Abstract:SummaryThe aim of this paper is to critically review the literature documenting the imaging approach in adult Femoral Head Avascular Necrosis (FHAVN). For this purpose we described and evaluated different radiological techniques, such as X-ray, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and Nuclear Medicine. Plain films are considered the first line imaging technique due to its ability to depict femoral head morphological changes, to its low costs and high availability. CT is not a routinely p… Show more
“…In accordance with the literature, we found that all osteonecrotic lesions could be detected with T1 fast spin-echo and short T1 inversion-recovery sequences, and therefore, diffusion-weighted and PET images probably can be omitted (28). For the detection of anthracycline-induced cardiomyopathy, ventricular volumes and ejection fractions are important metrics.…”
Purpose
To develop a positron emission tomography (PET)/magnetic resonance (MR) imaging protocol for evaluation of the brain, heart, and joints of pediatric cancer survivors for chemotherapy-induced injuries in one session.
Materials and Methods
Three teams of experts in neuroimaging, cardiac imaging, and bone imaging were tasked to develop a 20â30-minute PET/MR imaging protocol for detection of chemotherapy-induced tissue injuries of the brain, heart, and bone. In an institutional review boardâapproved, HIPAA-compliant, prospective study from April to July 2016, 10 pediatric cancer survivors who completed chemotherapy underwent imaging of the brain, heart, and bone with a 3-T PET/MR imager. Cumulative chemotherapy doses and clinical symptoms were correlated with the severity of MR imaging abnormalities by using linear regression analyses. MR imaging measures of brain perfusion and metabolism were compared among eight patients who were treated with methotrexate and eight untreated age-matched control subjects by using Wilcoxon rank-sum tests.
Results
Combined brain, heart, and bone examinations were completed within 90 minutes. Eight of 10 cancer survivors had abnormal findings on brain, heart, and bone images, including six patients with and two patients without clinical symptoms. Cumulative chemotherapy doses correlated significantly with MR imaging measures of left ventricular ejection fraction and end-systolic volume, but not with the severity of brain or bone abnormalities. Methotrexate-treated cancer survivors had significantly lower cerebral blood flow and metabolic activity in key brain areas compared with control subjects.
Conclusion
The feasibility of a single examination for assessment of chemotherapy-induced injuries of the brain, heart, and joints was shown. Earlier detection of tissue injuries may enable initiation of timely interventions and help to preserve long-term health of pediatric cancer survivors.
“…In accordance with the literature, we found that all osteonecrotic lesions could be detected with T1 fast spin-echo and short T1 inversion-recovery sequences, and therefore, diffusion-weighted and PET images probably can be omitted (28). For the detection of anthracycline-induced cardiomyopathy, ventricular volumes and ejection fractions are important metrics.…”
Purpose
To develop a positron emission tomography (PET)/magnetic resonance (MR) imaging protocol for evaluation of the brain, heart, and joints of pediatric cancer survivors for chemotherapy-induced injuries in one session.
Materials and Methods
Three teams of experts in neuroimaging, cardiac imaging, and bone imaging were tasked to develop a 20â30-minute PET/MR imaging protocol for detection of chemotherapy-induced tissue injuries of the brain, heart, and bone. In an institutional review boardâapproved, HIPAA-compliant, prospective study from April to July 2016, 10 pediatric cancer survivors who completed chemotherapy underwent imaging of the brain, heart, and bone with a 3-T PET/MR imager. Cumulative chemotherapy doses and clinical symptoms were correlated with the severity of MR imaging abnormalities by using linear regression analyses. MR imaging measures of brain perfusion and metabolism were compared among eight patients who were treated with methotrexate and eight untreated age-matched control subjects by using Wilcoxon rank-sum tests.
Results
Combined brain, heart, and bone examinations were completed within 90 minutes. Eight of 10 cancer survivors had abnormal findings on brain, heart, and bone images, including six patients with and two patients without clinical symptoms. Cumulative chemotherapy doses correlated significantly with MR imaging measures of left ventricular ejection fraction and end-systolic volume, but not with the severity of brain or bone abnormalities. Methotrexate-treated cancer survivors had significantly lower cerebral blood flow and metabolic activity in key brain areas compared with control subjects.
Conclusion
The feasibility of a single examination for assessment of chemotherapy-induced injuries of the brain, heart, and joints was shown. Earlier detection of tissue injuries may enable initiation of timely interventions and help to preserve long-term health of pediatric cancer survivors.
“…Hip MRI signal strength reflects a variety of pathological changes in the femoral head. For example, T1 sequences appear as high signals indicating the presence of oedema [37] . A high signal in ONFH generally demonstrates that violent changes have taken place in the bone structure.…”
SummaryCollapse of the femoral head is the most significant pathogenic complication arising from osteonecrosis of the femoral head. It is related to the disruption of the maintenance of cartilage and bone, and results in an impaired function of the vascular component. A method for predicting the collapse of the femoral head can be treated as a type of clinical index. Efforts in recent years to predict the collapse of the femoral head due to osteonecrosis include multiple methods of radiographic analysis, stress distribution analysis, finite element analysis, and other innovative methods. Prediction methods for osteonecrosis of the femoral head complications originated in Western countries and have been further developed in Asia. Presently, an increasing number of surgeons have chosen to focus on surgical treatments instead of prediction methods to guide more conservative interventions, resulting in a growing reliance on the more prevalent and highly effective total hip arthroplasty, rather than on more conservative treatments. In this review, we performed a literature search of PubMed and Embase using search terms including âosteonecrosis of femoral head,â âprediction,â âcollapse,â âfinite element,â âradiographic images,â and âstress analysis,â exploring the basic prediction method and prospects for new applications.
“…Femoral head AVN is considered to be a common cause of musculoskeletal weakening and is a major diagnostic and remedy challenge [8,9]. Its estimated that almost 50% of patients with femoral head AVN will experience extreme joint deterioration and around three years after the initial diagnosis they will require a hip arthroplasty which is known as a major surgical procedure [10,11].…”
Avascular necrosis (AVN) could remain with negligible clinical symptoms, but it would get worsen over the time if itâs left untreated and at the most cases will require surgical treatment. Prevalence of femoral head AVN is almost 0.45% among HIV patients which is approximately 45 times more than the rest of Society. AVN occurs 0.088%-1.33% annually among HIV victims. Avascular necrosis of the femoral head is a bone deteriorating plight. At this study, the clinical prevalence of it has been analyzed among a group of 180 patients at Rasool-e-Akram Hospital (Iran, between 2008 and 2016). Patients were including 121 men and 59 women. Analysis results showed that the prevalence of HCV, HBV, and HIV was 1.7%, 1.1%, and 1.1% respectively. It was found that 63% of patients was currently using immunosuppressive drugs. 17% had a history of drug abuse among which 3.3% were using IV drugs. It was concluded that femoral head AVN is more common among hepatitis and HIV patients.
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