Measurement of bone marrow blood volume in the knee by positron emission tomography.
Iida S,Harada Y,Ikenoue S,Moriya H
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association
Positron emission tomography was used to measure bone marrow blood volume (BBV), an important hemodynamics parameter, in the knee. The subjects were 11 healthy male volunteers (mean age, 23.6 years; range, 21-27 years). The 15O-labelled carbon monooxide (C15O) single-breath inhalation method was used. In the distal femur, regional (r) BBV in the posterior area of the epiphysis (medial, 2. 25 ml/100 cm3 bone marrow; lateral, 2.03 ml/100 cm3) was significantly less than that in the anterior area of the epiphysis (medial, 3.48 ml/100 cm3; lateral, 3.01 ml/100 cm3) and that in the metaphysis-to-distal diaphysis (2.90-3.67 ml/100 cm3). In the proximal tibia, rBBVs in the metaphysis-to-proximal diaphysis (2. 32-2.76 ml/100 cm3) were significantly less than those in the area of the physis (medial, 3.30 ml/100 cm3; lateral, 3.53 ml/100 cm3). These regional differences in rBBV within the knee may be associated with the development of ischemic bone marrow disorders, such as steroid-induced osteonecrosis, in the knee.
Assessment of vascularity of head of femur by bone scan and histopathology.
Sundram F X,Daruwalla J S,Pang M,Nather A
Annals of the Academy of Medicine, Singapore
A prospective study of 17 patients with fracture neck of femur was undertaken to study the vascularity of the femoral head by bone scan using Technetium-99m MDP, as well as to study the viability of the femoral head by histopathology, and therefore determine correlation, if any, between these two methods. Treatment was by primary endoprosthetic replacement (Moore's Arthroplasty). In 16 of the 17 patients the bone scan showed decreased vascularity of the head, but histopathological examination could not confirm non-viability of the head. It is likely that, since the majority of the patients were operated on within 4 days, there was insufficient time for histopathological evidence of ischemia to develop, prior to removal of the femoral heads.
[Prediction of segmental collapse of femoral head after femoral neck fracture by scintimetry].
Dong Q R,Wang J X,Dong T H
Zhonghua wai ke za zhi [Chinese journal of surgery]
A follow-up study regarding the occurrence of segmental collapse of femoral head has been done in 53 patients of united femoral neck fracture including a periodic examination by 99mTc-MDP scintimetry. The results showed that the sequential variations in the nuclide uptake ratio of the femoral heads could reflect the histological repairing process and metabolic level in the femoral head. A sustainedly high nuclide uptake in 12 months after operation often denotes that there are defects in the repairing process of the ischemic femoral head, and that the segmental collapse of the femoral head will ensue.
Prediction of traumatic avascular necrosis of the femoral head by single photon emission computerized tomography and computerized tomography: an experimental study in dogs.
Shen Feng,Yan Zuo-Qin,Guo Chang-An,Shi Hong-Cheng,Gu Yu-Shen,Zeng Meng-Su,Lu Xiao-Yu,Liu Jun
Chinese journal of traumatology = Zhonghua chuang shang za zhi
OBJECTIVE:To evaluate the femoral head perfusion and to predict the traumatic avascular necrosis (AVN) of the femoral head by single photon emission computerized tomography and computerized tomography (SPECT/CT). METHODS:Totally 18 adult beagle dogs were divided randomly into three equal-sized (n equal to 6) groups. Subsequently different degrees of ischemia model were developed by destroying blood vessels of the femoral head. The left hip received sham operation as normal control and the right hip underwent blood interruption. In Group A, the ligamentum teres was cut off. In Group B, the marrow cavity of the right femoral neck was destroyed while in Group C, the soft tissues at the base of the femoral neck were stripped in addition to the resection of the ligamentum teres and destruction of the marrow cavity. Three hours after surgery, SPECT/CT was performed. Laser Doppler Flowmetry (LDF) measurements were also obtained at three different time points (before operation, immediately and three hours after operation) in order to assess the change process of blood supply to the femoral head. RESULTS:SPECT/CT showed no significant difference in the radionuclide uptake between the right and left femoral heads in Group A (t equal to -0.09, P equal to 0.94) and Group B (t equal to 0.52, P equal to 0.62). However, in Group C, it was 261+/-62 for the right femoral head, only 12% of that in the left femoral head. LDF measurements indicated that the femoral head perfusion was decreased from (45.0+/-3.3) PU to (39.1+/-3.7) PU in Group A,from (44.0+/-2.7) PU to (34.3+/-2.6) PU in Group B, and from (47.3+/-2.1) PU to (4.96+/-0.6) PU in Group C immediately after operation. However, the perfusion was restored and returned to normal values three hours after operation except in Group C. CONCLUSION:SPECT/CT could assess the perfusion of the femoral head semiquantitatively, which might be useful in predicting the development of traumatic AVN.
