PMC2892653_01
Moderate bilateral joint effusion and fat-like aspects of osteonecrosis involving the weight bearing portion of the femoral heads. In the left hip where the articular surface is partially flattened. Bone marrow oedema is also present bilaterally, around the femoral capital necrosis.
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fig1
An MRI was performed (Figure 1) and revealed a moderate joint effusion, as well as fat-like aspects of osteonecrosis involving the weight bearing portion of the femoral heads particularly extruded in the left hip where the articular surface was partially flattened. Bone marrow oedema was also present bilaterally around the right femoral capital necrosis (Figure 1).
PMC2892653_02
Bilateral joint effusion and bone marrow oedema are disappeared. The right femoral head shows a regular articular surface but with aspects of midollary sclerosis. Partial aspect of fragmentation on the left femoral capital necrosis.
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fig2
The left femoral capital necrosis presented a partial aspect of fragmentation (Figure 2). 
PMC2892653_03
Flattened right femoral head, joint effusion, enlarged physes, bone marrow oedema of the femoral neck, and minimal sclerotic changes of the articular surface. There is a remarkable increase of the signal on T1W sequences only in the deep portion of the femoral head.
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fig3
After Gadolinium IV, there was a remarkable increase of the signal on T1W sequences only in the deep portion of the femoral head (Figure 3).
PMC2892653_04
Boundary line of the necrosis of the capital of the femur with a fat-like aspect, good remodelling of the femoral head, and morphologic normalization of the physes are shown in this follow up MRI.
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fig4
The last MRI, performed 30 months from initial symptoms, showed a better boundary line of the necrosis of the capital of the femur with a fat-like aspect, good remodelling of the femoral head, morphologic normalization of the physes, and only minimal flattening of the articular surface (Figure 4).