title: ACR Appropriateness Criteria Osteonecrosis of the Hip.
abstract: Osteonecrosis of the hip (Legg-Calvé-Perthes) is a common disease, with 10,000-20,000 symptomatic cases annually in the United States. The disorder affects both adults and children and is most frequently associated with trauma and corticosteroid usage. The initial imaging evaluation of suspected hip osteonecrosis is done using radiography. MRI is the most sensitive and specific imaging modality for diagnosis of osteonecrosis of the hip. The clinical significance of hip osteonecrosis is dependent on its potential for articular collapse. The likelihood of articular collapse is significantly increased with involvement of greater than 30%-50% of the femoral head area, which is optimally evaluated by MRI, often in the sagittal plane. Contrast-enhanced MRI may be needed to detect early osteonecrosis of the hip in pediatric patients, revealing hypoperfusion. In patients with a contraindication for MRI, use of either CT or bone scintigraphy with SPECT (single-photon emission CT) are alternative radiologic methods of assessment. Imaging helps guide treatment, which may include core decompression, osteotomy, and ultimately, need for joint replacement. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors: Uniformed Services University of the Health Sciences, Bethesda, Maryland. Electronic address: mmurphey@acr.org.
authors: Mark D
authors: MD
authors: Murphey
authors: Mayo Clinic, Phoenix, Arizona.
authors: Catherine C
authors: CC
authors: Roberts
authors: NYU Radiology Associates, New York, New York.
authors: Jenny T
authors: JT
authors: Bencardino
authors: James J. Peters VA Medical Center, Bronx, New York, American Academy of Orthopaedic Surgeons.
authors: Marc
authors: M
authors: Appel
authors: Orthopaedics and Rheumatology of the North Shore, Skokie, Illinois, American College of Rheumatology.
authors: Erin
authors: E
authors: Arnold
authors: VA San Diego Healthcare System, San Diego, California.
authors: Eric Y
authors: EY
authors: Chang
authors: Texas Scottish Rite Hospital for Children, Dallas, Texas.
authors: Molly E
authors: ME
authors: Dempsey
authors: University of Virginia Health System, Charlottesville, Virginia.
authors: Michael G
authors: MG
authors: Fox
authors: Bone, Spine and Hand Surgery, Chartered, Brick, New Jersey, American Academy of Orthopaedic Surgeons.
authors: Ian Blair
authors: IB
authors: Fries
authors: Medical College of Georgia at Georgia Regents University, Augusta, Georgia.
authors: Bennett S
authors: BS
authors: Greenspan
authors: Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors: Mary G
authors: MG
authors: Hochman
authors: University of Michigan Medical Center, Ann Arbor, Michigan.
authors: Jon A
authors: JA
authors: Jacobson
authors: Hospital for Special Surgery, New York, New York.
authors: Douglas N
authors: DN
authors: Mintz
authors: New England Baptist Hospital, Boston, Massachusetts.
authors: Joel S
authors: JS
authors: Newman
authors: Hospital for Joint Diseases, New York, New York.
authors: Zehava S
authors: ZS
authors: Rosenberg
authors: Washington University School of Medicine, Saint Louis, Missouri.
authors: David A
authors: DA
authors: Rubin
authors: Brigham & Women's Hospital, Boston, Massachusetts.
authors: Kirstin M
authors: KM
authors: Small
authors: Brigham & Women's Hospital, Boston, Massachusetts.
authors: Barbara N
authors: BN
authors: Weissman
mesh_terms: D000328:Adult; D002648:Child; D003952:Diagnostic Imaging; D006801:Humans; D007873:Legg-Calve-Perthes Disease / Q000000981:diagnostic imaging* / Q000473:pathology
keywords: Appropriateness criteria; MRI; adult; child; osteonecrosis; radiograph