Evaluation of the hemodynamics of the femoral head compared with the ilium, femoral neck and femoral intertrochanteric region in healthy adults: measurement with positron emission tomography (PET).
Nakamura Fuminori,Fujioka Mikihiro,Takahashi Kenji A,Ueshima Keiichiro,Arai Yuji,Imahori Yoshio,Itani Kenji,Nishimura Tsunehiko,Kubo Toshikazu
Annals of nuclear medicine
OBJECTIVE:Non-traumatic osteonecrosis of the femoral head (ONF) is considered to be a disease that occurs primarily due to ischemia of the femoral head, while its etiology and pathology are not fully understood. It is therefore necessary to identify the characteristics of the hemodynamics of the femoral head. In this study, the hemodynamics in the ilium and proximal regions of the femur, including the femoral head, was investigated using positron emission tomography (PET). METHODS:The subjects of this study consisted of 8 hip joints of four healthy male adults and 3 hip joints on the contralateral side of a femoral neck fracture, avulsion fracture of the greater trochanter and coxarthrosis (1 case each, all females) for a total of 11 hip joints of 7 subjects. The ages of the subjects ranged from 25 to 87 years (average age: 54 years). Blood flow was measured by means of the H215O dynamic study method and blood volume was measured by means of the 15O-labeled carbon monoxide bolus inhalation method. RESULTS:Blood flow was determined to be 9.1 +/- 4.8 ml/min/100 g in the ilium and among proximal regions of the femur (femoral head, neck and intertrochanteric region), 1.8 +/- 0.7 ml/min/100 g in the femoral head, 2.1 +/- 0.6 ml/min/100 g in the femoral neck, and 2.6 +/- 0.7 ml/min/100 g in the intertrochanteric region. In addition, blood volume was 4.7 +/- 1.3 ml/100 g in the ilium, and among proximal regions of the femur, 1.1 +/- 0.5 ml/100 g in the femoral head, 2.1 +/- 0.7 ml/100 g in the femoral neck, and 2.6 +/- 0.9 ml/100 g in the intertrochanteric region. The results showed that both blood flow and volume were lowest in the femoral head. Blood flow and volume were significantly lower in the proximal regions of the femur (femoral head, neck and intertrochanteric region) than in the ilium (p < 0.01). CONCLUSION:The present study demonstrated that the femoral head is in a hypoemic state as compared with other osseous tissue, indicating that even the slightest exacerbation of hemodynamics in the femoral head can trigger an ischemic condition culminating in ONF.
Transient ischaemia of the proximal femoral epiphysis in the child. Interpretation of bone scintimetry for diagnosis in hip pain.
Wingstrand H,Bauer G C,Brismar J,Carlin N O,Pettersson H,Sundén G
Acta orthopaedica Scandinavica
99mTc-MDP-scintimetry was performed in 25 consecutive cases of radiographically silent transient synovitis of the hip in children. Fourteen cases had normal scintimetry; seven cases had an increased uptake in the epiphysis; four cases had markedly defective uptake in the epiphysis, indicating interrupted vascular supply. At repeat scintimetry 6 weeks later, the uptake was normal or increased in three of these four cases; the one case with a persistent defect was the only case in this series who later developed radiographic evidence of Legg-Calvé-Perthes' disease. In some cases presenting with clinical symptoms of synovitis of the hip, there is a transient, spontaneously recovering ischaemia of the proximal femoral epiphysis, not followed by radiographic evidence of necrosis. This should be considered in attempts to make a pre-radiographic diagnosis of Legg-Calvé-Perthes' disease by radionuclide methods.
Diffusion-weighted MRI reveals epiphyseal and metaphyseal abnormalities in Legg-Calvé-Perthes disease: a pilot study.
