严重急性呼吸综合征康复患者骨坏死与骨髓转化的MRI研究

目的 采用MRI观察严重急性呼吸综合征（SARS）康复患者骨缺血坏死和股骨骨髓转化,分析SARS骨坏死的MRI特征及骨髓转化的意义。资料与方法 112例SAPS患者行股骨MRI检查,检查序列为SE T1WI及短时间反转恢复序列（STIR）。骨髓转化系数（MCI）值为T1WI干骺端信号强度与大转子信号强度的比值。结果 112例SAPS患者中23例发生骨坏死,双侧股骨头坏死13例,双侧股骨头坏死合并双侧股骨干远端骨梗死1例,单侧股骨头坏死2例,干骺端骨坏死6例,双侧膝关节骨坏死1例,MRI显示坏死区均含黄骨髓。21例无骨髓水肿的骨坏死患者MCI值高于年龄相似的无骨坏死患者,差异具有显著意义（P〈0．05）,两组激素的总量及日平均量差异显著（P〈0．05）。结论 SAPS康复患者骨坏死发生于黄骨髓含量高的部位,MCI对骨坏死的预测有重要意义。     

单侧激素性股骨头坏死患者正常侧股骨头脂肪含量及局部微循环：MR IDEAL-IQ和IVIM-DWI研究

目的:利用磁共振IDEAL-IQ和IVIM-DWI定量分析技术,评估单髋激素性股骨头坏死患者正常侧股骨头的脂肪含量及局部微循环状况及其临床意义.方法:将30例经临床首次确诊的单髋激素性股骨头坏死初治患者及16例性别和年龄相匹配的健康志愿者(对照组)纳入研究,所有患者行X线及MRI检查(包括常规序列、IDEAL-IQ及IVIMDWI),经图像后处理,获得股骨头脂肪含量(FF)及灌注分数(f)值.对各定量参数值在坏死侧、对侧及对照组之间的差异进行统计学分析,并采用ROC曲线评估其诊断效能.结果:对照组的FF值小于对侧组及坏死组,差异均有统计学意义(P＜0.01).坏死组的f值小于对侧正常组及对照组,差异均有统计学意义(P＜0.01).FF值的ROC曲线下面积为0.974,相应的敏感度和特异度分别为96.9％和86.7％(P＜0.01).f值的诊断效能无统计学意义(P＞0.05).结论:单髋激素性股骨头坏死患者的对侧股骨头在常规MRI上无异常形态学改变,但IDEAL-IQ及IVIM-DWI定量分析技术却能显示其内的脂肪含量和微循环状况已发生改变,为股骨头坏死的超早期诊断提供可能.     

成人股骨头缺血性坏死合并骨髓水肿的介入治疗

目的探讨成人股骨头缺血性坏死合并骨髓水肿的介入治疗及其疗效观察。方法选择临床症状突出,经磁共振成像（MRI）检查证实的成人股骨头缺血性坏死合并骨髓水肿的患者20例,24髋,经对侧股动脉插管,分别超选择至患侧旋股内、外动脉,闭孔动脉开口,造影确定导管位置后,灌注溶栓剂、解痉剂及血管扩张剂等。结果①经2次或3次介入灌注术后与灌注前造影片对比,股骨头颈部血管增多、增粗、股骨头染色变深16例22髋,2例2髋改变不明显。②本组20例中有19例患者疼痛消失、明显减轻或缓解,总有效率占95％。③24个髋关节介入治疗前后活动范围均有不同程度改善。④16髋介入治疗后MRI对比,骨髓水肿明显减轻。结论介入灌注术治疗股骨头缺血性坏死合并骨髓水肿疗效确切。     

SARS康复患者骨坏死改变的MRI筛查

目的　探讨SARS康复患者骨缺血坏死的患病率 ,及其与激素使用的关系。方法　对76例SARS康复患者进行双髋和双膝关节MR扫描。其中男 17例 ,女 5 9例。在治疗SARS时 8例未使用激素 ,其余 6 8例均使用了激素治疗 ,其中 30例有确切激素用量、疗程。对患者全身骨关节症状进行问卷调查。由高年资医生阅读MR图像 ,诊断有无骨缺血坏死改变。对骨缺血坏死患病率、激素用量和症状等参数进行统计学分析。结果　 (1)SARS康复患者股骨头和股骨髁部位出现的骨缺血坏死及骨髓内骨梗死的MRI表现符合临床诊断骨缺血坏死者的MRI典型表现。 (2 ) 8例未用过激素的SARS康复患者无一例出现骨缺血坏死改变 ,而 6 8例使用激素患者中 2 5例出现骨缺血坏死改变 ,两组比较差异有显著性意义 (P <0 0 5 )。 2 5例中有 2 0例累及双侧髋或 (和 )膝关节。骨缺血坏死改变累及股骨头 32个 ,股骨髁 2 6个 ,股骨、胫骨骨髓坏死 6处。在 30例有确切激素用量患者中 ,有骨缺血坏死表现的患者 13例 ,其使用激素总量的中位数为 35 70mg、每日最大用量的中位数为 2 5 0mg、激素使用时间的中位为数 2 3d ,均大于无骨缺血坏死组 (17例 ) ,相应中位数分别为 2 5 6 0mg、2 4 0mg和 2 2d。两组之间 3个参数经秩和检验差异无显著性意义 (P值均 >0 0 5 )     

DCE-MRI在JIA受累髋关节股骨头骨髓水肿中的研究初探

目的通过与常规MRI及临床表现的对比观察,探讨动态增强MRI在幼年特发性关节炎髋关节股骨头骨髓水肿评估中的应用价值,获得检测骨髓水肿的敏感量化指标。方法收集确诊为JIA的患儿9例作为病例组,收集10例因其它疾病进行盆腔或髋关节增强MRI的患儿作为对照组。收集患儿的动态增强(DCE)MRI参数、常规MRI、临床表现及红细胞沉降率(ESR)、C反应蛋白(CRP)检测结果,其中DCE数据包括冠状位股骨头最大单层面和股骨头容积测量数据,具体为最大强化率(ME%),强化峰值时间(TTP)和血流量(BF)。为避免年龄等因素的干扰,本组对以上数据进行转换,选择同一患儿双侧髋关节各参数的差异率进行分析。最大单层面参数以下角标max表示,股骨头容积参数以下角标vol表示。采用两独立样本t检验比较病例组与对照组间DCE-MRI各参数的差异;并对常规MRI双侧股骨头骨髓信号无异常病例,根据临床有无4字征进行分组,探讨组间DCE-MRI各参数的差异;此外,对DCE参数与炎性指标的相关性进行分析。结果病例组与对照组DCE参数比较,两组间股骨头最大单层面的MEmax(t=4.805,P0.001)和股骨头容积TTPvol(t=2.785,P=0.011)、BFvol(t=3.885,P=0.001)存在显著性差异。常规MRI双侧股骨头骨髓信号无异常病例中,4字征阳性组和阴性组比较,组间MEmax(t=3.049,P=0.007)和BFvol(t=2.089,P=0.041)具有统计学差异。实验室数据的相关分析显示ESR与DCE-MRI中的MEmax(相关系数r=0.532,P=0.016)具有显著相关性。结论 DCE-MRI能够较常规MRI更为早期敏感地检测到JIA受累关节的骨髓水肿情况,尤其股骨头MEmax和BFvol在检测过程中最为敏感,比临床查体及实验室检查更加精准。     

非创伤性股骨头坏死:不同病因间MRI及病理对比研究

目的 探讨不同病因所致的非创伤性股骨头坏死的MRI及病理学表现是否一致.方法 回顾性分析98例非创伤性股骨头坏死患者共152髋MR表现,98例股骨头坏死病因分别为激素性49例(共86个髋)、酒精性18例(共25个髋)、特发性31例(共41个髋).其中25例(共34个髋关节)行股骨头置换术,对置换所得的股骨头标本行大体切片及组织病理学检查.结果 不同病因所致股骨头坏死均累及股骨头的上外侧.MRI和大体标本上坏死的股骨头均由软骨、坏死区、周围的增生反应区和病灶外正常区组成.增生反应区呈低信号包绕坏死区.不同病理阶段坏死区呈不同的MR信号对应相应的组织病理学改变.结论 不同病因的非创伤性股骨头坏死有着极其相似的MRI和病理表现.     

