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Musculoskeletal Imaging |
1 From the Departments of Orthopedic Surgery (K.H.K., H.R.S., S.T.J., S.H.C.) and Radiology (I.O.A., J.B.N.), Gyeong-Sang National University School of Medicine, 90 Chilam-dong, Chinju 660-702, South Korea; the Department of Environmental Health, School of Public Health, Seoul National University, South Korea (R.K.); and the Department of Orthopedic Surgery, Saint Mary's Hospital, the Catholic University of Korea, Seoul, South Korea (Y.S.K.). Received December 16, 1998; revision requested March 6, 1999; final revision received April 13; accepted June 9. Address reprint requests to K.H.K. (e-mail: khkoo@nongae.gsnu.ac.kr).
PURPOSE: To determine whether the marrow edema around focal osteonecrosis on magnetic resonance (MR) images is associated with clinical symptoms.
MATERIALS AND METHODS: Thirty-three patients with 37 hips showing early stage osteonecrosis of the femoral head were followed up at 3-month intervals with clinical evaluation, conventional radiography, and serial MR imaging.
RESULTS: Seven (50%) of 14 symptomatic hips showed marrow edema around focal osteonecrosis on initial MR images, whereas only one (4%) of 23 asymptomatic hips showed edema (P < .01). Six (86%) of seven hips that were moderately to severely painful were associated with surrounding marrow edema. All eight hips showing osteonecrosis with marrow edema at the initial MR examination had joint effusion and exhibited intense radionuclide uptake in the proximal femur, which corresponded to the extent of edema on MR images. In all eight hips, the marrow edema resolved on follow-up MR images, and the pain subsided with the resolution of edema.
CONCLUSION: The results of this study suggest that the combination of marrow edema of the proximal femur and focal osteonecrosis of the femoral head are strongly associated with hip pain in early stage osteonecrosis, even prior to collapse. Pain improvement usually parallels the resolution of edema.
Index terms: Bone marrow, edema, 443.833 • Bone marrow, MR, 443.121411 • Bone marrow, radionuclide studies, 443.12172 • Femur, MR, 443.121411 • Femur, necrosis, 443.44 • Femur, radionuclide studies, 443.12172 • Hip, MR, 44.121411 • Hip, necrosis, 44.44 • Hip, radionuclide studies, 44.12172
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