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Background: The 2019 Revised Association Research Circulation Osseous (ARCO) Staging Criteria for Osteonecrosis of the Femoral Head (ONFH) only requires plain radiographs and magnetic resonance imaging (MRI) to diagnose and stage ONFH; however, the effectiveness of the 2019 ARCO criteria in the absence of computed tomography (CT) scans has not been investigated. Therefore, the purpose of this study was to evaluate whether CT scanning is a necessary modality for diagnosing/staging ONFH using the ARCO staging system. More specifically, do CT scans help differentiate pre- and post-collapse lesions more than MRI scans? Methods: A study was conducted on 228 ONFH patients diagnosed between January 1, 2008, and December 31, 2018, at a single academic medical center. CT and MRI scans were reviewed by the senior author and other contributors. The ONFH classification was compared between the 2 scans to determine if CT scans were able to further differentiate staging of collapsed lesions vs MRI scans. Results: A diagnosis of ONFH was made by MRI first in 57% (129/228) while 21% (48/228) used MRI and CT simultaneously. Only 22% (51/228) of cases were diagnosed by CT scans first. There were no cases where collapse was found by a CT scan that were not diagnosed by standard x-rays and/or MRIs. Conclusions: CT scans are not a useful adjunct for diagnosing or treating ONFH and are not necessary if MRI is ordered when using the Revised ARCO Staging System for ONFH diagnosis.

Background: MRI is the most effective diagnostic tool of osteonecrosis of the femoral head (ONFH), especially for early diagnosis, but its detection of subchondral or cortical fractures is less accurate than CT. Therefore, it is difficult to accurately stage ONFH in the peri‐collapse period by MRI. Purpose To improve the accuracy of MR for distinguishing between Association Research Circulation Osseous (ARCO) stages 2 and 3A in ONFH. Study Type: Retrospective. Subjects: One hundred and fifty five cases of ARCO stage 2/3A of ONFH underwent MR examinations, M/F = 72/83. CT was used as reference standard for collapse, which was decided by an orthopedist and a radiologist in consultation. Field Strength/Sequence: 3 T/axial and coronal T1‐weighted Turbo Spin Echo (T1W TSE) sequence, axial T2‐weighted fat‐saturated (T2W FS) TSE sequence, and coronal proton density‐weighted imaging (PDWI)‐FS‐Dixon fat/water image. Assessment Five potential MR signs (the maximum width of the necrotic‐viable interface, bone marrow edema (BME), irregular articular surface of the femoral head, T2 heterogeneous high signal, and the absence of a necrotic‐viable interface with the morphology of closed loop) were evaluated blindly by five radiologists independently and the total scores of different combinations of MR signs were calculated. Statistical Tests: Mann–Whitney U test and Chi‐square test were used to evaluate age, gender, and MR signs differences between the two groups. ROC curve was used to access the distinguishing value of MR signs. The consistency of the five radiologists was analyzed by intraclass correlation coefficient. Results: The area under the curve of the combined MR signs 2 for distinguishing between ARCO stages 2 and 3A was the greatest (0.967), sensitivity and specificity were 100.00% and 88.71% respectively, and greater than 1 was the threshold. Data Conclusion: Combined MR signs 2 has great values in distinguishing between ARCO stages 2 and 3A in ONFH, thus helping clinical therapy. Level of Evidence: 4 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

BACKGROUND: A variety of hip-preserving treatments for early osteonecrosis of the femoral head have been emerged. However, the favorite hip-preserving method is still under investigation. Core decompression combined with stem cell transplantation is a hip-preserving treatment for early osteonecrosis of the femoral head. However, its effectiveness and influencing factors are quite diverse reported in existing clinical studies. OBJECTIVE: To evaluate the mid-long-term effects of core decompression combined with stem cell transplantation in the treatment of osteonecrosis of the femoral head. METHODS: This was a retrospective study with the approval by the Ethics Committee of Xingtai People’s Hospital Affiliated to Hebei Medical University, China (approval No. 2018-JS037). From 2008 to 2012, 65 of 95 patients with osteonecrosis of the femoral head were treated with core decompression with bone marrow mesenchymal stem cell transplantation. There were 53 males and 12 females, with the mean age of 43.1(20-61) years. There were 65 hips, including 29 defined as ARCO stage I and 36 as ARCO stage II, as well as 15 as ARCO type A, 33 as ARCO type B, and 17 as ARCO type C. The mean follow-up period was 7.5 (6.5-10.1) years. Post-treatment collapse rate and hip replacement rate were assessed, and risk factors for post-treatment collapse were analyzed through a multivariate logistic regression analysis. RESULTS AND CONCLUSION: The overall collapse rate of the femoral head was 46% (30/65). For stage I and stage II collapses, the collapse rates of the femoral head were 34.5% (10/29) and 55.6% (20/36), respectively. For ARCO type A, B and C, the collapse rates of the femoral head were 26.7%(4/15), 42.4%(14/33), and 70.1%(12/17), respectively. The hip replacement rate of the 65 hips was 23% (15/65). In the multivariate logistic regression analysis, postoperative rate of femoral head collapse was significantly correlated with body mass index, preoperative ARCO stage and type (P < 0.05), which are defined as the risk factors for femoral head collapse. [ABSTRACT FROM AUTHOR]

