Osteonecrosis (ON) of the femoral head continues to be a devastating disorder for young patients. We evaluated the F-18 fluoride
positron emission tomography (PET) imaging modality for use in detection of the bone involved in ON of the hip. We retrospectively
reviewed the records of 60 consecutive patients diagnosed with ON and interviewed all by phone. Eleven patients (17 hips)
of those interviewed agreed to participate in the study. We classified the ON using the University of Pennsylvania classification
system and compared each patient’s plain AP bone scan, single photon emission 3-D computed tomography, and MRI. ON was associated
with HIV, alcohol, steroid use, and polycythemia vera in this group. Nine of 17 hips (8 patients) had acetabular increased
uptake when using the F-18 fluoride PET scans that were not seen on MRI, single photon emission computed tomography, or bone
scans. These data suggest earlier acetabular changes in osteonecrosis may exist that traditional imaging modalities do not
reveal.
Level of Evidence: Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
William M. Mihalko MD PhD is a consultant for Stryker Inc, Smith & Nephew Inc., Ethicon and Aesculap. He also receives research
support from Stryker and Aesculap. No research or consulting is related to this study.
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations
were conducted in conformity with ethical principles of research, and that informed consent for participation in the study
was obtained.