Clinical Study Of BME In The Nontraumatic Osteonecrosis Of The Femoral Head On MRI

Objective:To evaluate bone marrow edema(BME) on MRI image in nontraumatic osteonecrosis of the femoral head(NONFH) and the relationship between BME with age,etiological fator,hip pain and the stage of NONFH, discuss the mechanism and significance of occurrence and development of BME in NONFH, in order to strengthen further understandings about clinical significance of BME in NONFH and to provide objective imaging proof for Chinese traditional medicine treatment based on stasis theory.Methods:With all 123 hips in 72 patients with NONFH,BME is identified from etiological fator: 46 hips from Acohol,57 hips from Hormone,20 hips from others, according to age ,NONFH is divided into three groups:41 hips in 19-40,65 hips in 41-60,17 hips in >60;BME is identified from MRI:30 with grade 0 (no BME),62 with grade 1(small BME),31 with grade 2 (large BME).Based on rating scale of pain,NONFH is divided into three groups:28 hips in the no pain group,94 hips in the mild pain group,26 hips in the moderate or severe pain group. According to ARCO staging system,NONFH is divided into four stages:10 hips in stage I, 52 hips in stage II, 50 hips in stage III and 11 hips in stage IV. Contingency table analyses and rank sum tests are used to compare the difference of etiological fators,ages,pain gradings and stages among these groups.Results:There is no correlation of BME to etilogical fator and to age(X~2=3.8492,P= 0.4268; X~2=5.6131,P=0.2300).BME of the femur is best demonstrated on T2WI and STIR coronal images .Grade 1-2 BME are seen in 75.6% diseased femoral heads.BME of the femur is increasing with porgressing of the disease.BME is not commonly seen and localised in stage I of NONFH, but it is more commonly seen and extensive in stage II,IIIof NONFH. In the stage I-III,the prevalence of each score BME is of great significant Difference(X~2=27. 680,P<0.001).The results of rank sum tests for several independent samples showed, significant differerce of BME(P<0. 001)among three groups. With the advance of disease, the rank of BME increas gradually. In the three pain groups, the prevalence of each score BME 'is of great significant difference(X~2=26. 981, P<0. 001)。The results of rank sum tests for several independent samples show, significant differerce of BME(P<0. 001)among three groups. With the advance of pain scale, the rank of BME increas gradually. Conclusion:There is no correlation of BME to etilogical fator and to age.BME is a sign that is accompanied with NONFH. The probability and extent of BME correlated well with the stage of NONFH. The condition of BME can be used as a index for the appraisal of advancement of disease and the judgement of treatment result. The finding on MRI of BME is associated with the presence or absence of hip pain. The more severe the pain is, the more large the BME would be. BME on MRI can provide objective imaging proof for Chinese traditional medicine treatment based on stasis theory.