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Subchondral insufficiency fracture of the femoral head: histopathologic correlation with MRI
T Yamamoto1, R Schneider, P G Bullough
1Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan.
Objective:
To correlate the magnetic resonance imaging (MRI) features with the histopathologic findings in subchondral insufficiency fracture (SIF) of the femoral head.
Design And Patients:
This study was based on a retrospective review of the MRI features and histopathologic findings in seven patients with SIF who had had total hip replacement. Results. In all seven cases, MRI showed a bone marrow edema pattern in the femoral head, and a focal low-intensity band beneath the articular cartilage on some slices (not all) on the T1-weighted images. The shape of the low-intensity band varied: it was irregular and serpentine in four cases, well-delineated, smooth, and a mirror image to the articular surface in two cases, and parallel to the articular surface in one case. On histologic examination, the low-intensity band on MRI corresponded to a fracture line and its associated repair tissue. In all but one case, the band was not visible on T2-weighted or fat suppression images, and the proximal subchondral portion of the lesion had a homogeneous high signal intensity. This region of high signal intensity corresponded histopathologically to viable bone and marrow tissue with associated callus, edema, and vascular granulation tissue.
Conclusions:
SIF of the femoral head characteristically demonstrates a low-intensity band on T1-weighted images that corresponds, histopathologically, to a linear subchondral fracture and its associated repair tissue. In most cases, the subchondral portion of the lesion appears on T2-weighted images as an area of homogeneously high signal intensity.
Insights
Subchondral insufficiency fractures (SIF) of the femoral head show a characteristic low-intensity band on T1-weighted MRI, correlating with fracture lines. This finding aids in diagnosing SIF and understanding its histopathology.
Area of Science:
- Orthopedic imaging
- Radiology
- Pathology
Background:
- Subchondral insufficiency fracture (SIF) of the femoral head is a challenging diagnosis.
- Accurate correlation between imaging and histopathology is crucial for understanding SIF.
Purpose of the Study:
- To correlate magnetic resonance imaging (MRI) features with histopathologic findings in subchondral insufficiency fracture (SIF) of the femoral head.
Main Methods:
- Retrospective review of MRI and histopathologic findings in seven patients with SIF who underwent total hip replacement.
- Analysis of T1-weighted, T2-weighted, and fat suppression MRI sequences.
Main Results:
- MRI revealed bone marrow edema and a focal low-intensity band beneath the articular cartilage on T1-weighted images in all cases.
- Histopathology confirmed the low-intensity band corresponded to a fracture line and repair tissue.
- The subchondral lesion typically showed high signal intensity on T2-weighted/fat suppression images, representing viable bone and associated tissue.
Conclusions:
- SIF of the femoral head characteristically shows a low-intensity band on T1-weighted MRI, representing a subchondral fracture and repair tissue.
- High signal intensity in the subchondral portion on T2-weighted images is common and corresponds to viable bone and edema.