Yoo Won Joon,Kim Young-Jo,Menezes Nina M,Cheon Jung-Eun,Jaramillo Diego
Clinical orthopaedics and related research
BACKGROUND:Legg-Calvé-Perthes disease (LCP) is thought to be associated with ischemic events in the femoral head. However, the types and patterns of reperfusion after these ischemic events are unclear. PURPOSES:We therefore determined whether (1) there would be any age-related diffusion changes; (2) diffusion-weighted MR imaging would reveal ischemic damage; and (3) diffusion changes are correlated with prognostic MR findings in patients with LCP. METHODS:We prospectively performed conventional, perfusion, and diffusion-weighted MR imaging studies in 17 children with unilateral LCP. We then measured the apparent diffusion coefficient (ADC) values in the epiphysis and the metaphysis, and compared them with those of the contralateral normal side. Based on perfusion MR imaging, we assessed reperfusion to the epiphysis as either periphyseal or transphyseal. We studied T2-signal intensity changes in the metaphysis and the presence of focal physeal irregularity. We correlated diffusion changes with reperfusion to the epiphysis, T2-signal intensity change, and focal physeal irregularity. RESULTS:Normal diffusion decreased with age. In LCP hips, epiphyseal diffusion increased early and remained elevated through the healing stage. Six of the 17 patients who had a metaphyseal ADC greater than 50% over the normal side had 13 times greater odds of having an association with transphyseal reperfusion to the epiphysis. The increase of metaphyseal ADC also was associated with an increased T2-signal intensity in the metaphysis and presence of focal physeal irregularity. CONCLUSIONS:Diffusion-weighted MR imaging can be used as a complimentary modality to evaluate ischemic tissue damage with a potential prognostic value in patients with LCP.
Role of free vascularized bone grafts in the experimentally-induced ischemic necrosis of the femoral head.
González del Pino J,Gómez Castresana F,Benito M,Weiland A J
Journal of reconstructive microsurgery
In 15 mongrel adult dogs, an ischemic necrosis of the femoral head was produced, following the technique described by Gartsman and colleagues. Five weeks later, a 6- to 8-cm long rib graft was harvested with its vascular bundle and transferred into the previously induced ischemic femoral head. Microsurgical anastomoses were performed for revascularizing the rib graft. Dogs were studied using scintigraphy, blood flow measurements, roentgenograms, angiograms, and histology at four, eight and 12 weeks after grafting. New bone and vascular formation was exhibited throughout the study, as demonstrated by a highly positive scintigraphic activity and the formation of numerous arterial terminal branches arising from the rib graft circulation which entered the femoral head and reached the subchondral plate. The formerly necrotic femoral head bone exhibited osteoblastic activity, viable osteocytes, and well-populated bone marrow. The rib graft was also incorporated into the femoral head. These results suggest that a vascularized bone graft is able to repair a femoral head necrosis, and may be considered a rational approach for clinical purposes.
A comparison of magnetic resonance imaging to bone scintigraphy in early traumatic ischemia of the femoral head.
Ruland L J,Wang G J,Teates C D,Gay S,Rijke A
Clinical orthopaedics and related research
In adult rabbits, a unilateral subcapital osteotomy of the femoral neck was performed to induce avascularity. One half of the osteotomy sites were fixed with a magnetic resonance imaging (MRI) compatible absorbable pin and the other osteotomies had no fixation. The femoral heads were studied at three, five, and 12 days with roentgenographs, bone scintigraphy, and MRI, and MRI only at four weeks and six weeks after osteotomy. Histologic studies were performed after imaging to evaluate the viability of the femoral heads. At three, five, and 12 days after osteotomy, bone scintigraphy showed a decrease in uptake of radioisotope in the region of the femoral head on the operated side relative to the acetabulum and greater trochanter in 17 of 18 rabbits. A comparison of the surgically treated hip to the normal hip in fixed and unfixed osteotomies showed no change in the signal behavior of T1- or T2-weighted images in all rabbits Days 3, 5, and 12 (n = 18) after operation. The rabbit femoral heads with fixation of the osteotomy 28 days after operation showed a decrease in signal intensity in the subcapital region of the femoral head. Six weeks after operation, the fixed femoral head shows a loss of signal in a portion of the femoral head near the osteotomy. The MRI signal intensity appears to increase in the unfixed femoral heads six weeks after operation.(ABSTRACT TRUNCATED AT 250 WORDS)
[Bone infarction, or idiopathic metaphyseal and diaphyseal aseptic osteonecrosis of the long bones. Update and contribution of new imaging technics].
