Imaging
Avascular Necrosis
- Preliminary Diagnosis: Avascular necrosis
-
I. What imaging technique is first-line for this diagnosis?
- II. Describe the advantages and disadvantages of this technique for diagnosis of avascular necrosis.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of avascular necrosis.
- VI. What are the contraindications for the alternative imaging techniques?
Preliminary Diagnosis: Avascular necrosis
I. What imaging technique is first-line for this diagnosis?
MRI
II. Describe the advantages and disadvantages of this technique for diagnosis of avascular necrosis.
Advantages
Most sensitive and specific imaging technique for diagnosis of avascular necrosis
It is the preferred technique for early and accurate detection.
Noninvasive method
Does not use ionizing radiation
Disadvantages
Expensive
Time-consuming imaging modality
Requires marked patient cooperation to limit motion artifact
III. What are the contraindications for the first-line imaging technique?
MRI is contraindicated in patients with non-MR-compatible foreign bodies or metallic hardware.
IV. What alternative imaging techniques are available?
Bone scintigraphy
CT scan
Plain film (radiography)
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of avascular necrosis.
Bone scintigraphy
Advantages
Sensitive in diagnosing avascular osteonecrosis in early stages. However, it is less sensitive than MRI.
Disadvantages
Has less sensitivity, show less spatial resolution than the other methods and cannot grade the severity of the disease
Includes exposure to ionizing radiation
CT
Advantages
High-resolution images of structural anatomy
Notably more accurate than conventional radiography in staging the disease
Disadvantages
Requires a large amount of ionizing radiation
Plain film
Advantages
There is far less radiation exposure using plain film compared with CT.
Plain films can be used in staging of the disease.
Disadvantages
Low sensitivity level for diagnosis
Plain film is less accurate than CT in grading the disease in all stages and cannot show early stages (not sensitive to stages 0 and I).
VI. What are the contraindications for the alternative imaging techniques?
Bone
Bone scintigraphy is contraindicated in pregnant and breastfeeding patients.
CT is contraindicated in pregnant patients, especially within the first two trimesters.
No significant contraindications exist but must be avoided in pregnant patients.
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