1、Femoral head edema Differential diagnosisBruno Vande Berg, Frdric Lecouvet, Baudouin Maldague, Jacques MalghemSt Luc University hospital, Brussels, Belgium,DefinitionHistologyDifferential diagnosis,Bone marrow edema of the femoral head,Bone marrow edema: A generic term used by radiologiststo describ
2、e a lesion patternthat suggests an ongoing abnormal processin the bone marrowat MRI,Moderate decrease in signal intensity on T1 not very low Ill-delimited no sharp margins Subchondral area involvement- may extend in femoral neck,Bone marrow edema of the femoral head,T1,Intermediate to high on SE T2,
3、T1,T2,T1,T2,T1 + C,Very low signal Sharp margins,Slight decrease no margins subchondral,Edema,NOT edema,DefinitionHistologyDifferential diagnosis,Bone marrow edema of the femoral head, Bone marrow edema as described by the radiologists.,Bone marrow edema as described by the radiologistsdoes not corr
4、espond to edema for the pathologists !,Findings at histopathology in bone marrow edema medullary space infiltration by connective tissue, inflammatory cells, edema, necrosisabnormal trabeculaefat cells alteration .non specific microscopic findings,Bone marrow edema of the femoral head:A non specific
5、 pattern of epiphyseal marrow alterationthat develops in the medullary cavityin response to different insults.,Fem. head lesions,Definition Histology Differential diagnosis,Bone / marrow,Cartilage,Synovium,Fem. head lesions,Definition Histology Differential diagnosis,Bone marrow,Cartilage,Synovium,H
6、ip diseases,TBME syndrome Necrosis Fracture,Osteoarthritis OA variants, 55 y OA (+variants) Osteonecrosis Fractures, 55 y OA (+variants) Osteonecrosis Fractures Transient BME Tr. osteoporosis, 55 y.Osteoarthritis (and variants)Osteonecrosis Insufficiency fractures,Femoral head edema,Subchondral Ill-
7、delimited Moderate decrease in signal,Osteoarthritis,T1,Look at the cartilage ! Look at the acetabulum ! Not true edema (cysts),T1,FS PD,55 y.Osteoarthritisosteoarthritis variantsosteonecrosisinsufficiency fractures,Femoral head edema,+ 3 months,+ 6 months,Rapidly destructive osteoarthritis of the h
8、ip Joint space loss in less than 1 year Mimicks infection / neuro-arthropathy No osteophyte,Subchondral Ill-delimited Moderate decrease in signal,T1,T1,Cartilage destruction No spontaneous healing,T1,FS PD,3 months,T1,FS PD,Rapidly destructive OA Rapid loss of cartilage Subchondral impaction Subchon
9、dral necrosis Joint effusion,T1,FS PD, 55 y.OsteoarthritisOsteoarthritis variantsosteonecrosisinsufficiency fractures,Femoral head edema,Crescent-shaped Subchondral area Low signal T2 / FS PD / Enh. T1,T1,T2,+ 15 months,T1,FS PD,T1,T2,no rim,Crescent-shaped Subchondral area Low signal T2 / FS PD / E
10、nh. T1,GA,T1,Spontaneous osteonecrosis of the knee (SONK),T1,Spontaneous osteonecrosis of the knee (SONK),T2,Low signal area,Spontaneous osteonecrosis of the knee (SONK), 55 y.OsteoarthritisOsteoarthritis variantsosteonecrosisinsufficiency fracture,Femoral head edema,T1,T2,FS PD,Subchondral band in
11、impaction fracture,+ 3 months,+ 18 months,Spontaneous healing,T1,T1,T2,Spontaneous healing,Subtle depression of the bone plate, 55 y.OsteoarthritisOsteoarthritis variantsosteonecrosisinsufficiency fracture,Femoral head edema, 55 y.Osteoarthritis (+variants)OsteonecrosisInsufficiency fractureTransien
12、t BM edemaTransient osteoporosis,Transient bone marrow edemaMale, 35-55 y. Hip pain Transient (3 -6 months) Spontaneous Idiopathic Hot spot bone scan Normal X-rays Edema of the femoral head,Transient osteoporosisMale, 35-55 y. Hip pain Transient (3 -6 months) Spontaneous Idiopathic Hot spot bone sca
13、n Marked osteoporosis on X-rays Edema of the femoral head,Bloem JL Radiology 1988;167:753,T1,T2,FS PD,Initial,+ 3 months,+ 6 months, Transient osteoporosis , Transient edema ,Coronal T1: fem head edema ?,In conclusion,Moderate decrease in signal intensity Ill-delimited margins Predominates in subcho
14、ndral area,Coronal T1: fem head edema ?,Sagit/coronal T2 or FS PD or enh. FS T1 subchondral area ?,Coronal T1: fem head edema ?,Sagit/coronal T2 or FS PD or enh. FS T1 subchondral area ?,Cartilage Subchondral marrow,Coronal T1: fem head edema ?,Cartilage ? Osteoarthritis or variants ?Subchondral areanecrosis :low signal crescent-shaped area: marked deformityfracture : low signal line: subtle deformitynothing idiopathic edema,Sagit/coronal T2 or FS PD subchondral area ?,
