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Skeletal Radiology

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01-11-2016 | Scientific Article

Fat-suppressed T2-weighted MRI appearance of subchondral insufficiency fracture of the femoral head

Authors: Kazuhiko Sonoda, Takuaki Yamamoto, Goro Motomura, Kazuyuki Karasuyama, Yusuke Kubo, Yukihide Iwamoto

Published in: Skeletal Radiology | Issue 11/2016

Abstract

Objective

Our aims were to investigate the imaging appearance of subchondral insufficiency fracture (SIF) of the femoral head based on fat-suppressed T2-weighted MRI, and evaluate its correlation with the clinical outcomes following conservative treatment.

Materials and methods

We retrospectively evaluated 40 hips in 37 patients with SIF of the femoral head (12 males and 25 females; mean age 55.8 years, range 22–78 years). MRI examinations were performed within 3 months after the onset of hip pain. Using fat-suppressed T2-weighted imaging, we evaluated the hips for the intensity of the subchondral bone (corresponding to the area superior to the low intensity band on T1-weighted images) as well as bone marrow edema, joint effusion, and presence of the band lesion. We then correlated the intensity of the subchondral bone with clinical outcomes.

Results

The hips were classified into three types based on subchondral intensity on fat-suppressed T2-weighted images: type 1 (21 hips) showed high intensity, type 2 (eight hips) showed heterogeneous intensity, and type 3 (11 hips) showed low intensity. The mean period between pain onset and MRI examination was significantly longer for type 2 hips than for type 1. Healing rates were 86 % for type 1, 75 % for type 2, and 18 % for type 3.

Conclusion

SIF cases were classified into three types based on subchondral intensity on fat-suppressed T2-weighted imaging performed within 3 months after pain onset. Type 3 SIF tended to be intractable to conservative treatment compared to type 1 and type 2.

Bangil M, Soubrier M, Dubost JJ, et al. Subchondral insufficiency fracture of the femoral head. Rev Rhum Engl Ed. 1996;63:859–61.PubMed

Rafii M, Mitnick H, Klug J, Firooznia H. Insufficiency fracture of the femoral head: MR imaging in three patients. AJR Am J Roentgenol. 1997;168:159–63.CrossRefPubMed

Yamamoto T, Bullough PG. Subchondral insufficiency fracture of the femoral head: a differential diagnosis in acute onset of coxarthrosis in the elderly. Arthritis Rheum. 1999;42:2719–23.CrossRefPubMed

Hagino H, Okano T, Teshima R, Nishi T, Yamamoto K. Insufficiency fracture of the femoral head in patients with severe osteoporosis: report of 2 cases. Acta Orthop Scand. 1999;70:87–9.CrossRefPubMed

Legroux Gerot I, Demondion X, Louville AB, Delcambre B, Cortet B. Subchondral fractures of the femoral head: a review of seven cases. Joint Bone Spine. 2004;71:131–5.CrossRefPubMed

Iwasaki K, Yamamoto T, Motomura G, Ikemura S, Yamaguchi R, Iwamoto Y. Radiologic measurements associated with the prognosis and need for surgery in patients with subchondral insufficiency fracture of the femoral head. AJR Am J Roentgenol. 2013;201:W97–103.CrossRefPubMed

Yamamoto T, Schneider R, Bullough PG. Subchondral insufficiency fracture of the femoral head: histopathologic correlation with MRI. Skelet Radiol. 2001;30:247–54.CrossRef

Yamamoto T, Schneider R, Bullough PG. Insufficiency subchondral fracture of the femoral head. Am J Surg Pathol. 2000;24:464–8.CrossRefPubMed

Davis M, Cassar-Pullicino VN, Darby AJ. Subchondral insufficiency fractures of the femoral head. Eur Radiol. 2004;14:201–7.CrossRef

10.

Slocum KA, Gorman JD, Puckett ML, Jones SB. Resolution of abnormal MR signal intensity in patients with stress fractures of the femoral neck. AJR Am J Roentgenol. 1997;168:1295–9.CrossRefPubMed

11.

