PMC4873613_01
Short-tau inversion recovery (STIR) sequence image 2 days after the traumatic dislocation of the hip joint. Coronal STIR sequence image obtained 2 days after dislocation shows no bony injuries or bone marrow edema around the hip joint.
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On MRI performed two days after dislocation, no bony injuries or bone marrow edema were observed around the hip joint (Fig. 1).
Anteroposterior radiograph after the onset of right hip pain. An anteroposterior radiograph obtained after the onset of right hip pain shows an irregular contour at the outside of the femoral head, around which focal bone loss is observed (white arrows).
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An anteroposterior radiograph obtained four months after the injury showed an irregular contour along the outside of the femoral head, around which focal bone loss was observed (Fig. 2).
a-c Magnetic resonance images (MRI) performed 4 months after the injury following the onset of right hip pain. (a) A coronal T1-weighted image shows a low-intensity band convex to the articular surface above the epiphyseal scar (black arrows). (b) A coronal short-tau inversion recovery (STIR) sequence image shows bone marrow edema changes around the band (white arrowheads). (c) On gadolinium-enhanced magnetic resonance image MRI, the band and surrounding area were enhanced (white arrows), accompanied by diffuse bone marrow edema (white arrowheads).
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A low-intensity band convex to the articular surface was apparent above the epiphyseal scar on T1-weighted imaging (Fig. 3a), and bone marrow edema changes were observed around the band lesion on short-tau inversion recovery (STIR) imaging (Fig. 3b). Moreover, gadolinium-enhanced MRI showed the band and surrounding area to be enhanced, accompanied by diffuse bone marrow edema (Fig. 3c), and single-photon emission computed tomography/computed tomography (SPECT/CT) with Tc-99 m hydroxymethylene diphosphonate demonstrated the presence of increased uptake involving the entire femoral head (Fig. 4).
a,b Magnetic resonance images (MRI) performed at the end of a 2-month period of conservative therapy. (a) Coronal T1-weighted image. The band previously seen on MRI is no longer evident. (b) Coronal short-tau inversion recovery (STIR) sequence image. The band previously seen on MRI is no longer evident.
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After a two-month period of non-surgical conservative therapy, including the avoidance of weight-bearing activities, the patient's hip pain resolved and the low-intensity band previously seen on T1-weighted imaging was no longer observed on follow-up MRI performed two months after the onset of pain (Fig. 5).