Lafforgue P,Schiano A,Acquaviva P C
Revue du rhumatisme et des maladies osteo-articulaires
Twenty patients with "idiopathic" bone infarction were studied. There were 18 men and 2 women, age 30 to 69 years, at the time of the diagnosis (mean age = 49 years). Sixty-five lesions were recorded with a marked predominance to the lower extremities (77 p. cent are located around the knees) and to the metaphysis (only three pure diaphyseal lesions). Considered asymptomatic, these lesions were painful in 6 patients. They are multiple, and in this case symmetrical, in 12 patients (60 p. cent). X-Rays disclose the classic heterogeneous ball-like, smoke twirled or encapsulated calcifications. A periosteal thickening opposite the lesions was observed in 6 patients; this may be the only radiological sign. Finally, 18 of the 65 lesions were not visible on standard X-Rays, and obvious on MRI. The MRI aspect is characteristic and may be superposed on the basic lesions already described in the course of aseptic osteonecroses of the femoral head. This is, besides, the most sensitive test, snowing a larger number of more extended necroses than the other examinations. CT scanning as well as scintigraphy present a limited advantage. More than half of the patients also present epiphyseal aseptic osteonecroses, often multiple (55 sites for 13 patients), and often unrecognized. The etiological factors are in fact common to both of these diseases: steroid therapy, alcoholism, dyslipidemia, idiopathic forms. Among the possible causes, the literature mentions lupus erythematosus, renal transplant, cytosteatonecrosis, arteriopathies while there is no post-traumatic form. All of the characteristics of these bone infarctions determine a topographic form of the osteonecrotic disease.(ABSTRACT TRUNCATED AT 250 WORDS)
Tracer accumulation in femoral head during early phase of bone scintigraphy after renal transplantation.
Kubota T,Ushijima Y,Okuyama C,Kubo T,Nishimura T
Journal of nuclear medicine : official publication, Society of Nuclear Medicine
UNLABELLED:Nontraumatic osteonecrosis of the femoral head (ONF) is a complication of renal transplantation. The pathogenic mechanism of ONF is thought to be an ischemic event. The purpose of this study was to investigate whether 3-phase bone scintigraphy can reveal early hemodynamic changes associated with ONF after renal transplantation. METHODS:We performed 3-phase bone scintigraphy on 19 renal allograft recipients between 3 and 9 wk after they underwent renal transplantation. Regions of interest (ROI) were assigned bilaterally in the femoral heads, diaphyses, and soft tissue. The head-to-diaphysis ratio (HD) in each phase was then calculated. RESULTS:ONF occurred in 8 femoral heads of 4 patients. Three of the 4 ONF patients had no abnormal MRI findings at the time of bone scintigraphy. In phase 1, no significant difference in HDs was observed between the ONF patients (mean HD +/- SD, 0.62 +/- 0.44) and the non-ONF patients (0.31 +/- 1.40). The difference between the mean counts for bone and soft tissue was small in both instances, and the HD had a large dispersion. In phase 2, the HDs for the ONF patients (0.70 +/- 0.27) and the non-ONF patients (1.31 +/- 0.43) were significantly different (P = 0.0005). The HD was <1.00 in all femoral heads of the ONF patients, whereas 9 non-ONF heads had an HD that was <1.00. In phase 3, the HD of the ONF patients was significantly lower than that of the non-ONF patients (ONF patients, 0.92 +/- 0.17; non-ONF patients, 1.62 +/- 0.46; P = 0.0002). CONCLUSION:All ONF patients were in the group with a low HD in phase 2, suggesting a reduction in blood flow or blood pool. Phase 2 accumulation in 3-phase bone scintigraphy can be used to estimate early hemodynamic changes in patients with ONF after renal transplantation.
The early diagnosis of ischemic necrosis of bone.
Zizic T M,Marcoux C,Hungerford D S,Stevens M B
Arthritis and rheumatism
One hundred sixty-nine patients with radiographic or histologic evidence of ischemic necrosis of bone (INB) were evaluated. Ninety-nine (59%) of the 169 patients had multiple sites of INB, with 310 bones affected. Two hundred sixty-three (85%) of the 310 ischemic bones were symptomatic. Routine radiography produced negative findings in 58 (20%) of the bones with histologically confirmed INB. Results of hemodynamic studies, including baseline bone marrow pressure, saline stress test, and/or intraosseous venography, were abnormal in 243 (94%) of 259 ischemic bones so evaluated. Most importantly, hemodynamic studies detected 51 (93%) of the 55 bones that were radiographically normal but had histologically confirmed INB.
