Skip to main content
SpringerLink
Log in

Herniation pits and cystic-appearing lesions at the anterior femoral neck: an anatomical study by MSCT and µCT

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

To determine distinguishing features between herniation pits (HPs) and other cystic-appearing lesions at the anterior femoral neck in multi-slice computed tomography (MSCT) and micro-computed tomography (microCT) examinations.

Materials and methods

Institutional review board approval was obtained to examine 37 proximal femora of 23 cadaveric specimens (mean age available in 19 cadavers, 83 years; range 68–100 years; 9 female, 8 male, 6 unknown). All 37 femora were investigated by MSCT. 23 femora, which revealed cystic-appearing lesions at the anterior femoral neck in MSCT examinations, were additionally examined by microCT. Cystic-appearing lesions were categorized by their location, sclerotic margin, demarcation and shape in MSCT with assessment of inter-observer agreement. Detailed cortical and trabecular properties were evaluated in microCT examinations.

Results

There were seven HPs in three femora. There were a number of abnormalities potentially imitating HPs, including focal osteoporosis (13 in 13 femora), degenerative changes (5 in 4 femora) and trabecular restructuring (5 in 4 femora) at the anterior femoral neck. HPs were differentiated on the basis of their subchondral/subcortical location, completely surrounding sclerosis, clear demarcation and round-to-oval shape in MSCT. Because of their location and their microscopic appearance, HPs seem to resemble intra-osseous ganglia at the anterior femoral neck.

Conclusion

HPs have to be differentiated from other cystic appearing lesions at the anterior femoral neck to avoid overestimation of their incidence in the context of diagnosis of femoroacetabular impingement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Pitt MJ, Graham AR, Shipman JH, Birkby W. Herniation pit of the femoral neck. AJR. 1982;38:1115–21.

    Google Scholar 

  2. Angel JL. The reaction area of the femoral neck. Clin Orthop. 1964;32:130–42.

    CAS  PubMed  Google Scholar 

  3. Nokes SR, Vogler JB, Spritzer CE, Martinez S, Herfkens RJ. Herniation pits of the femoral neck: appearance at MR imaging. Radiology. 1989;172:231–4.

    CAS  PubMed  Google Scholar 

  4. Leunig M, Beck M, Kalhor M, Kim YJ, Werlen S, Ganz R. Fibrocystic changes at anterosuperior femoral neck: prevalence in hips with femoroacetabular impingement. Radiology. 2005;236:237–46.

    Article  PubMed  Google Scholar 

  5. Pfirrmann CWA, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J. Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology. 2006;240(3):778–85.

    Article  PubMed  Google Scholar 

  6. Kassarjian A, Yoon LS, Belzile E, Connolly SA, Millis MB, Palmer WE. Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement. Radiology. 2005;236:588–92.

    Article  PubMed  Google Scholar 

  7. Sundberg TP, Toomayan GA, Major NM. Evaluation of the acetabular labrum at 3.0-T MR imaging compared with 1.5-T MR arthrography: preliminary experience. Radiology. 2006;238(2):706–11.

    Article  PubMed  Google Scholar 

  8. Bredella MA, Stoller DW. MR imaging of femoroacetabular impingement. Magn Reson Imaging Clin N Am. 2005;13:653–64.

    Article  PubMed  Google Scholar 

  9. Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Othop Relat Res. 2003;417:112–20.

    Google Scholar 

  10. Wagner S, Hofstetter W, Chiquet M, et al. Early osteoarthritic changes of human femoral head cartilage subsequent to femoro-acetabular impingement. Osteoarthritis Cartilage. 2003;11:508–18.

    Article  CAS  PubMed  Google Scholar 

  11. Tanzer M, Noiseux N. Osseous abnormalities and early osteoarthritis: the role of hip impingement. Clin Orthop Relat Res. 2004;429:170–7.

    Article  PubMed  Google Scholar 

  12. Resnick D, Niwayama G, Coutts RD. Subchondral cysts (geodes) in arthritic disorders: pathologic and radiographic appearance of the hip joint. AJR Am J Roentgenol. 1977;128:799–806.

