title: Magnetic resonance perfusion and diffusion imaging characteristics of transient bone marrow edema, avascular necrosis and subchondral insufficiency fractures of the proximal femur.
abstract: OBJECTIVE
  To evaluate magnetic resonance (MR) perfusion and diffusion imaging characteristics in patients with transient bone marrow edema (TBME), avascular necrosis (AVN), or subchondral insufficiency fractures (SIF) of the proximal femur.
  
  
  METHODS
  29 patients with painful hip and bone marrow edema pattern of the proximal femur on non-contrast MR imaging were examined using diffusion-weighted and dynamic gadolinium-enhanced sequences. Apparent diffusion coefficients (ADCs) and perfusion parameters were calculated for different regions of the proximal femur. Regional distribution and differences in ADC values and perfusion parameters were evaluated.
  
  
  RESULTS
  Seven patients presented with TBME, 15 with AVN and seven with SIF of the proximal femur. Perfusion imaging showed significant differences for maximum enhancement values (Emax), slope (Eslope) and time to peak (TTP) between the three patient groups (p<0.05). In contrast, no significant differences for ADC values were calculated when comparing TBME, AVN, and SIF patients.
  
  
  CONCLUSIONS
  Diffusion weighted imaging of bone marrow of the proximal femur did not show significant differences between patients with TBME, AVN or SIF. In contrast, MR perfusion imaging demonstrated significant differences for the different patient groups and may as a complementary imaging technique add information to the understanding of the pathophysiology of diseases associated with bone marrow edema.
authors.affiliation: Department of Radiology, University of Cologne, Germany; Department of Radiology, Technische Universität München, Germany. Electronic address: d.mueller@uk-koeln.de.
authors.forename: Dirk
authors.initials: D
authors.lastname: Mueller
authors.affiliation: Department of Radiology, Cantonal Hospital Graubuenden, Chur, Switzerland; Department of Radiology, Cantonal Hospital Graubuenden, Chur, Switzerland. Electronic address: schaeffeler@me.com.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schaeffeler
authors.affiliation: Department of Radiology, Technische Universität München, Germany. Electronic address: thomas-baum@gmx.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Baum
authors.affiliation: Department of Radiology, Technische Universität München, Germany. Electronic address: flavia_walter2000@yahoo.de.
authors.forename: Flavia
authors.initials: F
authors.lastname: Walter
authors.affiliation: Department of Orthopaedics, Technische Universität München, Germany. Electronic address: rechl@tum.de.
authors.forename: Hans
authors.initials: H
authors.lastname: Rechl
authors.affiliation: Department of Radiology, Technische Universität München, Germany. Electronic address: rummeny@tum.de.
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Rummeny
authors.affiliation: Department of Radiology, Technische Universität München, Germany. Electronic address: klaus.woertler@tum.de.
authors.forename: Klaus
authors.initials: K
authors.lastname: Woertler
mesh_terms: D000328:Adult; D001853:Bone Marrow / Q000473:pathology*; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D004487:Edema / Q000175:diagnosis*; D005260:Female; D005264:Femoral Fractures / Q000175:diagnosis*; D005271:Femur Head Necrosis / Q000175:diagnosis*; D019786:Gadolinium DTPA; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: Bone marrow; Femur head necrosis; Hip joint; Magnetic resonance imaging; Perfusion imaging