Advanced hip osteoarthritis: magnetic resonance imaging aspects and histopathology correlations.
OBJECTIVE
To correlate magnetic resonance imaging (MRI) aspects of the femoral head with histological findings in advanced hip osteoarthritis (OA), with special emphasis on bone marrow edema (BME).


METHODS
MRI was performed in patients with advanced hip OA scheduled for hip arthroplasty. Coronal T1-, fat-suppressed T2-, T1 with gadolinium intravenous injection sequences were obtained on a 1.5 T MR-scanner within 1 month before surgery. Coronal MR images corresponding to the ligamentum teres plane were analyzed by two independent readers blinded to histological data. Normal bone marrow, subchondral cyst, subchondral fracture, edema-like, necrosis-like, and necrosis MR patterns were reported on a synthesis scheme. After surgery, the femoral heads specimens were cut through the ligamentum teres plane and histologically analyzed for correlations.


RESULTS
Twenty-three femoral heads were analyzed (female 56.5%, mean age 64.5 years). Edema-like MR pattern was correlated with histological (H) edema (Kappa (K): 0.77). Necrosis-like MR pattern was correlated with H fibrosis (K: 0.49) and with H necrosis (K: 0.24). Cyst MR pattern was correlated with H bone cysts (K: 0.58). Necrosis MR pattern corresponded to a mixture of histological lesions. Sensitivity and specificity of MRI varied from 26% to 80% and from 86% to 95% respectively.


CONCLUSIONS
In advanced hip OA, the so-called "BME" MR lesion corresponds to a combination of edema, fibrosis, and necrosis at histopathology. When the classical "BME" is more specifically separated into edema-like and necrosis-like MR patterns, MR Imaging and histological findings show substantial agreement, with edema-like MR pattern mainly corresponding to histological edema.
Leydet-Quilici
H
H
Service de Rhumatologie, Hôpital de la Conception, Marseille, France. helene.leydet@mail.ap-hm.fr
Le Corroller
T
T
Bouvier
C
C
Giorgi
R
R
Argenson
J-N
JN
Champsaur
P
P
Pham
T
T
de Paula
A Maues
AM
Lafforgue
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001845:Bone Cysts / Q000473:pathology; D001855:Bone Marrow Diseases / Q000473:pathology; D004487:Edema / Q000473:pathology; D005260:Female; D005270:Femur Head / Q000473:pathology*; D005271:Femur Head Necrosis / Q000473:pathology; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000473:pathology*; D011446:Prospective Studies; D011859:Radiography; D011868:Radioisotopes; D012680:Sensitivity and Specificity; D055815:Young Adult
D011868:Radioisotopes; D005682:Gadolinium