title: Quantifying the extent of osteonecrosis of the femoral head. A new method using MRI.
abstract: In a randomised trial comparing core decompression with conservative treatment we tested the hypothesis that the extent of necrosis at the initial MRI predicts the subsequent risk of collapse of the femoral head. After the initial clinical evaluation, including plain radiography and MRI, 37 hips with early-stage osteonecrosis (ON) in 33 patients were randomly assigned to a core-decompression group or a conservatively-treated group. All were followed regularly by clinical evaluation, plain radiography and MRI at intervals of three months. The extent of ON was estimated on the basis of abnormal signal intensity in the weight-bearing portion of the femoral head as determined from a combination of coronal and sagittal MRIs. The arc of the necrotic portion in the mid-coronal image (A) and that in the mid-sagittal image (B) were used to quantify the extent of necrosis by the formula: (A/180) x (B/180) x 100. There was a strong correlation between this index and the risk of collapse before and after adjustment for age, gender, stage and treatment group. We conclude that the extent of the necrotic portion ascertain by this method is a major predictor of future collapse. We propose a systematic method of determining the index of the necrotic portion which may be clinically useful in the management of early-stage ON of the femoral head.
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Gyeong-Sang National University, Chinju, Republic of Korea.
authors.forename: K H
authors.initials: KH
authors.lastname: Koo
authors.forename: R
authors.initials: R
authors.lastname: Kim
mesh_terms: D005270:Femur Head / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005271:Femur Head Necrosis / Q000145:classification / Q000175:diagnosis* / Q000628:therapy; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000209:etiology / Q000517:prevention & control; D006620:Hip Fractures / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D015588:Observer Variation; D010865:Pilot Projects; D011379:Prognosis; D016016:Proportional Hazards Models; D011859:Radiography; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis