Epiphysäre Osteonekrosen

Zusammenfassung

Beim epiphysären Knocheninfarkt und der epiphysären Osteonekrose handelt es sich um pathophysiologisch noch nicht vollständig geklärte Krankheitsbilder, die klinisch unterschieden werden müssen. Die möglichen und relevanten radiologischen Befunde werden unter besonderer Hervorhebung der MRT herausgearbeitet. Die Bildgebung liefert entscheidende Befunde zur Diagnosestellung und insbesondere zur Prognose. Schließlich wird auf einige, im Einzelfall durchaus schwierige Differenzialdiagnosen, wie die Insuffizienzfrakturen, das transiente Knochenmarködem und die rapid destruierende Arthrose, eingegangen.

Abstract

Based on a pathophysiological point of view, epiphyseal infarcts and epiphseal osteonecrosis are not fully understood. However, both entities have to be separated from each other clinically. The relevant radiographic signs of both entities are described, with emphasis on MRI. Imaging provides relevant, yet decisive finding for diagnosis and prognosis. In the epiphyses of long bones several differential diagnoses have to be considered, e. g. insufficiency fractures, transient bone marrow edema, and rapid destructive osteoarthritis.

Magnetic resonance imaging - infarct - hip joint - osteonecrosis, AVN, ischemia - bone marrow edema

Literatur

• 1 Fujioka M, Kubo T. et al . Initial changes of non-traumatic osteonecrosis of femoral head in fat suppression images: bone marrow edema was not found before the appearance of band patterns.  Magn Reson Imaging. 2001;  19 985-991
• 2 Cheng E Y, Thongtrangan I, Laorr A, Saleh K J. Spontaneous resolution of osteonecrosis of the femoral head.  J Bone Joint Surg Am. 2004;  86 2594-2599
• 3 Vande Berg B C, Bohndorf K. Osteonekrose. In: Bohndorf K, Imhof H, Fischer W (Hrsg) Radiologische Diagnostik der Knochen und Gelenke. Stuttgart; Thieme 2006: 236-247
• 4 Yamamoto T, DiCarlo E F, Bullough P G. The prevalence and clinicopathological appearance of extension of osteonecrosis in the femoral head.  J Bone Joint Surg Br. 1999;  81 328-332
• 5 Hernigou P, Poignard A, Nogier A, Manicom O. Fate of very small asymptomatic stage-I osteonecrotic lesiions of the hip.  J Bone Joint Surg Am. 2004;  86 2589-2593
• 6 Lafforgue P. Pathophysiologiy and natural history of avascular necrosis of bone.  Joint Bone Spine. 2006;  73 500-507
• 7 Yao L, Stanczak J, Boutin R D. Presumptive subarticular stress reactions of the knee: MRI detection and association with meniscal tear pattern.  Skeletal Radiol. 2004;  33 260-264
• 8 Mont M A, Marulanda G A. et al . Systematic analysis of classification systems for osteonecrosis of the femoral head.  J Bone Joint Surg Am. 2006;  88 S16-26
• 9 Iida S, Harada Y. et al . Correlation between bon marrow edema and collapse of the femoral head in steroid-induced osteonecrosis.  AJR. 2000;  174 735-743
• 10 Ito H, Matsuno T, Minami A. Relationship between bone marrow edema and development of symptoms in patients with osteonecrosis of the femoral head.  AJR. 2006;  186 1761-1770
• 11 Huang G S, Chan W P. et al . MR imaging of bone marrow edema and joint effusion in patients with osteonecrosis of the femoral head: relationship to pain.  AJR. 2003;  181 545-549
• 12 Shimizu K, Moriya H. et al . Prediction of collapse with magnetic resonance imaging of avascular necrosis of the femoral head.  J Bone Joint Surg Am. 1994;  76 215-223
• 13 Vande Berg B C, Malghem J J. et al . Idiopathic bone marrow edema lesions of the femoral head: predictive value of MR imaging findings.  Radiology. 1999;  212 527-535
• 14 Lecouvet F E, Vande B erg. et al . Early irreversible osteonecrosis versus transient lesions of the femoral condyle: Prognostic value of subchondral bone and marrow changes on MR imaging.  AJR. 1998;  170 71-77
• 15 Davies M, Cassar-Pullicinio V N, Darby A J. Subchondral insufficiency fractures of the femoral head.  Eur Radiol. 2004;  14 201-207
• 16 Yamamoto T, Bullough P G. Subchondral insufficiency fracture of the femoral head. A differential diagnosis in acute onset of coxarthrosis in the elderly.  Arthritis Rheum. 1999;  42 2719-2723
• 17 Yamamoto T, Kubo T. et al . A clinicopathologic study of transient osteoporosis of the hip.  Skeletal Radiol. 1999;  28 621-627
• 18 Kim Y M, Oh H C, Kim H J. The pattern of bone marrow oedema on MRI in osteonecrosis of the femoral head.  J Bone Joint Surg Br. 2000;  82 837-841
• 19 Yamamoto T, Bullough P G. The role of subchondral insufficiency fracture in rapid destruction of the hip joint: a preliminary study.  Arthritis Rheum. 2000;  43 2423-2427