06
2022
accepted:
19
10
2022
revised:
23
09
2022
pubmed:
18
11
2022
medline:
21
3
2023
entrez:
17
11
2022
Statut:
ppublish
Résumé
To evaluate the MRI perfusion changes in patients with risk factors for osteonecrosis and normally appearing femoral heads prior to overt femoral head osteonecrosis. Fifty-eight patients (105 hips) were prospectively included in this ethics committee-approved study. There were 46 hips with no image anomalies and no risk factors for osteonecrosis of the femoral head (ONFH) risk factors, 38 with ONFH risk factors and no image abnormalities, and 21 with overt ONFH. All patients underwent DCE-MRI. Semi-quantitative (peak enhancement [PE], area under the curve [AUC], time to maximum enhancement [TME]) and quantitative perfusion parameters (volume plasma, KTRANS, and KEP) were calculated. Excessive alcohol consumption, corticosteroid use, and trauma were considered major risk factors for osteonecrosis of the femoral head. Measured at the femoral neck and compared to the healthy hips without OFNH risk factors, PE was significantly lower in the hips of patients with OFNH risk factors. Moreover, the difference was greater in females with risk factors, who presented significantly lower PE values (p = 0.0096). A PE threshold of 1.4% yielded a 92% sensitivity and 54% specificity for the presence of associated ONFH risk factors. The hips with overt OFNH compared to those with normally appearing showed an increase of PE of 45% in the neck (p < 0.014). Various epiphyseal femoral head perfusion parameters (PE, TME, AUC, and K DCE-MRI can identify perfusion marrow changes related to the presence of ONFH risk factors and adjacent to osteonecrosis areas. • Bone marrow perfusion changes may occur prior to overt ONFH and extend beyond the osteonecrosis area to the entire femoral head and neck. • Peak enhancement values were significantly reduced in patients with ONFH risk factors, compared to those without. • The presence of ONFH led to a significant increase in marrow perfusion adjacent to the osteonecrosis area.
Identifiants
pubmed: 36394602
doi: 10.1007/s00330-022-09250-z
pii: 10.1007/s00330-022-09250-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2340-2349Informations de copyright
© 2022. The Author(s), under exclusive licence to European Society of Radiology.
Références
Mourad C, Laperre K, Halut M, Galant C, Van Cauter M, Vande Berg BC (2018) Fused micro-computed tomography (μCT) and histological images of bone specimens. Diagn Interv Imaging. août 99(7-8):501
doi: 10.1016/j.diii.2018.01.011
Lamb JN, Holton C, O’Connor P, Giannoudis PV (2019) Avascular necrosis of the hip. BMJ 365:l2178
doi: 10.1136/bmj.l2178
pubmed: 31147356
Arbab D, König DP (2016) Atraumatic femoral head necrosis in adults. Dtsch Ärztebl Int 113:31–38
pubmed: 26857510
pmcid: 4748149
Seeley MA, Georgiadis AG, Sankar WN (2016) Hip vascularity: a review of the anatomy and clinical implications. J Am Acad Orthop Surg 24:515–526
doi: 10.5435/JAAOS-D-15-00237
pubmed: 27428883
Johnson EO, Soultanis K, Soucacos PN (2004) Vascular anatomy and microcirculation of skeletal zones vulnerable to osteonecrosis: vascularization of the femoral head. Orthop Clin North Am 35:285–291, viii
Choi H-R, Steinberg ME, Cheng EY (2015) Osteonecrosis of the femoral head: diagnosis and classification systems. Curr Rev Musculoskelet Med 8:210–220
doi: 10.1007/s12178-015-9278-7
pubmed: 26088795
pmcid: 4596207
Sun W, Shi Z, Gao F et al (2016) The pathogenesis of multifocal osteonecrosis. Sci Rep 11;6:29576
Yoon B-H, Jones LC, Chen C-H et al (2019) Etiologic classification criteria of ARCO on Femoral head osteonecrosis part 1: glucocorticoid-associated osteonecrosis. J Arthroplasty 34:163-168.e1
Traistaru M-R, Kamal D, Kamal KC et al (2015) Imaging and histopathological aspects in aseptic osteonecrosis of the femoral head. Rom J Morphol Embryol 56(4):1447–1453
pubmed: 26743293
Geith T, Niethammer T, Milz S et al (2016) Transient bone marrow edema syndrome versus osteonecrosis: perfusion patterns at dynamic contrast-enhanced MR imaging with high temporal resolution can allow differentiation. Radiology 283:478–485
doi: 10.1148/radiol.2016152665
pubmed: 27905865
Nadel SN, Debatin JF, Richardson WJ et al (1992) Detection of acute avascular necrosis of the femoral head in dogs: dynamic contrast-enhanced MR imaging vs spin-echo and STIR sequences. AJR Am J Roentgenol 159:1255–1261
doi: 10.2214/ajr.159.6.1442396
pubmed: 1442396