Functional bone imaging in the detection of ischemic osteopathies.
MacLeod M A,Houston A S
Clinical nuclear medicine
The efficiency and accuracy of a functional imaging technique in the detection of ischemic osteopathy is reviewed over a 10-year period. The study includes 161 patients who had trauma, 101 patients who had suspected Perthes disease, 43 patients who had dysbarism, and 22 patients who had renal transplants on steroid immunosuppressive therapy. After intravenous injection of 7.7 MBq kg-1 Tc-99m HDP data were collected on all patients during the first 20 minutes, accretion rate functional images were produced, and static bone scans performed after 3 hours. All patients were followed up until a definitive diagnosis (clinical and radiologic) of avascular necrosis or osteochondritis was confirmed or denied. Of the 327 patients studied, 114 had positive accretion rate images and 213 negative accretion rate images. There were 8 false-positive scan results and 2 false-negative scan results. The overall predictive accuracy was 97% (disease prevalence 33%) with a sensitivity rate of 98% and a specificity rate of 96%. The authors conclude that the technique is a valuable predictive diagnostic indicator for ischemic osteopathies.
Magnetic resonance imaging identifies early femoral head ischemic necrosis in patients receiving systemic glucocorticoid therapy.
Kalunian K C,Hahn B H,Bassett L
The Journal of rheumatology
Ischemic necrosis of bone, a frequent complication of glucocorticoid therapy, can result in disability due to bone collapse and destruction. Some investigators have suggested that core decompression of involved marrow benefits patients with early disease. As radiographs are normal in early disease, identification of patients has been dependent on nonspecific radionuclide imaging or more specific but invasive hemodynamic studies. In order to define a sensitive, noninvasive diagnostic tool, we compared magnetic resonance imaging (MRI) to 99mtechnetium diphosphonate and 99mtechnetium sulfur colloid scintigraphy in 10 consecutive glucocorticoid treated patients with suspected femoral head ischemic necrosis of bone but normal roentgenograms. MRI identified the ischemic necrosis (defined by characteristic radiographic progression or histology) in 13/13 femoral heads. Both scans together identified only 5/13 of the cases. Only 1/20 osteoarthritic femoral heads had MRI patterns similar to those seen in ischemic necrosis of bone. We conclude that MRI is a sensitive and relatively specific method to detect early femoral head ischemic necrosis of bone.
Management of osteonecrosis in sickle-cell anemia and its genetic variants.
Chung S M,Alavi A,Russell M O
Clinical orthopaedics and related research
Osteonecrosis secondary to sickling disorders differs from most other forms of osteonecrosis, because vaso-occlusive episodes generally involve many other organs. For this reason optimum management and care of these patients requires a team approach. The spectrum of clinical symptoms and bone involvement varies widely from one patient to another, even among patients with the same abnormal hemoglobin patterns. Although the efficacy of conservative therapeutic measures has not been definitely established, these may be all that can be offered because of the patient's other problems. Before contemplating surgery, the surgical and anesthetic risks should be evaluated and measures taken to prevent complications. The varus osteotomy, Chiari pelvic osteotomy, prosthetic or total hip replacement, and the Neer shoulder prosthesis may benefit a limited number of carefully selected patients.
Pretreatment bone scan in SCFE: a predictor of ischemia and avascular necrosis.
Rhoad R C,Davidson R S,Heyman S,Dormans J P,Drummond D S
Journal of pediatric orthopedics
Sixty-two consecutive patients with 73 slipped capital femoral epiphyses (SCFEs) underwent pretreatment planar technetium bone scan to identify the presence of ischemia of the femoral head. The relationship of pretreatment ischemia and the development of avascular necrosis (AVN) was evaluated after a minimum follow-up of 12 months. All patients were treated with spica casting or pinning across the physis. No forceful manipulation was performed. None of the 63 stable SCFEs demonstrated ischemia by bone scan, and none developed AVN. Of the 10 unstable SCFEs, six demonstrated ischemia by bone scan, and five of the six developed AVN. None of the four unstable SCFEs without ischemia on bone scan developed AVN. Pretreatment bone scan is a sensitive predictor for development of AVN in unstable SCFEs and may provide a method for evaluating interventional treatments for AVN associated with SCFE.
