Diagnostic Imaging of Aseptic Osteonecrosis Related to Occupations
L. Németh1, Á. Mester2, M. Posgay1,
T. Kákosy1, and K. Karlinger2
1National Institute of Occupational Health, Department of Radiology,
Budapest, Hungary
2Semmelweis University of Medical Sciences, Department of
Radiology, Budapest, Hungary
CEJOEM 1997, Vol.3. No.4.:332
The etiology of aseptic (avascular) bone necrosis is multifactorial. If
it is proved to be caused by decompression or vibration, it is subject
to the Hungarian Workers’s Compensation Act. Osteonecroses develop in different
bones and different localisation, within the bone, their imaging can be
evaluated in the same manner because of the same pathologic process of
the bone tissue. The early stage of necrosis is characterised by the obstruction
of perfusion and edema of the marrow which can be visualised by Magnetic
Resonance Imaging (MRI). Bone scanning adds no more information, therefore
it has less clinical importance. Later, within the necrosis, reparation
develops as resorption (porosis and/or cysts) or sclerotisation of new
osteoid tissue and calcification of fibrovascular tissue occurs. But conventional
radiography cannot demonstrate this process, the really fine structural
abnormalities will be better imaged by High Resolution Computed Tomography
(HRCT) with its correct anatomical representation. Still it offers a correct
value about the allowed load of articular surface and the real staging
of bone necrosis. MRI with contrast material is the most effective diagnostic
means to show the reparation of bone marrow and its recirculation. The
stage of pathologic process will offer the most effective and economically
suitable examination and therapy, they are interdependent upon the team
work of the internist, the orthopaedist and the iconographer.
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