Article Figures & Data
Figures
- Figure 1.
Search strategy for magnetic resonance imaging (MRI) hip osteoarthritis (OA) scoring systems. The 5 scoring systems are reported4,5,6,8,9.
- Figure 2.
Assessment of cartilage lesions on magnetic resonance imaging (MRI). A. Method according to Schmid, et al4. Sagittal proton density (PD) fat saturated (FS) MRI. Acetabular zones are labeled anterosuperior (AS), anteroinferior (AI), posterosuperior (PS), posteroinferior (PI). Note that the PI zone is present only medially. B. Method according to Neumann, et al5. C, D. Method according to Roemer, et al6, Hip OsteoArthritis MRI Scoring System. C: sagittal PD FS MRI. The edges of the joint (anterior and posterior 9 mm of femoral head) are scored in 4 zones: AS: anterior-superior, AI: anterior-inferior, PS: posterior-superior, PI: posterior-inferior. D: coronal PD FS MRI showing one of the central slices of joint (between anterior and posterior 9 mm). Scoring is in 5 zones: CL: central-lateral, CS: central-superior, CC: central-central, CI: central-inferior, CM: central-medial. From Roemer, et al. Osteoarthritis Cartilage 2011;19:946–62; adapted with permission.
- Figure 3.
Assessment of bone marrow lesions on magnetic resonance imaging (MRI). A, B. Method according to Hip OsteoArthritis MRI Scoring System6. A: Sagittal proton density fat saturated (PD FS) MRI showing scoring for edges of joint, at anterior and posterior 9 mm of femoral head. Seven zones, including ASF: anterior-superior femoral, AIF: anterior-inferior femoral, PSF: posterior-superior femoral, PIF: posterior-inferior femoral, ASA: anterior-superior acetabulum, PSA: posterior-superior acetabulum, PIA: posterior-inferior acetabulum. B: Coronal PD FS MRI at one of the central slices of the joint (between anterior and posterior 9 mm). Three acetabular zones (CSA: central-superior acetabulum, CCA: central-central acetabulum, CIA: central-inferior acetabulum) and 5 femoral head zones (CLF: central-lateral femoral, CSF: central-superior femoral, CCF: central-central femoral, CIF: central-inferior femoral, CMF: central-medial femoral). C. Method according to Hip Inflammation MRI Scoring System (HIMRISS)8. Coronal short-tau inversion recovery MRI. The central 5 slices of femoral head (right image) have 8 circle sectors, numbered 1 = superomedial, clockwise to 8 = superolateral; center = 9. The central 5 slices of acetabulum have 3 sectors each, numbered 10 (lateral) to 12 (medial). Anterior slices (D) and posterior slices (E) have 2 regions for femoral head and acetabulum (e.g., anterior superior femoral, anterior superior acetabular). Edema in each region receives a score of 1, no edema = score of 0. AS: anterosuperior; AI: anteroinferior; PS: posterosuperior; PI: posteroinferior. See www.arthritisdoctor.ca for more detailed methodology. From Roemer, et al. Osteoarthritis Cartilage 2011;19:946–62; adapted with permission.
Tables
0 Normal 1 Doubtful joint space narrowing, possible osteophytes 2 Possible joint space narrowing, definite osteophytes 3 Definite joint space narrowing, multiple osteophytes, some sclerosis, possible deformity of bone ends 4 Marked joint space narrowing, large osteophytes, severe sclerosis, definite deformity of bone ends Neumann, et al5 HOAMS6 HIMRISS8 Concept Overall grading of hip degeneration, as statistical combination of maximum changes in each of 5 zones Score of 14 features of osteoarthritis in the hip, developed by multidisciplinary consensus committee Sum of signs of inflammation (edema, synovitis, effusion) in portions of femoral head, acetabulum and adjacent tissue, across each slice of MRI Base sequence MR arthrogram Proton density fat saturated (PD FS), small field of view (1 hip), axial and sagittal Coronal inversion recovery (STIR), can be large field of view (full pelvis) or 1 hip Zones: femoral head 1 5 sectors in central hip: central-central, central-superior, central-inferior, central-medial, central-lateral Central 5 slices: 8 equal sectors of arc + 1 central zone, per slice 4 zones in anterior and posterior 9 mm of femoral head: anterosuperior, anteroinferior, posterosuperior, posteroinferior 2 zones (superior and inferior) per slice up to 5 anterior slices and up to 5 posterior slices Zones: acetabulum 4 3 sectors in central hip (central-central, central-superior, central-inferior); 2 sectors in anterior and posterior 9 mm (superior and inferior) 3 sectors per slice for central 5 slices; 2 sectors per slice for up to 5 