Investigative Magnetic Resonance Imaging

Korean Society of Magnetic Resonance in Medicine (대한자기공명의과학회)
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Comparison of Subchondral Fracture on Radiographs with MR Images in Evaluation of Osteonecrosis in LCP Patients

LCP 환아에서 골괴사의 평가방법으로 연골하 골절선과 자기공명영상의 비교

  • Kim, Jin-Won (Department of Radiology, Gyeongsang National University, College of Medicine) ;
  • Park, Mee-Jung (Department of Radiology, Gyeongsang National University, College of Medicine) ;
  • Choi, Ho-Chul (Department of Radiology, Gyeongsang National University, College of Medicine) ;
  • Cho, Jae-Min (Department of Radiology, Gyeongsang National University, College of Medicine) ;
  • Ryoo, Jae-Wook (Department of Radiology, Gyeongsang National University, College of Medicine) ;
  • Jeong, Seong-Hoon (Department of Radiology, Gyeongsang National University, College of Medicine) ;
  • Kim, Dong-Hee (Department of Orthopedicsurgery, Gyeongsang National University, College of Medicine) ;
  • Lee, Gyung-Kyu (Department of Radiology, Hallym University, College of Medicine) ;
  • Na, Jae-Boem (Department of Radiology, Gyeongsang National University, College of Medicine)
  • 김진원 (경상대학교 의학전문대학원 영상의학교실) ;
  • 박미정 (경상대학교 의학전문대학원 영상의학교실) ;
  • 최호철 (경상대학교 의학전문대학원 영상의학교실) ;
  • 조재민 (경상대학교 의학전문대학원 영상의학교실) ;
  • 유재욱 (경상대학교 의학전문대학원 영상의학교실) ;
  • 정성훈 (경상대학교 의학전문대학원 영상의학교실) ;
  • 김동희 (경상대학교 의학전문대학원 정형외과학교실) ;
  • 이경규 (한림대학교 의과대학 영상의학교실) ;
  • 나재범 (경상대학교 의학전문대학원 영상의학교실)
  • Published : 2009.12.30
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Abstract

Purpose : To compare the subchondral fracture on plain radiography and MR image as a method for assessing osteonecrosis in Legg-Calve-Perthes(LCP) pateients. Materials and methods: We retrospetively reviewed 15 hip joint MR images and plain radiography which visualized subchondral fracture. With basis of the Salter-Thompson classification, extent of necrosis was graded group A to B, as follows; Group A = < 50%, B = > 50%. On PACS workstation, necrotic area of each MR image was measured to calculate the volume of necrotic portion: volume = necrotic area $\times$ slice thickness. Necrotic areas on MR images were graded group A to B and results were compared with that measured in Salter-Thompson classification. On follow up, bone resorption was measured and the extent was compared with subchondral fracture representing necrotic area and that on MR volume method respectively. Results : In 9 joints of 15 hip joints (60%), the degree of necrosis in Salter-Thompson classification on plain radiographs was different from that on MR volume method. Based on plain radiographs by Salter-Thompson classification, the degree of necrosis was overestimated in 6(67%) joints, and underestimated in 3(33%) joints compared with MR volume method. On follow up study, bone resorption was not correlated with necrotic extent of subchondral fracture and MR volume method. Conclusion : The extent of femoral head necrosis measured by subchondral fracture was different from that measured by MR and was not correlated with bone resorption on follow up. Therefore, usefulness of subchondral fracture as a prognostic factor may be limited.

목적 : Legg-Calve-Perthes 환아에서 골괴사의 측정방법으로서 단순촬영상 관찰되는 연골하 골절선과 자기공명영상을 비교하여 두 방법 간의 차이를 알아보고자 하였다. 대상 및 방법 : 단순촬영에서 연골하 골절선이 보이고 자기공명영상을시행한 15예의 고관절을 후향적으로 연구하였다. 연골하 골절선을 기준으로 Salter-Thompson분류법에 따른 대퇴골두의 골괴사 부위 범위에 따라, 50% 이하를 A군, 50% 이상을 B군으로 분류하였다. PACS workstation상에서 자기공명영상에서 보이는 골괴사 부위의 면적을 측정하고 부피를 계산하였다. 자기공명영상에서 측정한 골괴사 부위는 50% 이하를 A군, 50% 이상을 B군으로 구분하여 Salter-Thompson분류법과 비교하였다. 3년 이상 추적검사를 시행한 10명의 환아에서 골흡수 정도를 연골하 골절선과 자기공명영상에 의한 골괴사 정도와 비교하였다. 결과 : 연골하 골절선과 자기공명영상을 이용한 골괴사 정도는 15고관절 중 9관절(60%)에서 grade가 달랐다. 9관절 중 연골하 골절선을 이용한 골괴사 정도가 자기공명영상을 이용한 골괴사 정도보다 grade가 높게 나타난 경우가 6관절(67%)이었고, 낮게 나타난 경우는 3관절(33%)이었다. 추적검사상 나타난 골흡수는 두 방법에 의한 골괴사 부위와 일치하지 않았다. 결론 : 연골하 골절선에 의한 골괴사 정도는 자기공명영상을 이용한 골괴사 정도와 일치하지 않았고, 추적검사상 나타난 골흡수 정도도 유의한 연관이 없었다. 그러므로 연골하 골절선으로 골괴사의 예후를 측정하는 것은 제한적일 것으로 생각된다.

Keywords

References

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