title: Fast sequences MR imaging at the investigation of painful skeletal sites in patients with hip osteonecrosis.
abstract: BACKGROUND
  Multiple osteonecrotic foci can be clinically silent when located in metaphyses and becomes painful when it affects juxta-articular areas. The purpose of this study was to assess the value of fast MR imaging to depict the underlying pathology in cases with skeletal pain other than the already diagnosed hip osteonecrosis.
  
  
  METHODS
  Between 2008 and 2013, 49 patients with already diagnosed hip osteonecrosis reported symptoms of deep skeletal pain in an anatomical site different from the affected hip joint. All patients after thorough history & clinical examination underwent evaluation with x-rays and a single fat suppressed sequence with MR Imaging applying either T2-w TSE or STIR-TSE at the painful site. False positive and false negative findings were recorded for the conventional x-rays and compared to MRI.
  
  
  CONCLUSIONS
  Forty four (89.8%) patients were positive for osteonecrotic lesions in this study and 76 symptomatic osteonecrosis lesions were revealed at 14 distinct anatomic sites. The agreement between the x-ray findings and the MR imaging regarding osteonecrosis was 46.9%. Plain x-rays showed 43.4% sensitivity, 100% specificity, 100% positive predictive value and 10.4% negative predictive value. Fast MR imaging with fat suppressed sequences is necessary and adequate as a single method for the investigation of painful skeletal sites in patients with already diagnosed hip osteonecrosis. It allows early diagnosis of the potentially debilitating multiple juxta-articular lesions and consequently their prompt management.
authors: Department of Anatomy Facutly of Medicine, School of Health Sciences, University of Thessaly Panepistimiou 3 (Biopolis), Larissa, 41500 Greece.
authors: Aristidis H
authors: AH
authors: Zibis
authors: Department of Orthopaedic Surgery Facutly of Medicine, School of Health Sciences, University of Thessaly Panepistimiou 3 (Biopolis), Larissa, 41500 Greece.
authors: Sokratis E
authors: SE
authors: Varitimidis
authors: Department of Orthopaedic Surgery Facutly of Medicine, School of Health Sciences, University of Thessaly Panepistimiou 3 (Biopolis), Larissa, 41500 Greece.
authors: Zoe H
authors: ZH
authors: Dailiana
authors: Department of Radiology, University Hospital of Heraklion, Heraklion, Crete, 71110 Greece.
authors: Apostolos H
authors: AH
authors: Karantanas
authors: Department of Anatomy Facutly of Medicine, School of Health Sciences, University of Thessaly Panepistimiou 3 (Biopolis), Larissa, 41500 Greece.
authors: Dimitrios L
authors: DL
authors: Arvanitis
authors: Department of Orthopaedic Surgery Facutly of Medicine, School of Health Sciences, University of Thessaly Panepistimiou 3 (Biopolis), Larissa, 41500 Greece.
authors: Konstantinos N
authors: KN
authors: Malizos
keywords: Fast MRI sequences; Hip osteonecrosis; Multifocal osteonecrosis; Osteonecrosis