严重急性呼吸综合征康复者髋、膝关节骨坏死与激素治疗的关系

目的了解严重急性呼吸综合征（SARS）康复者下肢骨缺血与激素治疗的关系。资料与方法对来自广州市5所医院的148例SARS康复医务人员下肢骨包括双侧髋关节及膝关节进行MRI检查。148例中42例未使用激素治疗，106例使用不同剂量的激素治疗。MRI检查分为筛查与详查。筛查包括T1WI及短反转时间反转恢复序列（STIR）冠状位成像。筛查有阳性发现者则进行详查，在筛查的基础上加用横断位、冠状位T2WI及STIR成像。结果42例未使用激素治疗者未发现下肢骨坏死。106例使用激素治疗康复者中，共发现8例骨缺血改变，其中1例为双侧股骨头缺血坏死，2例为单侧股骨头缺血坏死，1例为双侧股骨头、胫骨髁及单侧股骨髁缺血坏死，1例单侧股骨髁缺血坏死，1例单侧股骨颈骨梗死并钙化，2例双侧股骨、胫骨骨髓水肿。多因素Logistic回归分析显示激素累积剂量是骨缺血性坏死最重要的危险因素（P=0．001）。结论使用激素治疗的SARS康复者中，少数发生下肢骨缺血坏死，而激素累积剂量与骨缺血性坏死关系密切。     

正常股骨骨髓MRI定量分析及图像观察

目的　利用SE/T1WI像的信号强度值 ,定量研究股骨红、黄骨髓的转变 ;描述不同年龄组股骨骨髓MRI表现。方法　选择无骨髓相关疾病者 14 2例 ,男 97例 ,女 45例 ,按年龄分为 11组。行股骨冠状SE/T1WI及FS/T2 WI扫描。在SE/T1WI像上测量股骨干、股骨颈、大转子及股骨头的MRI信号强度值。观察股骨不同部位红、黄骨髓转变方式。结果　不同性别股骨各部位MRI信号强度值无显著性差异 (Ρ >0 .0 5 ) ;上述各部位MRI信号强度在 2 5岁以前与年龄呈正相关 (r =0 .71～ 0 .91,Ρ <0 .0 0 0 1) ,其后则随年龄增长 ,MRI信号强度变化不显著 (r =0 .0 4～ 0 .2 4,Ρ >0 .0 5 ) ;股骨近端MRI表现分为四型 ,各型在不同年龄组所占比例不同 ;股骨干 5岁前MRI表现为红骨髓 ,10岁后为黄骨髓。股骨头及大转子骨化中心一旦出现即为黄骨髓信号。结论　MRI信号强度值的测定可用于观察股骨红、黄骨髓的转变 ,MRI能区分股骨红、黄骨髓及不同年龄的表现特点     

MRI随访在经导管灌注治疗非创伤性股骨头缺血性坏死疗效评估中的价值

目的 探讨MRI随访在经导管动脉灌注(TAI)治疗非创伤性股骨头缺血性坏死(ANFH)疗效评估中的价值.方法 对22例(30髋)经临床和影像学检查确诊的非创伤性ANFH患者采用TAI治疗,并比较治疗前后临床症状、髋关节功能及MRI影像改变.随访观察9～ 36个月.按ARCO分期,0期1髋;Ⅰ期6髋;Ⅱ期20髋;Ⅲa期3髋.结果 TAI术后,0期+Ⅰ期患者髋关节功能评分由术前平均(82.7±2.48)分增至术后平均(99.98±3.45)分;Ⅱ期患者髋关节功能评分由术前平均(76.9±3.23)分增至术后平均(95.07±3.68)分;Ⅲa期患者髋关节功能评分由术前平均(69.8±1.22)分增至术后平均(90.09±3.17)分.差异均有显著性统计学意义(P＜0.05).MRI随访发现19髋(63.3％)有不同程度好转,股骨头坏死区病灶稳定,见增生、硬化及囊变缩小,骨髓水肿范围变小,髋关节积液减少;2髋(6.7％)病变基本保持不变;9髋(30％)病变加重,表现为骨髓水肿范围增大、髋关节积液增多,但在继续随访中病变好转.结论 非创伤性ANFH患者TAI术后MRI随访有一定的价值,但需结合患者的临床及其他影像资料才是科学的随访措施.     