Application of magnetic resonance imaging to ischemic necrosis of the lunate.
Sowa D T,Holder L E,Patt P G,Weiland A J
The Journal of hand surgery
Twenty patients (22 wrists), in whom ischemic necrosis of the lunate was suspected clinically, were studied prospectively by physical examination, conventional radiography, radionuclide bone scintigraphy, and magnetic resonance imaging. Magnetic resonance imaging showed more specificity than radiography or radionuclide bone imaging in making the diagnosis of ischemic necrosis of the lunate. Two patterns of lunate signal defect were seen on magnetic resonance imaging with focal or generalized signal loss on T1-weighted and T2-weighted images. Generalized loss of lunate signal on T1-weighted images was diagnostic for ischemic necrosis of the lunate. Focal signal loss on the radial one half of the lunate suggested early involvement. Normal or increased signal on the corresponding T2-weighted image implied an earlier stage and a better prognosis. Magnetic resonance imaging evaluation of the lunate may be useful for subclassification of Lichtman's radiographic stage 2 and can be employed to follow lunate revascularization after treatment. Magnetic resonance imaging is a low risk, noninvasive diagnostic technique, which can modify diagnosis, staging, treatment and prognosis of ischemic necrosis of the lunate.
[Quantitative study of therapeutic efficacy on early intervention of hyperbaric oxygen to model of steroid-induced avascular osteonecrosis of femoral head by multi-slice perfusion imaging].
Yang Jin-cai,Pan Zhen-yu,Gu Hua,Li Nan,Qian Xiao-jun,Zhai Ren-you,Wu Lian-hua,Gao Chun-jin
Zhonghua yi xue za zhi
OBJECTIVE:To quantitatively evaluate the hemodynamic status in animal models of steroid-induced avascular osteonecrosis of femoral head (SANFH) by multislice CT (MSCT) perfusion imaging, and estimate the therapeutic efficacy on early intervention of hyperbaric oxygen (HBO) to improve the region blood flow (rBF) of ischemic femoral head. METHODS:Forty-eight New Zealand male rabbits were injected with Escherichia coli endotoxin and methyl-prednisolone to establish SANFH models and then divided into 3 subgroups to undergo MSCT to measure the rBF, regional blood volume (rBV), and mean transit time (MTT) to obtain perfusion maps at the femoral head epiphysis, metaphysic, and neck of femur, and then were killed to undergo histological examination of the bilateral femoral heads 2, 4, and 6 weeks later respectively (Groups M(2), M(4), and M(6)). Twenty-four rabbits underwent HOB treatment after the second injection of E. c. endotoxin for 1-3 courses respectively (Groups H(1), H(2), and H(3)), and then underwent MSCT and pathological examination as described above. Eight rabbits were used as controls (Group N). RESULTS:(1) The rBF values of Groups M(2), M(4), and M(6) were all significantly lower than that of Group N (P < 0.001, < 0.001, and < 0.002). The rBF value of femoral head epiphysis of Group M(2) was remarkably lower than that of Group N, decreased to the lowest in Group M(4), and re-increased in Group M(6). The rBV value demonstrated similar change pattern in femoral head epiphysis. The MTT values of Groups M(2) and M(4) were longer than that of Group N, and then re-decreased in Group M(6). (2) It did differ significantly between the perfusion data of different femoral head anatomic regions in Groups M(2), M(4), M(6) and N (rBF: F = 52.190, P < 0.001; rBV: F = 42.677, P < 0.001; MTT: F = 3.09, P = 0.048). The changes of the perfusion data in femoral head epiphysis were more significant than those in other anatomic regions. (3) There were no statistically significant differences in the rBF value of the femoral head epiphysis and metaphysis (F = 2.081, P = 0.115; F = 1.142, P = 0.341), in the rBV value of the femoral metaphysis and neck of femur (F = 2.642, P = 0.059; F = 1.568, P = 0.209), and the MTT value of all the anatomic regions (F = 1.111, P = 0.347) among Groups H(1), H(2), H(3), and N. The rBF values of Groups H(1), H(2), and H(3) were statistically higher than those of the corresponding phase model groups (all P < 0.05). CONCLUSIONS:Able to detect hemodynamic status of femoral head, MSCT perfusion imaging technique may be used in the early detection of SANFH. Early intervention of HBO therapy can improve the blood perfusion of femoral head.
