Recovery of the blood flow around the femoral head during early corticosteroid therapy: dynamic magnetic resonance imaging in systemic lupus erythematosus patients.
Disturbance of blood supply to the femoral head is a risk factor for corticosteroid-associated osteonecrosis. The aim was to measure blood supply of the proximal femur during corticosteroid therapy in systemic lupus erythematosus (SLE) patients. We repeatedly performed 78 dynamic MRIs of 19 hip joints in 19 SLE patients after initiation of corticosteroid administration for one year. Blood supply of the femoral head (epiphysis, growth plate, and metaphysis), the femoral neck, and the medial circumflex femoral artery were measured in terms of peak percent enhancement. At the first month, blood supply of the growth plate was significantly higher in the pediatric group (<15 years old) than in the adolescent and adult group (>15 years old). At the fourth month, blood supply in every part of the femoral head (epiphysis, growth plate, and metaphysis) was significantly higher in the pediatric group than in the adolescent and adult group. Multiple regression analysis revealed that blood supply to the femoral head depended on the number of days after initiation of corticosteroid administration and the age at the time of dynamic MRI. Blood supply to the femoral head is abundant in pediatric patients and is a function of the number of days after initiation of corticosteroid administration.
Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan. njonedr@yahoo.co.jp
J
J
Nakamura
S
S
Ohtori
A
A
Watanabe
K
K
Nakagawa
G
G
Inoue
S
S
Kishida
Y
Y
Harada
M
M
Suzuki
K
K
Takahashi
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D005260:Female; D005270:Femur Head / Q000098:blood supply* / Q000187:drug effects; D005272:Femur Neck / Q000098:blood supply / Q000187:drug effects; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006132:Growth Plate / Q000098:blood supply / Q000187:drug effects; D006621:Hip Joint / Q000098:blood supply / Q000187:drug effects; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
D005938:Glucocorticoids