Extent of osteonecrosis on MRI predicts humeral head collapse

Although MRI is useful for predicting progression of osteonecrosis (ON) of the femoral head or femoral condyle, predicting outcome of atraumatic osteonecrosis of the humeral head using MRI has not been previously examined. We asked whether the prognosis was related to the extent and location of necrotic lesions on MRI. We investigated 46 radiographically noncollapsed humeral heads in 27 patients, 24 steroid-related and three alcohol-related, using MRI and serial radiographs. The minimum followup was 24 months (mean, 84.9 months; range, 24-166 months). The necrotic lesion was typically located at the medial and superior aspect of the humeral head. The necrotic angle, which expressed the extent of the necrotic lesion, was measured on midoblique-coronal plane (range; 0 degrees -134.7 degrees ) and on midoblique-sagittal plane (range; 0 degrees -150.6 degrees ). Of the 46 lesions, 34 were less than 90 degrees and did not collapse, whereas 11 of the other 12 lesions of more than 90 degrees (92%) collapsed within 4 years. Of these 11 collapsed lesions, four of less than 100 degrees did not progress, followed by reparative reaction on plain radiographs, whereas the other seven of more than 100 degrees progressed to osteoarthritis. The extent of a necrotic lesion on MRI is useful to predict collapse of the humeral head.