儿童股骨头坏死磁共振早期的定量研究北大核心CSCD

目的:使用磁共振增强序列测量减影后信号强度和骨骺软骨面积以评价儿童发育性髋关节发育不良(DDH)并发股骨头坏死患者复位术前后的改变。方法:回顾性纳入2018年1月—2021年7月在本院接受髋关节MRI检查的DDH并发股骨头坏死患儿28例(男25例,女3例)为研究对象,定量分析其磁共振减影信号强度和骨骺软骨面积,以减影后的图像表示血液灌注的效果。结果:儿童股骨头坏死患侧和健侧骨骺软骨面积分别为(0.232±0.074)cm^(2)和(0.358±0.104)cm^(2),差异有统计学意义(P<0.001)。术前、术后减影信号强度与软骨面积都有很好相关性(r=0.683,r=0.513,均P<0.001)。结论:磁共振增强减影的方法能显示股骨头血流灌注微循环和软骨生长情况,有助于对儿童股骨头坏死的早期发现。     

Bone scintigraphy screening for osteonecrosis of the shoulder in patients with non-traumatic osteonecrosis of the femoral head

OBJECTIVE: In patients with non-traumatic osteonecrosis of the femoral head (ONFH), the shoulder is one of the major affected sites secondary to the proximal and distal femur in cases of multiple osteonecrosis. The present study attempted to investigate whether technetium bone scintigraphy is useful for screening of non-traumatic osteonecrosis of the shoulder (ONS). DESIGN AND PATIENTS: A total of 170 shoulder joints in 85 patients with ONFH were evaluated by bone scintigraphy and the findings compared with those of magnetic resonance imaging (MRI). The MR diagnosis was used as the gold standard. RESULTS: Based on the diagnosis by MRI, ONS was detected in 43 shoulders of 27 patients (25%). All necrotic lesions were located in the humeral head. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of bone scintigraphy for ONS detection were 65%, 81%, 77%, 54% and 87%, respectively. When the necrotic angle of the lesions on the mid-coronal MRI was more than 40 degrees, the sensitivity of bone scintigraphy for ONS detection increased to 88% (21/24 shoulders). CONCLUSION: Bone scintigraphy may be useful for demonstrating medium or large ONS lesions on screening of patients with ONFH.     

Correlation between baseline femoral neck marrow status and the development of femoral head osteonecrosis in corticosteroid-treated patients: a longitudinal study by MR imaging

OBJECTIVE: To test the hypothesis that the development of corticosteroid (CS)-associated femoral head osteonecrosis (ON) is influenced by baseline femoral neck marrow status. PATIENTS AND METHODS: The population consisted of 20 untreated patients with a newly diagnosed rheumatic disease in whom a standardized CS regimen was planned. Before CS treatment, baseline femoral neck marrow status was determined by magnetic resonance (MR) imaging on T1-weighted images (proportion of surface area of femoral neck and intertrochanteric area occupied by fatty marrow; index of marrow conversion [IMC]) and on a quantitative MR sequence (bulk T1 values of femoral head and neck). The presence of ON was assessed by coronal T1-weighted MR images of the hips at 6 and 12 months. RESULTS: None of the patients suffered from ON at baseline. Four patients (20%) developed bilateral femoral head ON at 6 months. The mean percentage of fat marrow in the femoral neck before treatment was significantly higher in ON-positive than in ON-negative patients (p=0.0025). The mean baseline femoral neck IMC value, which parallels the degree of red to yellow marrow conversion, was higher in ON-positive than in ON-negative patients (p=0.089). The mean baseline bulk T1 value of the femoral neck (but not of the femoral head), which inversely correlates with the amount of fat marrow, was significantly shorter in ON-positive than in ON-negative patients (p=0.0298). CONCLUSION: The development of CS-associated femoral head ON is correlated with a high fat content in the proximal femur before CS therapy.     

