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首页> 外文期刊>Acta Radiologica >The role of the subchondral layer in osteonecrosis of the femoral head: analysis based on HR-QCT in comparison to MRI findings
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The role of the subchondral layer in osteonecrosis of the femoral head: analysis based on HR-QCT in comparison to MRI findings

机译：Subchindrall层在股骨头骨折中的作用：基于HR-QCT的MRI调查结果分析

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Background Non-traumatic avascular osteonecrosis of the femoral head (ONFH) is a severe disease causing destruction of the hip joint, often necessitating total hip arthroplasty (THA) even in young patients. Magnetic resonance imaging (MRI) is commonly used for diagnosis of ONFH, but provides limited insight into the subchondral bone microstructure. Purpose To analyze routine MRI findings in comparison to high-resolution quantitative computed tomography (HR-QCT) with a special focus on the subchondral layer and to estimate the importance of differences determining the indication for THA. Material and Methods Twelve patients with ONFH were included before THA. Preoperative MRI and HR-QCT of the retrieved femoral heads were aligned using a registration algorithm. Pathological findings and trabecular bone parameters in matched areas were analyzed by two readers. McNemar, marginal homogeneity test, and Pearson's correlation coefficient were used for comparison. Results Subchondral delamination was found in nine cases on HR-QCT, but missed or underestimated in all but one case on MRI (P = 0.016). Chondral discontinuity was found in all cases on HR-QCT and in two cases on MRI (P = 0.016). Areas of complete bone resorption on HR-QCT were linked to high signal intensity on 3D gradient-echo MRI sequences with water-selective excitation, while there was no correlation between trabecular bone parameters and MRI signal intensities in other areas (P = 0.304). Conclusion Subchondral delamination, subchondral resorption, and chondral discontinuity are found frequently in advanced stages of ONFH. These lesions tend to be underestimated on conventional MRI. Our results support the importance of CT imaging in the evaluation of ONFH.
机译：背景技术股骨头（ONFH）的非创伤性缺血性骨折是一种严重的疾病，导致髋关节破坏，通常需要在年轻患者中甚至需要总髋关节置换术（THA）。磁共振成像（MRI）通常用于诊断ONFH，但对Subchindrallal骨微观结构提供有限的洞察力。目的与高分辨率定量计算断层扫描（HR-QCT）相比，分析常规MRI调查结果，特别关注Subchindralls层，并估计确定THA指示的差异的重要性。材料和方法在Tha之前包括12名牛肉患者。使用注册算法对齐检索到的股骨头的术前MRI和HR-QCT。两位读者分析了匹配区域中的病理发现和骨小梁骨参数。 McNemar，边缘均匀性测试和Pearson的相关系数用于比较。结果在HR-QCT的9例患者中发现了Subchondral分层，但在MRI的所有案例中错过或低估了（P = 0.016）。在HR-QCT的所有病例中发现了Chintral不连续性，并在MRI的两种情况下发现（P = 0.016）。 HR-QCT的完全骨吸收区域与3D梯度回声MRI序列的高信号强度与水选择性激发有关，同时在其他区域中的小梁骨参数和MRI信号强度之间没有相关性（P = 0.304）。结论Subchindral分层，潜水性吸收和骨髓不连续性频繁发现ONFH的高级阶段。这些病变倾向于在常规MRI上低估。我们的结果支持CT成像在评估ONFH中的重要性。

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