Menezes NM, Connolly SA, Shapiro F et al (2007) Early ischemia in growing piglet skeleton: MR diffusion and perfusion imaging. Radiology 242:129–136
doi: 10.1148/radiol.2421050680
pubmed: 17185664
Cova M, Kang YS, Tsukamoto H et al (1991) Bone marrow perfusion evaluated with gadolinium-enhanced dynamic fast MR imaging in a dog model. Radiology 179(2):535–539
doi: 10.1148/radiology.179.2.2014306
pubmed: 2014306
Arlet J, Ficat C (1990) Ischemic necrosis of the femoral head. Treatment by core decompression. J Bone Joint Surg Am 72:151–152
doi: 10.2106/00004623-199072010-00027
pubmed: 2295665
Johnson CP, Wang L, Tóth F et al (2018) Quantitative MRI helps to detect hip ischemia: preclinical model of Legg-Calvé-Perthes disease. Radiology 289:386–395
doi: 10.1148/radiol.2018180497
pubmed: 30063188
Du J, Lu A, Dempsey M et al (2013) MR perfusion index as a quantitative method of evaluating epiphyseal perfusion in Legg-Calve-Perthes disease and correlation with short-term radiographic outcome: a preliminary study. J Pediatr Orthop 33:707–713
doi: 10.1097/BPO.0b013e3182a05dc1
pubmed: 23872796
Chan WP, Liu Y-J, Huang G-S et al (2011) Relationship of idiopathic osteonecrosis of the femoral head to perfusion changes in the proximal femur by dynamic contrast-enhanced MRI. AJR Am J Roentgenol 196:637–643
Wing PC, Nance P, Connell DG, Gagnon F (1998) Risk of avascular necrosis following short term megadose methylprednisolone treatment. Spinal Cord 36:633–636
doi: 10.1038/sj.sc.3100647
pubmed: 9773448
Budzik J-F, Lefebvre G, Behal H et al (2018) Assessment of the zonal variation of perfusion parameters in the femoral head: a 3-T dynamic contrast-enhanced MRI pilot study. Skeletal Radiol 47:261–270
doi: 10.1007/s00256-017-2802-7
pubmed: 29143112
Aaron RK, Dyke JP, Ciombor DM et al (2007) Perfusion abnormalities in subchondral bone associated with marrow edema, osteoarthritis, and avascular necrosis. Ann N Y Acad Sci 1117:124–137
doi: 10.1196/annals.1402.069
pubmed: 18056039
Brix G, Semmler W, Port R et al (1991) Pharmacokinetic parameters in CNS Gd-DTPA enhanced MR imaging. J Comput Assist Tomogr 15:621–628
doi: 10.1097/00004728-199107000-00018
pubmed: 2061479
Tofts PS, Brix G, Buckley DL et al (1999) Estimating kinetic parameters from dynamic contrast-enhanced T(1)-weighted MRI of a diffusable tracer: standardized quantities and symbols. J Magn Reson Imaging 10:223–232
doi: 10.1002/(SICI)1522-2586(199909)10:3<223::AID-JMRI2>3.0.CO;2-S
pubmed: 10508281
Yoon B, Mont M et al (2020) The 2019 revisited version of association research circulation osseous staging system for osteonecrosis of the femoral head. J Arthroplasty 35(4):933–940
Hynes JP, Hughes N, Cunningham P et al (2019) Whole-body MRI of bone marrow: a review. J Magn Reson Imaging 50:1687–1701
doi: 10.1002/jmri.26759
pubmed: 31016800
Tsuji T, Sugano N, Sakai T, Yoshikawa H (2003) Evaluation of femoral perfusion in a non-traumatic rabbit osteonecrosis model with T2*-weighted dynamic MRI. J Orthop Res 21:341–351
Budzik J-F, Lefebvre G, Behal H et al (2017) Bone marrow perfusion measured with dynamic contrast enhanced magnetic resonance imaging is correlated to body mass index in adults. Bone 99:47–52
Gondim Teixeira PA, Cherubin T, Badr S et al (2019) Proximal femur fat fraction variation in healthy subjects using chemical shift-encoding based MRI. Sci Rep 9:20212
doi: 10.1038/s41598-019-56611-8
pubmed: 31882855
pmcid: 6934523
Cultot A, Norberciak L, Coursier R et al (2020) Bone perfusion and adiposity beyond the necrotic zone in femoral head osteonecrosis: a quantitative MRI study. Eur J Radiol 131:109206
doi: 10.1016/j.ejrad.2020.109206
pubmed: 32871293
Koo KH, Dussault RG, Kaplan PA et al (1999) Fatty marrow conversion of the proximal femoral metaphysis in osteonecrotic hips. Clin Orthop:159–167
Fang S, Li Y, Chen P (2019) Osteogenic effect of bone marrow mesenchymal stem cell-derived exosomes on steroid-induced osteonecrosis of the femoral head. Drug Des Devel Ther 13:45–55
doi: 10.2147/DDDT.S178698
pubmed: 30587927
Meier R, Kraus TM, Schaeffeler C et al (2014) Bone marrow oedema on MR imaging indicates ARCO stage 3 disease in patients with AVN of the femoral head. Eur Radiol 24:2271–2278
doi: 10.1007/s00330-014-3216-8
pubmed: 24863885
Gondim Teixeira PA, Savi de Tové K-M, Abou Arab W et al (2017) Subchondral linear hyperintensity of the femoral head: MR imaging findings and associations with femoro-acetabular joint pathology. Diagn Interv Imaging 98:245–252
doi: 10.1016/j.diii.2016.06.006
pubmed: 27401501