anterior slices, 5 posterior Zones: total 5 total 9 femoral, 5 acetabular, total 14 65 femoral, 35 acetabular, total 100 Planes to use Coronal for central slices, sagittal for ant/post Coronal only Cartilage 0 normal 0 normal Not scored 1 = signal change only 1 focal partial thickness < 25% of region area 2 fissuring only, < 1 mm width 2 focal full thickness < 25% of region area 3 defect < 50% of thickness 3 several partial or 1 full > 25% 4 defect > 50% of thickness 4 several full thickness defects or one large, > 25% 5 exposed bone Width of lesion A = < 1 cm, B = 1–2 cm, C = > 2 cm per zone BML 0 = none 0 = none 0 = normal 1 = < 0.5 cm from bone 1 = < 33% of region 1 = higher signal than reference signal (uninvolved or contralateral marrow) 2 = < 1.5 cm from bone 2 = < 66% of region 3 = > 1.5 cm from bone 3 = > 66% of region Subchondral cysts Grade whole joint: 0 none 0 = none Not scored 1 = 1–2 cysts 1 = < 33% of region 2 = 3–4 cysts 2 = < 66% of region 3 = 5+ cysts 3 = > 66% of region Osteophytes Locations 5 zones (ant/post/med/lat + central) Femoral in each location Not scored Scoring Per zone: 0 = absent; 1 = mild (< 2 mm); 2 = mod (< 5 mm); 3 = severe > 5 mm 5 locations: (ant/post on axial slices; superomedial/inferolateral/central intra-articular on coronal slices) Whole-joint score, from sum of partial scores: 0 if 0; 1 if 1–2; 2 if 3–4; 3 if > 5+ 0 absent; 1 = equivocal; 2 = small definite beak-like; 3 = intermediate; 4 = large proliferative Labrum Locations Anterior/posterior/medial/lateral Anterior on sagittal; superolateral/posteromedial on coronal; anterior/posterior on axial Not scored Scoring 0 = normal 0 = normal 1 = signal change or small labrum 1 = signal change or small labrum 2 = simple tear 2 = simple tear 3 = complex tear 3 = maceration Synovitis Locations 4 sites: ant/post/med/lat femoral head/neck junction Scored once per slice × 15 slices Scoring NA Synovium only; thickness 0 if < 2 mm; 1 if 2–4 mm; 2 if > 4 mm Combined synovium + effusion: thickness 0 < 2 mm; 1 if 2–4 mm; 2 if > 4 mm Effusion NA Single grade 0, 1, 2 (overall joint assessment) Combined with synovitis Other Loose bodies NA Present or absent NA Attrition (flattened articular surface) 1 if definite flattening/asphericity of femoral head Dysplasia (undercoverage of acetabular roof) Measure centre-edge angle at mid coronal slice, if < 25*, score as dysplastic Bursitis/enthesopathy Trochanteric bursitis, greater & lesser trochanteric tendinopathy each either present or absent Paralabral cysts Present or absent Superolateral femoral head cyst Present or absent (“herniation pit”) Maximum score Statistical combination scheme using max. individual score at each site 45 (cartilage) + 45 (BML) + 45 (cysts) + 40 (osteophytes) + 15 (labrum) + 8 (synovitis) + 10 (other) = 208 57 (femoral head BML) + 27 (acetabular BML) + 30 (synovitis/effusion) = 114 -
HOAMS: Hip OsteoArthritis Scoring System; HIMRISS: Hip Inflammation MRI Scoring System; BML: bone marrow lesion; NA: not applicable.
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T1 T2 Post-gadolinium Enhancement Other Interpretation Low High Homogeneous Ill defined margins Edema-like Low High Heterogeneous Well defined margins Necrosis-like Low Low No Sclerosis Low Low Maybe Generally surrounded by edema-like Sclerosis-like Linear low signal line Surrounding high Subchondral bone deformity Subchondral fracture Low Very high Rim enhancement Well defined, rounded Cyst - Table 4.
Studies of histologic findings in areas of marrow “edema” on magnetic resonance imaging (MRI) at the hip.
Authors Design Finding in Specimen at Site of MRI “Edema” Extent of Finding on Specimen vs MRI Hofmann, et al 199325 Marrow from core decompression in transient osteoporosis of hip “Pale to dark staining homogeneous fluid” Necrotic and reparative changes, ? early osteonecrosis Specimens “filled” with fluid Taljanovic, et al 200823 Resected hip components post total arthroplasty. Decalcified specimens, MRI within 48 h pre-surgery “Palely eosinophilic extracellular fluid” Much less than on MRI: 8/20 patients, only 3% of subchondral bone Leydet-Quilici, et al, 201024 Resected femoral heads post total arthroplasty. Non-decalcified specimens, MRI within 1 mo pre-surgery Edema (SN 80%, SP 95%)
Combined with vascular marrow fibrosis (SN 69%, SP 80%)
Some necrosisMRI more specific than sensitive for true edema
Kappa = 0.77-
SN: sensitivity; SP: specificity.
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