常规CT联合虚拟去钙技术诊断早期股骨头坏死的可行性研究

目的 探讨常规CT联合虚拟去钙技术(VNCa)对早期股骨头坏死(ONFH)诊断的价值.方法 前瞻性搜集2020年9月至2021年4月本院拟诊断为ONFH的患者共58例,排除骨折、骨性关节炎,先天性髋关节发育不良、髋关节置换术后、无MR检查患者30例,经X线检查或CT检查排除ONFH(3、4期)髋关节19个,共纳入28例...     

MRI of joint fluid in femoral head osteonecrosis

OBJECTIVE: To evaluate the relationship between joint fluid, intramedullary pressure (IMP), bone marrow edema, and stages of osteonecrosis of the femoral head (ONFH). MATERIAL AND METHODS: We reviewed the magnetic resonance (MR) images of 28 patients with 40 documented ONFHs. IMP was measured in 16 symptomatic hips. The amount of joint fluid was graded as 0 (no fluid), 1 (fluid <5 mm in width), or 2 (fluid > or = 5 mm in width) adjacent to the entire length of the femoral neck. Associated focal and diffuse bone marrow abnormalities were evaluated. A control group of 29 recruited individuals without symptoms related to hip disease were examined. Follow-up MR images were obtained in four patients (five affected hips) 6-10 months after core decompression. RESULTS:Of the 40 affected hips, the severity of ONFH was divided into stages 0 (n=4), I (n=28), and II (n=8 hips) on MR findings. The correlation of joint fluid to IMP and to the presence of bone marrow edema was poor. The amount of joint fluid correlated significantly with the stage of ONFH. None of the five affected hips showed decreased joint fluid on follow-up MR images. CONCLUSION:The amount of joint fluid correlates well with the stage of ONFH. The amount of joint fluid does not correlate with IMP or bone marrow edema.     

股骨头缺血性坏死的MRI表现

目的：探讨常规MRI平扫及增强扫描对股骨头缺血性坏死的诊断价值。方法：对30例确诊为股骨头缺血性坏死患者进行常规MRI平扫检查（共51个缺血性坏死股骨头）、其中10例加做增强MRI检查（共15个缺血性坏死股骨头）。结果：按股骨头缺血性坏死MRI分期,I期见于13个股骨头,Ⅱ期见于19个股骨头,Ⅲ期见于8个股骨头,Ⅳ期见于11个股骨头。增强MRI强化表现为：无强化（n=2）;轻微强化为主（n=10）和强化较明显（n=3）。骨髓水肿10例。髋关节积液48例。结论：常规MRI与增强MRI检查相结合可更好的反映病理改变过程,评估组织活性,有利于临床医师判断病程分期,选择治疗方案。     

Reproducibility of MR perfusion and 1H spectroscopy of bone marrow

Purpose

To determine the reproducibility of proton (¹H) magnetic resonance (MR) spectroscopy and dynamic contrast‐enhanced MR imaging in a clinical setting for the assessment of marrow fat fraction and marrow perfusion in longitudinal studies.

Materials and Methods

In all, 36 subjects (17 females, 19 males, mean age 72.9 ± 2.9 years) who underwent MR spectroscopy and/or dynamic contrast‐enhanced perfusion imaging of the proximal femur were asked to return after 1 week for a repeat MR examination.

Results

Reproducibility of ¹H MR spectroscopy in all bone areas tested was high, ranging from 0.78–0.85, with the highest reproducibility being in the femoral head and lowest in the femoral neck. Reproducibility of paired perfusion measurements ranged from 0.59 (enhancement slope femoral head) to 0.98 (enhancement maximum acetabulum). Overall reproducibility of ¹H MR spectroscopy and dynamic contrast‐enhanced imaging tended to be best in areas with the highest inherent fat fraction or perfusion.

Conclusion

Reproducibility of ¹H MR spectroscopy or perfusion imaging is sufficiently high to warrant these techniques being applied to the longitudinal study of bone diseases. J. Magn. Reson. Imaging 2009;29:1438–1442. © 2009 Wiley‐Liss, Inc.     

