Advantage of magnetic resonance imaging over X-Ray in diagnosis and evaluation of avascular necrosis of femoral head in patients with sickle cell disease

Abstract

Background: Avascular necrosis (AVN) of the femoral head in sickle cell disease (SCD) individuals causes substantial morbidity and joint dysfunction. Preventing disease progression and planning therapy need early identification. MRI and X-ray are standard diagnostic techniques, although their efficiency in identifying early AVN in SCD patients is unknown. Objective: This research compares MRI and conventional X-ray in identifying AVN of the femoral head in SCD patients and evaluates Ficat-Arlet and Mitchell classification systems for AVN progression. Method: From August 2023 to March 2024, the Radiology Department of Al Sader Teaching Hospital performed a cross-sectional research of 80 SCD patients with hip pain, stiffness, or limping. All subjects had MRIs and X-rays. Imaging data were staged using Ficat-Arlet and Mitchell classifications to assess AVN severity and progression. Results: MRI detected early-stage AVN lesions that X-rays missed. MRI revealed early-stage AVN in 15.6% of Ficat-Arlet stage 1 patients, compared to 6.2% by X-ray. MRI had a 31.9% and 18.7% detection rate in stages 2 and 3, compared to 17.5% and 16.2% for X-ray. MRI showed precise femoral head structural and pathological alterations, essential for early management. MRI also revealed bone marrow edoema and the "double-line sign," which indicate persistent ischemia damage and were not visible by X-ray. Conclusion: MRI surpasses X-ray in detecting and staging AVN in SCD patients, offering crucial insights for early treatment. In SCD patients at risk for AVN, MRI is indicated as a key diagnostic technique for comprehensive anatomical and pathological examination to improve clinical outcomes.