Abstract
Aims: The pathomechanism of avascular necrosis of the femoral head (AVN) is still debated. Hip joint synovitis and effusion may impair blood ßow to the femoral head. The critical ischemia time is around 6 hours, but repeated ischemic episodes may impair reperfusion and elicit AVN. The aims of this study were to investigate the value of dynamic MRI in femoral head after ischemia and during reperfusion. Methods: In 15 domestic pigs, 3–4 months old, femoral head ischemia was achieved by raising the joint pressure to 250 mmHg by dextran infusion through a hole in the acetabular wall. MRI was performed (Philips gyroscan S15, 1.5 T, Gd-DTPA enhancement, dynamic imaging interval 39 sec.) before ischemia, after 6 hours of ischemia, and again after 4 hours of reperfusion. Results: Signal intensity versus time (SI/t) plots were constructed from 347 MR studies. By regression analysis of SI/t curves an index (enhancement/decrease) was developed as criterion for arterial or venous circulatory disturbance. Index values < 1.1 signiþed arterial impairment, > 100 venous disturbance. Values between 1.1 and 100 were considered normal. The positive predictive value for disturbed osseous blood ßow was 96%. Conclusions: Early detection of intraosseous circulatory disturbance was possible with a mathematical model for dynamic MRI results. The method is reproducible and may be employed in the early diagnosis of AVN and during treatment for monitoration of revascularisation.
Theses abstracts were prepared by Professor Dr. Frantz Langlais. Correspondence should be addressed to him at EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