Local bioavailability and distribution of systemically (parenterally) administered ibandronate in the infarcted femoral head.
Kim Harry K W,Sanders Mike,Athavale Sanjay,Bian Haikuo,Bauss Frieder
Recent studies show that bisphosphonates can decrease the development of femoral head deformity following ischemic osteonecrosis by inhibiting osteoclast-mediated bone resorption. Given the potential new indication, improved understanding of pharmacokinetics of bisphosphonates as it applies to the infarcted head would be beneficial. The purpose of this study was to investigate the local bioavailability and the distribution of ibandronate in the infarcted head at the avascular and vascular phases of the disease process. Ischemic osteonecrosis of the femoral head was surgically induced in 15 piglets. One, 3, and 6 weeks following the induction of ischemia, which represent various stages of revascularization and repair, 14C-labeled ibandronate was administered intravenously. Twenty-four hours following 14C-drug administration, the level of radioactivity and its distribution in the infarcted heads were determined using liquid scintillation analysis and autoradiography. A significant correlation was found between the extent of revascularization and the level of radioactivity measured in the infarcted heads (r=0.80, P<0.05). The radioactivity level in the infarcted heads measured by liquid scintillation was similar to the negative controls at 1 week when revascularization was absent, but it increased significantly at 6 weeks when extensive revascularization was present (P<or=0.00004). Autoradiographic assessment showed similar silver grain counts in the infarcted heads compared to the background at 1 week. At 3 weeks, a significant increase in the silver grain count was observed in the necrotic regions of the infarcted heads compared to the background (P=0.001) even though only a small area of the heads (2%) was found to be revascularized, suggesting diffusion of 14C-drug from the revascularized to the non-revascularized areas of the head. At 6 weeks, extensive 14C-drug binding was observed in the areas of revascularization with preferential binding of 14C-drug to the newly formed bone compared to the remaining necrotic bone (P=0.000001). These results indicate that revascularization and repair produce significant alteration of local bioavailability and distribution of ibandronate in the infarcted head. To our knowledge, this is the first study to examine the local bioavailability and distribution of bisphosphonate in the infarcted head. Current findings have important implications with regard to the timing and dosing of bisphosphonate after the onset of ischemic osteonecrosis.
Maxillofacial osteonecrosis in a patient with multiple "idiopathic" facial pains.
Adams W R,Spolnik K J,Bouquot J E
Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology
Previous investigations have identified focal areas of alveolar bone tenderness, increased mucosal temperature, abnormal anesthetic response, radiographic abnormality, increased radioisotope uptake on bone scans, and abnormal marrow within the quadrant of pain in patients with chronic, idiopathic facial pain. The present case reports a 53-year-old man with multiple debilitating, "idiopathic" chronic facial pains, including trigeminal neuralgia and atypical facial neuralgia. At necropsy he was found to have numerous separate and distinct areas of ischemic osteonecrosis on the side affected by the pains, one immediately beneath the major trigger point for the lancinating pain of the trigeminal neuralgia. This disease, called NICO (neuralgia-inducing cavitational osteonecrosis) when the jaws are involved, is a variation of the osteonecrosis that occurs in other bones, especially the femur. The underlying problem is vascular insufficiency, with intramedullary hypertension and multiple intraosseous infarctions occurring over time. The present case report illustrates the extreme difficulties involved in the diagnosis and treatment of this disease.
[Clinical condition of steroid-induced osteonecrosis of the femoral head].
Kubo Toshikazu,Fujioka Mikihiro,Ishida Masashi
Steroid-induced osteonecrosis of the femoral head (steroid-induced ONF) is an aseptic and ischemic disease developing after steroid therapy. Functions of hip joint are markedly disturbed when collapse is developed on the femoral head. Steroid-induced ONF accounted for the majority of the ONF. The occurrence mechanism is unknown, and prevention methods and fundamental remedies remain to be established. The timing of the occurrence of steroid-induced ONF is within several months after steroid administration. During the continuous steroid administration, no expansion of necrotic area was found. Recurrence was not also noticed. Patients have no symptoms when steroid-induced ONF occurs due to the establishment of ischemic conditions, and pain appears when the collapse of femoral head develops. There is an interval of several months or years between the occurrence of ONF and the onset of symptoms. Generally, conservative treatment is chosen during the asymptomatic period, and surgical treatment is considered after the symptoms appear. Appropriate screening and early detection are important to rational remedy for steroid-induced ONF.