Marvin E Steinberg1, Seong C Oh2, Viviane Khoury2, Jayaram K Udupa2, David R Steinberg3. 1. Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 3737 Market Street, Suite 600, Philadelphia, PA, 19104, USA. 2. Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 3. Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 3737 Market Street, Suite 600, Philadelphia, PA, 19104, USA. David.steinberg@uphs.upenn.edu.
Abstract
BACKGROUND: Management of patients with early stages of osteonecrosis of the femoral head remains controversial. Uniform use of an effective method of evaluation and classification, including both stage and lesion size, would allow for comparison and would significantly improve treatment of patients. There is no consensus on how best to determine lesion size. The purpose of this study was to evaluate and compare accuracy and ease of use of different techniques for determining the size of femoral head lesions. METHODS: Twenty-five hips with stages I or II osteonecrosis were evaluated with radiographs and MRI. 3-D MRI measurements of lesion size were used as the standard against which to compare visual estimates and angular measurements: necrotic angle of Kerboul, index of necrosis, and adjusted index of necrosis. RESULTS: 3-D measurements (necrotic volume) showed regular progression from 2.2 to 59.2% of the femoral head. There was a rough correlation with angular measurements; index of necrosis was closer than the necrotic angle. Visual estimates from serial MRI images were as accurate as angular measurements. CONCLUSIONS: Simple visual estimates of lesion size from serial MRI images are reasonably accurate and are satisfactory for clinical use. Angular measurements provide some indication of prognosis and treatment; however, they have limited accuracy, with considerable variability between techniques. 3-D MRI volumetric measurements are the most accurate. Using current techniques and software, they are easier to use, requiring similar time and effort to angular measurements. They should be considered for clinical research and publications when the most accurate measurements are required.
BACKGROUND: Management of patients with early stages of osteonecrosis of the femoral head remains controversial. Uniform use of an effective method of evaluation and classification, including both stage and lesion size, would allow for comparison and would significantly improve treatment of patients. There is no consensus on how best to determine lesion size. The purpose of this study was to evaluate and compare accuracy and ease of use of different techniques for determining the size of femoral head lesions. METHODS: Twenty-five hips with stages I or II osteonecrosis were evaluated with radiographs and MRI. 3-D MRI measurements of lesion size were used as the standard against which to compare visual estimates and angular measurements: necrotic angle of Kerboul, index of necrosis, and adjusted index of necrosis. RESULTS: 3-D measurements (necrotic volume) showed regular progression from 2.2 to 59.2% of the femoral head. There was a rough correlation with angular measurements; index of necrosis was closer than the necrotic angle. Visual estimates from serial MRI images were as accurate as angular measurements. CONCLUSIONS: Simple visual estimates of lesion size from serial MRI images are reasonably accurate and are satisfactory for clinical use. Angular measurements provide some indication of prognosis and treatment; however, they have limited accuracy, with considerable variability between techniques. 3-D MRI volumetric measurements are the most accurate. Using current techniques and software, they are easier to use, requiring similar time and effort to angular measurements. They should be considered for clinical research and publications when the most accurate measurements are required.
Entities:
Keywords:
Adjusted index of necrosis; Classification; Femoral head; Index of necrosis; MRI; Necrotic angle of Kerboul; Osteonecrosis
Authors: David R Steinberg; Marvin E Steinberg; Jonathan P Garino; Murray Dalinka; Jayaram K Udupa Journal: J Bone Joint Surg Am Date: 2006-11 Impact factor: 5.284
Authors: Michael A Mont; German A Marulanda; Lynne C Jones; Khaled J Saleh; Noah Gordon; David S Hungerford; Marvin E Steinberg Journal: J Bone Joint Surg Am Date: 2006-11 Impact factor: 5.284
Authors: Philippe Hernigou; Guillaume Rigoulot; Jean Charles Auregan; Victor Housset; Claire Bastard; Arnaud Dubory; Charles Henri Flouzat Lachaniette Journal: SICOT J Date: 2018-11-05