Subchondral linear hyperintensity of the femoral head: MR imaging findings and associations with femoro-acetabular joint pathology

• Published in: Diagnostic and interventional imaging 2017-03, Vol.98 (3), p.245-252
• Main Authors: Gondim Teixeira, P.A, Savi de Tovi, K.-M, Abou Arab, W, Raymond, A, Louis, M, Polet Lefebvre, K, Blum, A
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Cartilage Diseases - diagnostic imaging; Case-Control Studies; Female; Femoral head; Femur Head - diagnostic imaging; Hip Fractures - diagnostic imaging; Hip Joint - diagnostic imaging; Humans; Magnetic Resonance Imaging; Male; Middle Aged; MR imaging; Osteonecrosis; Osteonecrosis - diagnostic imaging; Radiology; Retrospective Studies; Subchondral bone; Subchondral insufficiency fracture; Young Adult
• ISSN: 2211-5684; 2211-5684
• DOI: 10.1016/j.diii.2016.06.006

Abstract Purpose The goal of this study was to evaluate the associations between linear hyperintensity in the subchondral bone of the femoral head on T2-weighted MR imaging and structural bone lesions. Material and methods The MR imaging examinations of 63 patients (66 hips) that showed a bone marrow edema pattern (BMEP) of the hip were retrospectively evaluated (study group). The study group comprised 43 men and 20 women, with a mean age of 55.3 years ± 16.9 (SD) (range: 19–84 years). A control group of 61 patients (77 hips) without BMEP of the hip on MR imaging was created. The control group comprised 30 men and 31 women, with a mean age of 53.1 years ± 15.6 (SD) (range: 25–83 years). The presence of linear abnormalities of the subchondral bone on T2-weighted fat-saturated sequences (TR/TE = 4220–4340/42–45 ms) was evaluated and MR imaging findings were correlated with structural femoro-acetabular pathology (advanced chondropathy, osteonecrosis, subchondral insufficiency fractures and macroscopic fractures) and with pain duration. Results A linear hyperintensity in the subchondral bone on T2-weighted MR imaging was found in 43/66 hips with areas of BMEP (65.1%) and in 3/77 hips without BMEP (3.8%). Subchondral linear hyperintensity was seen in 15/16 (93.7%) hips with a subchondral insufficiency fracture. Among the 16 hips with an ARCO stage III osteonecrosis, 13 (76.9%) presented BMEP associated with a subchondral linear hyperintensity. BMEP was present in 6/8 hips with ARCO stage IV osteonecrosis; however, only two hips (25%) exhibited subchondral linear hyperintensities. Finally, 77.7% of patients with subchondral linear hyperintensities presented with acute or subacute hip pain ( P < 0.0001). Conclusion Femoral head subchondral linear hyperintensity on T2-weighted MR imaging is common and is associated with acute subchondral bone damage.