MR imaging findings in transient osteoporosis of the hip

Purpose: The authors sought to describe the magnetic resonance (MR) imaging findings including perfusion imaging, in association with the course of acute bone marrow oedema syndrome (aBMEs), in a group of patients with acute hip pain and a final diagnosis of transient osteoporosis of the hip (TOH). Materials and methods: From 217 patients referred with a probable diagnosis of avascular necrosis (AVN) of the femoral head, we identified 42 patients who had clinical and radiographic findings not relevant to AVN. MR imaging examinations were performed on a 1.0T scanner. Perfusion imaging was performed in 20 patients. The bone marrow oedema (BME) was classified in four stages. In addition, the presence or absence of oedema in the subchondral area and the presence of other subchondral lesions were recorded. Acetabular bone marrow was also assessed for the presence of oedema. The quantitative measurements included: maximum size of the effusion, percentage of enhancement (PE) and time of peak enhancement of abnormal marrow compared to the first pass, on the perfusion images. Results: Osteopenia was present on plain radiographs in 87% of cases. The most common pattern of BME was extending to the femoral head and neck. Acetabulum was involved in 16.6%. In 22.6% the BME spared the subchondral region of the femoral head. There were two cases (4.7%) with subchondral changes. A joint effusion was noted in 33 of the 42 patients. On perfusion imaging, a delayed peak enhancement was noted in 20 patients between 40 and 65 s after the first pass of contrast. No patient had any evidence of femoral head collapse or change in sphericity on follow-up MRI. None of the patients developed avascular necrosis in a time frame of 18 months from the onset of the acute hip pain. Conclusion: The aBMEs MR imaging pattern varies and is most commonly appearing on X-rays as osteopenia. Absence of subcondral lesions, delayed peak enhancement of the abnormal marrow on perfusion images, and sparing of subchondral zone from marrow oedema are MR imaging findings highly correlated to TOH.     

Bone marrow perfusion evaluated with gadolinium-enhanced dynamic fast MR imaging in a dog model

The authors studied, in a dog model, the feasibility of using gadolinium-enhanced dynamic magnetic resonance (MR) imaging to noninvasively monitor bone marrow perfusion of the proximal femur. With a gradient-recalled acquisition, sequential images of 10 hips in five healthy dogs were obtained for 14 minutes after an intravenous bolus injection of 0.2 mmol of gadopentetate dimeglumine per kilogram. The study was repeated after unilateral arterial embolization of major femoral vessels. Radiolabeled microspheres were injected before and after vessel occlusion. After unilateral embolization, statistically significant differences in enhancement were observed between embolized and control sides (eg, 31% vs 83% average peak enhancement in the femoral neck). There was a high correlation (r = .81 [average]) between the MR data and the microsphere blood flow measurements. The postembolization data indicate that contrast-enhanced fast MR imaging may allow early detection of abnormal bone marrow flow. This technique may be valuable in evaluating patients at risk for avascular necrosis of the femoral head, especially in posttraumatic cases.     

Effect of Arterial Deprivation on Growing Femoral Epiphysis: Quantitative Magnetic Resonance Imaging Using a Piglet Model

Objective

To investigate the usefulness of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion MRI for the evaluation of femoral head ischemia.

Materials and Methods

Unilateral femoral head ischemia was induced by selective embolization of the medial circumflex femoral artery in 10 piglets. All MRIs were performed immediately (1 hour) and after embolization (1, 2, and 4 weeks). Apparent diffusion coefficients (ADCs) were calculated for the femoral head. The estimated pharmacokinetic parameters (Kep and Ve from two-compartment model) and semi-quantitative parameters including peak enhancement, time-to-peak (TTP), and contrast washout were evaluated.

Results

The epiphyseal ADC values of the ischemic hip decreased immediately (1 hour) after embolization. However, they increased rapidly at 1 week after embolization and remained elevated until 4 weeks after embolization. Perfusion MRI of ischemic hips showed decreased epiphyseal perfusion with decreased Kep immediately after embolization. Signal intensity-time curves showed delayed TTP with limited contrast washout immediately post-embolization. At 1-2 weeks after embolization, spontaneous reperfusion was observed in ischemic epiphyses. The change of ADC (p = 0.043) and Kep (p = 0.043) were significantly different between immediate (1 hour) after embolization and 1 week post-embolization.

Conclusion

Diffusion MRI and pharmacokinetic model obtained from the DCE-MRI are useful in depicting early changes of perfusion and tissue damage using the model of femoral head ischemia in skeletally immature piglets.