Background: In the future, biochemical MRI might provide a valuable noninvasive quantitative analysis of the biochemical composition of cartilage in osteonecrosis of the femoral head (ONFH).Purpose: To investigate the diagnostic performance of T1 ρ and T2 mapping in cartilage denaturalization with ONFH and to determine the correlation between T1 ρ and T2 mapping and the Association Research Circulation Osseous (ARCO) stage.Study Type: Prospective.Subjects: Forty-seven patients with ONFH (stage I to III according to the ARCO criteria) and 24 volunteers (control group) were recruited for the prospective study.Sequence: Conventional MRI, multiple echo recalled gradient echo (MERGE), and T1 ρ and T2 mapping sequences.Assessment: Pseudocolor images and MERGE images were combined in the AW4.5 workstation. The region of interest (ROI) of the hip cartilage was 4-6 mm². The sagittal T1 ρ and T2 mapping values were calculated by the two first authors.Statistical Tests: One-way analysis of variance (ANOVA), LSD t-tests, Pearson correlation analysis, and receiver operator characteristic (ROC) curves. The significance level was set at P < 0.05.Results: The T1 ρ and T2 mapping values of the ONFH group were significantly higher than the values of the control group (P = 0.000). Regarding the assessment of the severity of ARCO staging, both T1 ρ (r = 0.66, P = 0.004) and T2 mapping (r = 0.501, P = 0.002) were positively associated with disease severity. The T1 ρ values were positively correlated with the T2 mapping values (r = 0.381, P = 0.000). The areas under the curve (AUC) for the T1 ρ and T2 mapping values were 0.822 and 0.791, respectively. The diagnostic sensitivity and specificity were 72.34% and 70.83% for T1 ρ mapping and 72.34% and 58.33%, respectively, for T2 mapping.Data Conclusion: Both T1 ρ and T2 mapping performed well in diagnosing the cartilage denaturalization in ARCO stage I-III ONFH patients. T1 ρ mapping had a higher diagnostic sensitivity and specificity than T2 mapping.Level Of Evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:760-767. [ABSTRACT FROM AUTHOR]

Background: In the future, biochemical MRI might provide a valuable noninvasive quantitative analysis of the biochemical composition of cartilage in osteonecrosis of the femoral head (ONFH)., Purpose: To investigate the diagnostic performance of T 1 ρ and T 2 mapping in cartilage denaturalization with ONFH and to determine the correlation between T 1 ρ and T 2 mapping and the Association Research Circulation Osseous (ARCO) stage., Study Type: Prospective., Subjects: Forty-seven patients with ONFH (stage I to III according to the ARCO criteria) and 24 volunteers (control group) were recruited for the prospective study., Sequence: Conventional MRI, multiple echo recalled gradient echo (MERGE), and T 1 ρ and T 2 mapping sequences., Assessment: Pseudocolor images and MERGE images were combined in the AW4.5 workstation. The region of interest (ROI) of the hip cartilage was 4-6 mm². The sagittal T 1 ρ and T 2 mapping values were calculated by the two first authors., Statistical Tests: One-way analysis of variance (ANOVA), LSD t-tests, Pearson correlation analysis, and receiver operator characteristic (ROC) curves. The significance level was set at P < 0.05., Results: The T 1 ρ and T 2 mapping values of the ONFH group were significantly higher than the values of the control group (P = 0.000). Regarding the assessment of the severity of ARCO staging, both T 1 ρ (r = 0.66, P = 0.004) and T 2 mapping (r = 0.501, P = 0.002) were positively associated with disease severity. The T 1 ρ values were positively correlated with the T 2 mapping values (r = 0.381, P = 0.000). The areas under the curve (AUC) for the T 1 ρ and T 2 mapping values were 0.822 and 0.791, respectively. The diagnostic sensitivity and specificity were 72.34% and 70.83% for T 1 ρ mapping and 72.34% and 58.33%, respectively, for T 2 mapping., Data Conclusion: Both T 1 ρ and T 2 mapping performed well in diagnosing the cartilage denaturalization in ARCO stage I-III ONFH patients. T 1 ρ mapping had a higher diagnostic sensitivity and specificity than T 2 mapping., Level of Evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:760-767., (© 2018 International Society for Magnetic Resonance in Medicine.)