HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Griffith, J. F. Articles by Ahuja, A. T. Search for Related Content PubMed PubMed Citation Articles by Griffith, J. F. Articles by Ahuja, A. T.

Osteonecrosis of Hip and Knee in Patients with Severe Acute Respiratory Syndrome Treated with Steroids¹

¹ From the Departments of Diagnostic Radiology and Organ Imaging (J.F.G., G.E.A., J.K.T.W., A.T.A.), Orthopaedics and Traumatology (S.M.K., K.H.C., K.M.C., P.C.L.,), Medicine (D.S.C.H., A.K.L.W.), Anaesthesia and Intensive Care (G.M.J.), and Centre for Epidemiology and Biostatistics (A.Y.K.C.), Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. Received January 19, 2004; revision requested March 19; final revision received June 30; accepted July 26. Address correspondence to J.F.G. (e-mail: griffith@ruby.med.cuhk.edu.hk).

View larger version (106K): [in a new window]   Figure 1a. Subchondral abnormality. (a) Coronal T1-weighted (590/20) image of both knees shows foci of low signal intensity (arrows) in the inferior aspects of both lateral patellar facets. Transverse (b) T1-weighted (518/15) and (c) intermediate-weighted fat-suppressed (2480/21) images of left patella show area of ill-defined subchondral edema (arrow) in lateral patellar facet and mild lateral patellar subluxation. Although cartilage overlying this area is thin, this level is at the inferior aspect of patella, where articular cartilage is normally thinned. Cartilage located immediately cephalad (not shown) was of normal thickness. Radiographs were normal.

View larger version (116K): [in a new window]   Figure 1b. Subchondral abnormality. (a) Coronal T1-weighted (590/20) image of both knees shows foci of low signal intensity (arrows) in the inferior aspects of both lateral patellar facets. Transverse (b) T1-weighted (518/15) and (c) intermediate-weighted fat-suppressed (2480/21) images of left patella show area of ill-defined subchondral edema (arrow) in lateral patellar facet and mild lateral patellar subluxation. Although cartilage overlying this area is thin, this level is at the inferior aspect of patella, where articular cartilage is normally thinned. Cartilage located immediately cephalad (not shown) was of normal thickness. Radiographs were normal.

View larger version (111K): [in a new window]   Figure 1c. Subchondral abnormality. (a) Coronal T1-weighted (590/20) image of both knees shows foci of low signal intensity (arrows) in the inferior aspects of both lateral patellar facets. Transverse (b) T1-weighted (518/15) and (c) intermediate-weighted fat-suppressed (2480/21) images of left patella show area of ill-defined subchondral edema (arrow) in lateral patellar facet and mild lateral patellar subluxation. Although cartilage overlying this area is thin, this level is at the inferior aspect of patella, where articular cartilage is normally thinned. Cartilage located immediately cephalad (not shown) was of normal thickness. Radiographs were normal.

View larger version (145K): [in a new window]   Figure 2a. Subchondral abnormality related to chondral defect. (a) Coronal T1-weighted (590/20) image of both knees shows small focus of low signal intensity (arrow) in intercondylar region of right knee. Localized sagittal (b) intermediate-weighted (3500/43) and (c) T2-weighted fat-suppressed (3970/74) images of right knee show small focus of subchondral edema (arrow in b and arrowhead in c) in intercondylar region and overlying focal cartilage defect (arrow in c). Radiographs were normal.

View larger version (142K): [in a new window]   Figure 2b. Subchondral abnormality related to chondral defect. (a) Coronal T1-weighted (590/20) image of both knees shows small focus of low signal intensity (arrow) in intercondylar region of right knee. Localized sagittal (b) intermediate-weighted (3500/43) and (c) T2-weighted fat-suppressed (3970/74) images of right knee show small focus of subchondral edema (arrow in b and arrowhead in c) in intercondylar region and overlying focal cartilage defect (arrow in c). Radiographs were normal.

View larger version (147K): [in a new window]   Figure 2c. Subchondral abnormality related to chondral defect. (a) Coronal T1-weighted (590/20) image of both knees shows small focus of low signal intensity (arrow) in intercondylar region of right knee. Localized sagittal (b) intermediate-weighted (3500/43) and (c) T2-weighted fat-suppressed (3970/74) images of right knee show small focus of subchondral edema (arrow in b and arrowhead in c) in intercondylar region and overlying focal cartilage defect (arrow in c). Radiographs were normal.

View larger version (179K): [in a new window]   Figure 3a. Subchondral abnormality not related to chondral defect. Localized sagittal (a) T1-weighted (518/14) and (b) T2-weighted fat-suppressed (3970/74) MR images of knee show area of subchondral bone marrow edema (large arrow) situated posteriorly in medial femoral condyle. No osteonecrosis is present, as is evidenced by the lack of any demarcation line on any of the MR images. Overlying articular cartilage (small arrows) is normal. Radiographs were normal.

View larger version (145K): [in a new window]   Figure 3b. Subchondral abnormality not related to chondral defect. Localized sagittal (a) T1-weighted (518/14) and (b) T2-weighted fat-suppressed (3970/74) MR images of knee show area of subchondral bone marrow edema (large arrow) situated posteriorly in medial femoral condyle. No osteonecrosis is present, as is evidenced by the lack of any demarcation line on any of the MR images. Overlying articular cartilage (small arrows) is normal. Radiographs were normal.

View larger version (47K): [in a new window]   Figure 4. Diagram shows sites in knee for 161 subchondral abnormalities (dark gray) in 64 patients and for 54 intramedullary abnormalities (light gray) in 38 patients. The relative frequency of abnormalities in each site is represented as a percentage.

View larger version (134K): [in a new window]   Figure 5. Coronal T1-weighted (590/20) MR image of both hips shows discrete intramedullary bone marrow abnormalities, 12-14 mm in length, in the right greater trochanter and left femoral neck (arrows). Radiographs were normal.

View larger version (129K): [in a new window]   Figure 6. Coronal T1-weighted (590/20) MR image of both hips shows well-demarcated areas of osteonecrosis (arrows) in the anterosuperior aspect of both femoral heads. Radiographs were normal. Other MR images in this patient also depicted established osteonecrosis in the distal femora and proximal tibiae.

View larger version (183K): [in a new window]   Figure 7a. (a) Coronal T1-weighted (590/20) MR image of both knees shows foci of low signal intensity (arrows) in the posterior aspect of both lateral femoral condyles. (b) Sagittal T1-weighted (518/14) MR image of right knee shows area of subchondral osteonecrosis (arrow) in posterior aspect of lateral condyle. Detailed MR images of left knee (not shown) revealed subchondral edema without demarcation line (similar to features depicted in Fig 3). Radiographs were normal.

View larger version (181K): [in a new window]   Figure 7b. (a) Coronal T1-weighted (590/20) MR image of both knees shows foci of low signal intensity (arrows) in the posterior aspect of both lateral femoral condyles. (b) Sagittal T1-weighted (518/14) MR image of right knee shows area of subchondral osteonecrosis (arrow) in posterior aspect of lateral condyle. Detailed MR images of left knee (not shown) revealed subchondral edema without demarcation line (similar to features depicted in Fig 3). Radiographs were normal.

View larger version (25K): [in a new window]   Figure 8. Histogram shows spectrum of cumulative prednisolone-equivalent doses for patients with no osteonecrosis, patients with nonspecific bone marrow abnormality, and patients with osteonecrosis.