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(Radiology. 1999;212:527-535.)
© RSNA, 1999

Musculoskeletal Imaging

Idiopathic Bone Marrow Edema Lesions of the Femoral Head: Predictive Value of MR Imaging Findings1

Bruno C. Vande Berg, MD, PhD, Jacques J. Malghem, MD, Frederic E. Lecouvet, MD, Jacques Jamart, MD and Baudouin E. Maldague, MD

1 From the Department of Radiology and Medical Imaging, Cliniques Universitaires St Luc, Universite catholique de Louvain, 10 Avenue Hippocrate, 1200 Brussels, Belgium (B.C.V.B., J.J.M., F.E.L., B.E.M.) and the Center for Biostatistics and Medical Documentation, Universite catholique de Louvain, Cliniques Universitaires de Mont Godinne, Yvoir, Belgium (J.J.). Received June 29, 1998; revision requested August 5; final revision received November 11; accepted February 22, 1999. Address reprint requests to B.C.V.B. (e-mail: vandeberg@rdgn.ucl.ac.be).

PURPOSE: To determine the frequency of several subchondral magnetic resonance (MR) imaging features observed in bone marrow edema lesions of the femoral head and to determine their value for differentiation of irreversible from transient lesions.

MATERIALS AND METHODS: The authors reviewed MR images of 72 femoral head lesions in 42 men and 25 women (median age, 48 years) with equivocal radiographic findings and bone marrow edema seen at MR imaging (T1- and T2-weighted images in all patients and contrast material–enhanced T1-weighted images in 39 patients). Follow-up MR images showed 57 lesions to be transient and 15 to be irreversible. The presence and size of subtle subchondral features observed on initial MR images were compared for both types of lesion.

RESULTS: Lack of any additional subchondral change on T2-weighted or contrast-enhanced T1-weighted images had 100% positive predictive value for transient lesions. For irreversible lesions, presence of a subchondral area of low signal intensity at least 4 mm thick or 12.5 mm long had positive predictive values of 85% and 73%, respectively, on T2-weighted images and 87% and 86%, respectively, on contrast-enhanced T1-weighted images.

CONCLUSION: Careful assessment of subchondral changes enables confident differentiation between early irreversible lesions and transient bone marrow edema lesions.

Index terms: Alcohol, 443.869 • Bone marrow, edema, 443.499 • Hip, MR, 443.121411, 443.12143 • Hip, necrosis, 443.44 • Myeloma, 443.34 • Osteoporosis, 443.56 • Osteomalacia, 443.57 • Steroids, complications, 443.542




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