Korean J Radiol.  2015 Jun;16(3):617-625. 10.3348/kjr.2015.16.3.617.

Effect of Arterial Deprivation on Growing Femoral Epiphysis: Quantitative Magnetic Resonance Imaging Using a Piglet Model

• Cheon JE
• Yoo WJ
• Kim IO
• Kim WS
• Choi YH

• KMID: 2155532
• DOI: http://doi.org/10.3348/kjr.2015.16.3.617

Abstract

OBJECTIVE
To investigate the usefulness of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion MRI for the evaluation of femoral head ischemia.
MATERIALS AND METHODS
Unilateral femoral head ischemia was induced by selective embolization of the medial circumflex femoral artery in 10 piglets. All MRIs were performed immediately (1 hour) and after embolization (1, 2, and 4 weeks). Apparent diffusion coefficients (ADCs) were calculated for the femoral head. The estimated pharmacokinetic parameters (Kep and Ve from two-compartment model) and semi-quantitative parameters including peak enhancement, time-to-peak (TTP), and contrast washout were evaluated.
RESULTS
The epiphyseal ADC values of the ischemic hip decreased immediately (1 hour) after embolization. However, they increased rapidly at 1 week after embolization and remained elevated until 4 weeks after embolization. Perfusion MRI of ischemic hips showed decreased epiphyseal perfusion with decreased Kep immediately after embolization. Signal intensity-time curves showed delayed TTP with limited contrast washout immediately post-embolization. At 1-2 weeks after embolization, spontaneous reperfusion was observed in ischemic epiphyses. The change of ADC (p = 0.043) and Kep (p = 0.043) were significantly different between immediate (1 hour) after embolization and 1 week post-embolization.
CONCLUSION
Diffusion MRI and pharmacokinetic model obtained from the DCE-MRI are useful in depicting early changes of perfusion and tissue damage using the model of femoral head ischemia in skeletally immature piglets.

Keyword

Diffusion-weighted imaging; Dynamic contrast enhanced MRI; Femoral head ischemia

MeSH Terms

Animals
Arteries/physiopathology
Diffusion Magnetic Resonance Imaging/*methods
Disease Models, Animal
Embolism/complications
Epiphyses/*blood supply/*pathology
Femur Head/*blood supply/*pathology
Male
Osteonecrosis/pathology
Pelvic Bones/blood supply/pathology
Reperfusion Injury/complications/*diagnosis
Swine

Figure

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  Fig. 1 Occlusion of medial circumflex femoral artery. A. Aortography at level of bifurcation demonstrating angiographic anatomy of iliac and femoral arteries. Note medial circumflex femoral artery (arrow). B. Follow-up aortography demonstrating abrupt cutoff of medial circumflex femoral artery (arrow) suggesting successful embolization.

• 

  Fig. 2 Gross and histopathologic findings at 2 weeks postoperative specimen. A. Faxitron radiography of harvested femurs showing no significant femoral head collapse or fragmentation. B, C. Gross cut section of ischemic area (B) demonstrating pale epiphyseal bone marrow (arrows) and metaphyseal congestion compared to contralateral areas (C). D, E. Microscopically, collagen fibers are seen in marrow cavity (D, hematoxylin and eosin stain, × 100). Note acellular zones (arrows, E) near growth plate (*, E) (hematoxylin and eosin stain, × 40).

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  Fig. 3 Time-interval change of diffusion and perfusion parameters. A. Relative ratio of ADC showing that ADC values in secondary ossification center of femoral head decreased in ischemic hip immediately after embolization, rapidly increased during 1-week postoperative period, and then maintained until 4 weeks post-embolization compared to control side. ADC ratios obtained immediately and 1 week post-embolization showed statistically significant difference (p = 0.043). B. Kep ratio obtained immediately and 1 week post-embolization showed statistically significant difference (p = 0.043). ADC = apparent diffusion coefficient

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  Fig. 4 Signal intensity-time curves. A. Dynamic contrast enhanced T1-weighted image obtained immediately after embolization demonstrating markedly decreased contrast enhancement in right femoral head (arrow). B. Signal intensity-time curve obtained in immediate postoperative period demonstrating decreased peak enhancement, delayed time-to-peak, and persistent enhancement on wash-out phase in ischemic area. C. Signal intensity-time curve of same experimental animal obtained 1 week after embolization showing shortened time-to-peak and partially improved delayed wash-out in ischemic area.

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