Quantitative dynamic contrast-enhanced MRI of bone marrow perfusion at the proximal femur: influence of femoral head osteonecrosis risk factor and overt osteonecrosis

Objective To evaluate the MRI perfusion changes in patients with risk factors for osteonecrosis and normally appearing femoral heads prior to overt femoral head osteonecrosis. Methods Fifty-eight patients (105 hips) were prospectively included in this ethics committee–approved study. There were 46 hips with no image anomalies and no risk factors for osteonecrosis of the femoral head (ONFH) risk factors, 38 with ONFH risk factors and no image abnormalities, and 21 with overt ONFH. All patients underwent DCE-MRI. Semi-quantitative (peak enhancement [PE], area under the curve [AUC], time to maximum enhancement [TME]) and quantitative perfusion parameters (volume plasma, KTRANS, and KEP) were calculated. Excessive alcohol consumption, corticosteroid use, and trauma were considered major risk factors for osteonecrosis of the femoral head. Results Measured at the femoral neck and compared to the healthy hips without OFNH risk factors, PE was significantly lower in the hips of patients with OFNH risk factors. Moreover, the difference was greater in females with risk factors, who presented significantly lower PE values ( p = 0.0096). A PE threshold of 1.4% yielded a 92% sensitivity and 54% specificity for the presence of associated ONFH risk factors. The hips with overt OFNH compared to those with normally appearing showed an increase of PE of 45% in the neck ( p < 0.014). Various epiphyseal femoral head perfusion parameters (PE, TME, AUC, and K trans ) presented statistically significant differences in hips with ONFH and those without ( p < 0.0001). Conclusion DCE-MRI can identify perfusion marrow changes related to the presence of ONFH risk factors and adjacent to osteonecrosis areas. Key Points • Bone marrow perfusion changes may occur prior to overt ONFH and extend beyond the osteonecrosis area to the entire femoral head and neck. • Peak enhancement values were significantly reduced in patients with ONFH risk factors, compared to those without. • The presence of ONFH led to a significant increase in marrow perfusion adjacent to the osteonecrosis area.