Avascular necrosis of neck of femur containing Ficat staging along with some images

1. STAGES OF AVN
DR AVINASH DAHATRE
JR II RADIOLOGY

2. STEINBERG STAGING
 stage 0: normal or non-diagnostic radiographs, MRI and bone scan of at risk hip (often
contralateral hip involved, or patient has risk factors and hip pain)
 stage I: normal radiograph, abnormal bone scan and/or MRI
 stage II: cystic and sclerotic radiographic changes
 stage III: subchondral lucency or crescent sign
 stage IV: flattening of femoral head, with depression graded into
 mild: <2 mm
 moderate: 2-4 mm
 severe: >4 mm
 stage V: joint space narrowing with or without acetabular involvement
 stage VI: advanced degenerative changes

3. FICAT AND ARLET
STAGING OF AVN

4.  stage 0
 plain radiograph: normal
 MRI: normal
 clinical symptoms: nil
 stage I
 plain radiograph: normal or
minor osteopenia
 MRI: edema
 bone scan: increased uptake
 clinical symptoms: pain typically in the
groin

5.  stage II-
 plain radiograph: mixed osteopenia
and/or sclerosis and/or subchondral
cysts, without any subchondral
 MRI: geographic defect
 bone scan: increased uptake
 clinical symptoms: pain and stiffnes

6. COR T1WI

7. AXIAL T2WI SAG T2WI

8.  stage III:-
 plain radiograph: crescent sign
which is subchondral leucency
with sclerosis.
 MRI: same as plain radiograph
 clinical symptoms: pain and
stiffness +/- radiation to knee
and limp

9. SAG T1WI

10.  stage IV-
 plain radiograph: end-stage with
evidence of secondary
degenerative change.
 Flattening of femoral head
1. mild: <2 mm
2. moderate: 2-4 mm
3. severe: >4 mm
 MRI: same as plain radiograph
 clinical symptoms: pain and limp

11. COR T1WI

12. COR T2WI FATSAT