    CAS  PubMed  Google Scholar 

  13. Ondrouch AS. Cyst formation in osteoarthritis. J Bone Joint Surg. 1963;45:755–60.

    CAS  Google Scholar 

  14. Milgram JW. Morphologic alterations of the subchondral bone in advanced degenerative arthritis. Clin Orthop Relat Res. 1983;173:293–312.

    PubMed  Google Scholar 

  15. Ferguson AB. The pathological changes in degenerative arthritis of the hip and treatment by rotational osteotomy. J Bone Joint Surg. 1964;46:1337–52.

    PubMed  Google Scholar 

  16. Schajowicz F, Sainz MC, Slullitel JA. Juxta-articular bone cysts (intra-osseous ganglia): a clinicopathological study of eighty-eight cases. J Bone Joint Surg. 1979;61:107–16.

    CAS  Google Scholar 

  17. Landells JW. The bone cysts of osteoarthritis. J Bone Joint Surg. 1953;35:643–9.

    Google Scholar 

  18. Feldman F, Johnston A. Intraosseous ganglion. AJR Am J Roentgenol. 1973;18:328–43.

    Google Scholar 

  19. Feldkamp LA, Goldstein SA, Parfitt AM, Jesion G, Kleerekoper M. The direct examination of three-dimensional bone architecture in vitro by computed tomography. J Bone Miner Res. 1989;4:3–11.

    Article  CAS  PubMed  Google Scholar 

  20. Chappard D, Retailleau-Gaborit N, Legrand E, Baslé MF, Audran M. Comparison insight bone measurements by histomorphometry and µCT. J Bone Miner Res. 2005;20:1177–84.

    Article  PubMed  Google Scholar 

  21. Augat P, Eckstein F. Quantitative imaging of musculoskeletal tissue. Annu Rev Biomed Eng. 2008;10:369–90.

    Article  CAS  PubMed  Google Scholar 

  22. Crabbe JP, Martel W, Matthews LS. Rapid growth of femoral herniation pit. AJR Am J Roentgenol. 1992;159:1038–40.

    CAS  PubMed  Google Scholar 

  23. Daenen B, Preidler KW, Padmanabhan S, et al. Symptomatic herniation pits of the femoral neck: anatomic and clinical study. AJR Am J Roentgenol. 1997;168:149–53.

    CAS  PubMed  Google Scholar 

  24. Panzer S, Augat P, Esch U. CT assessment of herniation pits: prevalence, characteristics, and potential association with morphological predictors of femoroacetabular impingement. Eur Radiol. 2008;18:1869–75.

    Article  PubMed  Google Scholar 

  25. Martin RB. Porosity and specific surface of bone. Crit Rev Biomed Eng. 1984;3:179–222.

    Google Scholar 

  26. Kambolis C, Bullough PG, Jaffe HL. Ganglionic cystic defects of bone. J Bone Joint Surg. 1973;55:496–505.

    CAS  PubMed  Google Scholar 

  27. Mainzer F, Minagi H. Intraosseous ganglion: a solitary subchondral lesion of bone. Radiology. 1970;94:387–9.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Prof. Dr. Reinhard Putz and Prof. Dr. Magdalena Müller-Gerbl, Department of Anatomy, LMU Munich, Germany, for providing the anatomical specimens and Julia Körber, Institute of Biomechanics, Trauma Center Murnau for proofreading of the manuscript.

Author information

Authors and Affiliations

  1. Department of Radiology, Trauma Center Murnau, Prof.-Küntscher-Strasse 8, 82418, Murnau, Germany

    Stephanie Panzer & Ulrich Esch

  2. Biomechanics Laboratory, Paracelsus University Salzburg and Trauma Center Murnau, Prof.-Küntscher-Strasse 8, 82418, Murnau, Germany

    Ahmed Nabil Abdulazim & Peter Augat

Authors
  1. Stephanie Panzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ulrich Esch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmed Nabil Abdulazim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter Augat
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stephanie Panzer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Panzer, S., Esch, U., Abdulazim, A.N. et al. Herniation pits and cystic-appearing lesions at the anterior femoral neck: an anatomical study by MSCT and µCT. Skeletal Radiol 39, 645–654 (2010). https://doi.org/10.1007/s00256-009-0792-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-009-0792-9

Keywords

Search

Navigation