title: MRI-detected bone marrow changes within 3 weeks after initiation of high-dose corticosteroid therapy: a possible change preceding the subsequent appearance of low-intensity band in femoral head osteonecrosis.
abstract: Osteonecrosis of the femoral head is considered to occur early during the course of corticosteroid treatment. However, it remains unclear exactly how early it can develop after initiation of corticosteroid treatment. We report a case of osteonecrosis of the femoral head in which abnormal findings were observed on short-tau inversion recovery (STIR) sequence image performed 2 weeks and 4 days after initiation of high-dose corticosteroid therapy. A 45-year-old man with hemophagocytic syndrome was started on prednisolone, with a maximum dose of 40 mg/day. On day 13 after initiation of this corticosteroid therapy, he transiently experienced left hip pain with no apparent cause. STIR sequence image 5 days after the onset of pain revealed high-intensity bone marrow lesions at the femoral neck of both hips. At 3 months after initiation of corticosteroid therapy, T1-weighted magnetic resonance imaging revealed concave-shaped low-intensity bands, which corresponded to the preceding high-intensity lesions on both hips. Because of the subsequent progression to collapse of the left femoral head, he underwent prosthetic replacement surgery. The high-intensity lesions on STIR sequence image indicate the possibility that osteonecrosis can occur within 3 weeks after initiation of high-dose corticosteroid therapy.
authors: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors: Yusuke
authors: Y
authors: Kubo
authors: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. yamataku@ortho.med.kyushu-u.ac.jp.
authors: Takuaki
authors: T
authors: Yamamoto
authors: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors: Goro
authors: G
authors: Motomura
authors: Department of Orthopaedic Surgery, Saga Prefectural Medical Center Koseikan, 400 Kase-Town, Saga City, 840-8571, Japan.
authors: Nobuaki
authors: N
authors: Tsukamoto
authors: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors: Kazuyuki
authors: K
authors: Karasuyama
authors: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors: Kazuhiko
authors: K
authors: Sonoda
authors: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors: Hiroyuki
authors: H
authors: Hatanaka
authors: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors: Takeshi
authors: T
authors: Utsunomiya
authors: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors: Yukihide
authors: Y
authors: Iwamoto
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D001853:Bone Marrow / Q000187:drug effects* / Q000473:pathology; D018450:Disease Progression; D042241:Early Diagnosis; D005270:Femur Head / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology / Q000601:surgery; D005271:Femur Head Necrosis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D051359:Lymphohistiocytosis, Hemophagocytic / Q000175:diagnosis / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects*; D011859:Radiography; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone
keywords: Corticosteroid treatment; Hemophagocytic syndrome; Osteonecrosis of the femoral head; Short-tau inversion recovery (STIR) sequence image