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The Journal of Bone and Joint Surgery, Vol 71, Issue 5 650-663, Copyright © 1989 by Journal of Bone and Joint Surgery, Inc
Evaluation of magnetic resonance imaging in the diagnosis of osteonecrosis of the femoral head. Accuracy compared with radiographs, core biopsy, and intraosseous pressure measurements
HJ Robinson, PD Hartleben, G Lund and J Schreiman
Department of Orthopaedic Surgery, University of Minnesota Hospital and Clinics, Minneapolis.
The accuracy of magnetic resonance imaging in the detection of
osteonecrosis of the femoral head was compared with that of other
diagnostic methods in current use: plain radiography, bone-marrow pressure
determinations, intramedullary venography, and histological examination of
core-biopsy bone specimens. In the first phase of the study, forty-eight
patients (ninety-six hips) who were at high risk for avascular necrosis
were studied. Abnormal patterns on magnetic resonance imaging, consistent
with those seen in necrosis, were found in all hips that were suspected of
having Ficat Stage-2 or 3 changes on the basis of radiographic evidence of
the disease. Abnormal patterns on magnetic resonance imaging that were
characteristic of avascular necrosis were also observed in 17 per cent of
the hips that were suspected of having Ficat Stage-0 changes and in 64 per
cent of those that showed Stage-1 changes, all with no radiographic
changes. In the second phase of the study, twenty-three of the ninety-six
hips that were suspected of having early-stage necrosis of the femoral head
but showed slight or no radiographic changes were studied by repeat
radiographs, Ficat functional evaluations of bone, core biopsies of the
femoral head, and magnetic resonance imaging. Of the twenty-three hips,
eighteen (78 per cent) had positive changes on magnetic resonance imaging;
nineteen (83 per cent) had positive histological evidence of necrosis; and
fourteen (61 per cent) had positive findings by bone-marrow pressure
studies and intramedullary venography. Although false-negative and
false-positive results were observed with magnetic resonance imaging, the
over-all results of this study suggest that magnetic resonance imaging may
be useful for the early diagnosis of avascular necrosis.
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