Dirk Mueller1, Christoph Schaeffeler2, Thomas Baum3, Flavia Walter4, Hans Rechl5, Ernst J Rummeny6, Klaus Woertler7. 1. Department of Radiology, University of Cologne, Germany; Department of Radiology, Technische Universität München, Germany. Electronic address: d.mueller@uk-koeln.de. 2. Department of Radiology, Cantonal Hospital Graubuenden, Chur, Switzerland; Department of Radiology, Cantonal Hospital Graubuenden, Chur, Switzerland. Electronic address: schaeffeler@me.com. 3. Department of Radiology, Technische Universität München, Germany. Electronic address: thomas-baum@gmx.de. 4. Department of Radiology, Technische Universität München, Germany. Electronic address: flavia_walter2000@yahoo.de. 5. Department of Orthopaedics, Technische Universität München, Germany. Electronic address: rechl@tum.de. 6. Department of Radiology, Technische Universität München, Germany. Electronic address: rummeny@tum.de. 7. Department of Radiology, Technische Universität München, Germany. Electronic address: klaus.woertler@tum.de.
Abstract
PURPOSE: To evaluate magnetic resonance (MR) perfusion and diffusion imaging characteristics in patients with transient bone marrow edema (TBME), avascular necrosis (AVN), or subchondral insufficiency fractures (SIF) of the proximal femur. MATERIALS AND METHODS: 29 patients with painful hip and bone marrow edema pattern of the proximal femur on non-contrast MR imaging were examined using diffusion-weighted and dynamic gadolinium-enhanced sequences. Apparent diffusion coefficients (ADCs) and perfusion parameters were calculated for different regions of the proximal femur. Regional distribution and differences in ADC values and perfusion parameters were evaluated. RESULTS: Seven patients presented with TBME, 15 with AVN and seven with SIF of the proximal femur. Perfusion imaging showed significant differences for maximum enhancement values (Emax), slope (Eslope) and time to peak (TTP) between the three patient groups (p<0.05). In contrast, no significant differences for ADC values were calculated when comparing TBME, AVN, and SIF patients. CONCLUSION: Diffusion weighted imaging of bone marrow of the proximal femur did not show significant differences between patients with TBME, AVN or SIF. In contrast, MR perfusion imaging demonstrated significant differences for the different patient groups and may as a complementary imaging technique add information to the understanding of the pathophysiology of diseases associated with bone marrow edema.
PURPOSE: To evaluate magnetic resonance (MR) perfusion and diffusion imaging characteristics in patients with transient bone marrow edema (TBME), avascular necrosis (AVN), or subchondral insufficiency fractures (SIF) of the proximal femur. MATERIALS AND METHODS: 29 patients with painful hip and bone marrow edema pattern of the proximal femur on non-contrast MR imaging were examined using diffusion-weighted and dynamic gadolinium-enhanced sequences. Apparent diffusion coefficients (ADCs) and perfusion parameters were calculated for different regions of the proximal femur. Regional distribution and differences in ADC values and perfusion parameters were evaluated. RESULTS: Seven patients presented with TBME, 15 with AVN and seven with SIF of the proximal femur. Perfusion imaging showed significant differences for maximum enhancement values (Emax), slope (Eslope) and time to peak (TTP) between the three patient groups (p<0.05). In contrast, no significant differences for ADC values were calculated when comparing TBME, AVN, and SIF patients. CONCLUSION: Diffusion weighted imaging of bone marrow of the proximal femur did not show significant differences between patients with TBME, AVN or SIF. In contrast, MR perfusion imaging demonstrated significant differences for the different patient groups and may as a complementary imaging technique add information to the understanding of the pathophysiology of diseases associated with bone marrow edema.
Authors: George R Matcuk; Scott R Mahanty; Matthew R Skalski; Dakshesh B Patel; Eric A White; Christopher J Gottsegen Journal: Emerg Radiol Date: 2016-03-22