Ikemura S, Yamamoto T, Motomura G, Nakashima Y, Mawatari T, Iwamoto Y. MRI evaluation of collapsed femoral heads in patients 60 years old or older: differentiation of subchondral insufficiency fracture from osteonecrosis of the femoral head. AJR Am J Roentgenol. 2010;195:W63–8.CrossRefPubMed

12.

Miyanishi K, Hara T, Kaminomachi S, Maeda H, Watanabe H, Torisu T. Contrast-enhanced MR imaging of subchondral insufficiency fracture of the femoral head: a preliminary comparison with that of osteonecrosis of the femoral head. Arch Orthop Trauma Surg. 2009;129:583–9.CrossRefPubMed

13.

Chung CY, Park MS, Lee KM, et al. Hip osteoarthritis and risk factors in elderly Korean population. Osteoarthr Cart. 2010;18:312–6.CrossRef

14.

Mitchell DG, Rao V, Dalinka M, et al. MRI of joint fluid in the normal and ischemic hip. AJR Am J Roentgenol. 1986;146:1215–8.CrossRefPubMed

15.

Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.CrossRefPubMed

16.

Frihagen F, Nordsletten L, Tariq R, Madsen JE. MRI diagnosis of occult hip fractures. Acta Orthop. 2005;76:524–30.CrossRefPubMed

17.

Bogost GA, Lizerbram EK, Crues III JV. MR imaging in evaluation of suspected hip fracture: frequency of unsuspected bone and soft-tissue injury. Radiology. 1995;197:263–7.CrossRefPubMed

18.

Lee K, Yao L. Stress fractures: MR imaging. Radiology. 1988;169:217–20.CrossRefPubMed

19.

Deutsche AL, Mink JH, Waxman AD. Occult fractures of the proximal femur: MR imaging. Radiology. 1989;170:113–6.CrossRef

20.

Miyanishi K, Ishihara K, Jingushi S, Torisu T. Risk factors leading to total hip arthroplasty in patients with subchondral insufficiency fracture of the femoral head. J Orthop Surg (Hong Kong). 2010;18:271–5.

21.

Yamamoto T, Karasuyama K, Iwasaki K, Doi T, Iwamoto Y. Subchondral insufficiency fracture of the femoral head in males. Arch Orthop Trauma Surg. 2014;134:1199–203.CrossRefPubMed

22.

Bullough PG, DiCarlo EF. Subchondral avascular necrosis: a common cause of arthritis. Ann Rheum Dis. 1990;49:412–20.CrossRefPubMedPubMedCentral

23.

Yamamoto T, DiCarlo EF, Bullough PG. The prevalence and clinicopathological appearance of extension of osteonecrosis in the femoral head. J Bone Joint Surg (Br). 1999;81:328–32.

24.

Ikemura S, Yamamoto T, Nakashima Y, Shuto T, Jingushi S, Iwamoto Y. Bilateral subchondral insufficiency fracture of the femoral head after renal transplantation: a case report. Arthritis Rheum. 2005;52:1293–6.CrossRefPubMed

25.

Yamamoto T, Iwamoto Y, Schneider R, Bullough PG. Histopathological prevalence of subchondral insufficiency fracture of the femoral head. Ann Rheum Dis. 2008;67:150–3.CrossRefPubMed

26.

Kubo T, Yamazoe S, Sugano N, et al. Initial MRI findings of non-traumatic osteonecrosis of the femoral head in renal allograft recipients. Magn Reson Imaging. 1997;15:1017–23.CrossRefPubMed

Title: Fat-suppressed T2-weighted MRI appearance of subchondral insufficiency fracture of the femoral head
Authors: Kazuhiko Sonoda
Takuaki Yamamoto
Goro Motomura
Kazuyuki Karasuyama
Yusuke Kubo
Yukihide Iwamoto
Publication date: 01-11-2016
Publisher: Springer Berlin Heidelberg
Published in: Skeletal Radiology / Issue 11/2016
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI: https://doi.org/10.1007/s00256-016-2462-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Fat-suppressed T2-weighted MRI appearance of subchondral insufficiency fracture of the femoral head

Abstract

Objective

Materials and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Materials and methods

Results

Conclusion

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