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Avascular Necrosis
Bimal Vyas, MD, MS; Andrew T. Trout, MD
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Avascular necrosis (AVN)
          • Definitions

            • Osseous necrosis involving marrow and trabecular bone related to ischemia
              • Also called osteonecrosis, bone infarct, medullary infarct, osseous necrosis
              • Predisposing history: Sickle cell disease, corticosteroids, chemotherapy

          IMAGING

          • General Features

            • Nuclear Medicine Findings

              • Imaging Recommendations

                • Radiographic Findings

                  • MR Findings

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Image Interpretation Pearls

                                  Selected References

                                  1. Grant FD et al: Radiation doses for pediatric nuclear medicine studies: comparing the North American consensus guidelines and the pediatric dosage card of the European Association of Nuclear Medicine. Pediatr Radiol. ePub, 2014
                                  2. Mazloumi SM et al: Evolution in diagnosis and treatment of Legg-Calve-Perthes disease. Arch Bone Jt Surg. 2(2):86-92, 2014
                                  3. Roca I et al: Evaluation of bone viability. Pediatr Radiol. 43(4):393-405, 2013
                                  4. Gelfand MJ et al: Pediatric radiopharmaceutical administered doses: 2010 North American consensus guidelines. J Nucl Med. 52(2):318-22, 2011
                                  5. Segall G et al: SNM practice guideline for sodium 18F-fluoride PET/CT bone scans 1.0. J Nucl Med. 51(11):1813-20, 2010
                                  6. Stauss J et al: Guidelines for paediatric bone scanning with 99mTc-labelled radiopharmaceuticals and 18F-fluoride. Eur J Nucl Med Mol Imaging. 37(8):1621-8, 2010
                                  7. Dasa V et al: F-18 fluoride positron emission tomography of the hip for osteonecrosis. Clin Orthop Relat Res. 466(5):1081-6, 2008
                                  8. Comte F et al: Confirmation of the early prognostic value of bone scanning and pinhole imaging of the hip in Legg-Calve-Perthes disease. J Nucl Med. 44(11):1761-6, 2003
                                  9. Lamer S et al: Femoral head vascularisation in Legg-Calvé-Perthes disease: comparison of dynamic gadolinium-enhanced subtraction MRI with bone scintigraphy. Pediatr Radiol. 32(8):580-5, 2002
                                  10. Harel L et al: Meyer dysplasia in the differential diagnosis of hip disease in young children. Arch Pediatr Adolesc Med. 153(9):942-5, 1999
                                  11. Smith SW et al: Interobserver reliability and intraobserver reproducibility of the modified Ficat classification system of osteonecrosis of the femoral head. J Bone Joint Surg Am. 78(11):1702-6, 1996
                                  12. Conway JJ: A scintigraphic classification of Legg-Calve-Perthes disease. Semin Nucl Med. 23(4):274-95, 1993
                                  13. Ficat RP: Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br. 67(1):3-9, 1985
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Imaging

                                    • Top Differential Diagnoses

                                      • Pathology

                                        • Clinical Issues

                                          TERMINOLOGY

                                          • Abbreviations

                                            • Avascular necrosis (AVN)
                                          • Definitions

                                            • Osseous necrosis involving marrow and trabecular bone related to ischemia
                                              • Also called osteonecrosis, bone infarct, medullary infarct, osseous necrosis
                                              • Predisposing history: Sickle cell disease, corticosteroids, chemotherapy

                                          IMAGING

                                          • General Features

                                            • Nuclear Medicine Findings

                                              • Imaging Recommendations

                                                • Radiographic Findings

                                                  • MR Findings

                                                    DIFFERENTIAL DIAGNOSIS

                                                      PATHOLOGY

                                                      • General Features

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Demographics

                                                            • Natural History & Prognosis

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Image Interpretation Pearls

                                                                  Selected References

                                                                  1. Grant FD et al: Radiation doses for pediatric nuclear medicine studies: comparing the North American consensus guidelines and the pediatric dosage card of the European Association of Nuclear Medicine. Pediatr Radiol. ePub, 2014
                                                                  2. Mazloumi SM et al: Evolution in diagnosis and treatment of Legg-Calve-Perthes disease. Arch Bone Jt Surg. 2(2):86-92, 2014
                                                                  3. Roca I et al: Evaluation of bone viability. Pediatr Radiol. 43(4):393-405, 2013
                                                                  4. Gelfand MJ et al: Pediatric radiopharmaceutical administered doses: 2010 North American consensus guidelines. J Nucl Med. 52(2):318-22, 2011
                                                                  5. Segall G et al: SNM practice guideline for sodium 18F-fluoride PET/CT bone scans 1.0. J Nucl Med. 51(11):1813-20, 2010
                                                                  6. Stauss J et al: Guidelines for paediatric bone scanning with 99mTc-labelled radiopharmaceuticals and 18F-fluoride. Eur J Nucl Med Mol Imaging. 37(8):1621-8, 2010
                                                                  7. Dasa V et al: F-18 fluoride positron emission tomography of the hip for osteonecrosis. Clin Orthop Relat Res. 466(5):1081-6, 2008
                                                                  8. Comte F et al: Confirmation of the early prognostic value of bone scanning and pinhole imaging of the hip in Legg-Calve-Perthes disease. J Nucl Med. 44(11):1761-6, 2003
                                                                  9. Lamer S et al: Femoral head vascularisation in Legg-Calvé-Perthes disease: comparison of dynamic gadolinium-enhanced subtraction MRI with bone scintigraphy. Pediatr Radiol. 32(8):580-5, 2002
                                                                  10. Harel L et al: Meyer dysplasia in the differential diagnosis of hip disease in young children. Arch Pediatr Adolesc Med. 153(9):942-5, 1999
                                                                  11. Smith SW et al: Interobserver reliability and intraobserver reproducibility of the modified Ficat classification system of osteonecrosis of the femoral head. J Bone Joint Surg Am. 78(11):1702-6, 1996
                                                                  12. Conway JJ: A scintigraphic classification of Legg-Calve-Perthes disease. Semin Nucl Med. 23(4):274-95, 1993
                                                                  13. Ficat RP: Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br. 67(1):3-9, 1985