Mitchell classification of avascular necrosis

Last revised by Dr Varun Babu on 21 Dec 2017

Mitchell classification of avascular necrosis is based on MRI signal characteristics within the center of the lesion on T1 and T2-weighted images.

The lesion is classified into four stages with stage A representing early disease and stage D representing late disease. However, the signal intensity of more than one stage can be found in a single lesion.

  • stage A
    • T1: hyperintense
    • T2: intermediate
    • signal analogous to that of fat
  • stage B
    • T1: hyperintense
    • T2: hyperintense
    • signal analogous to that of subacute blood
  • stage C
    • T1: hypointense
    • T2: hyperintense
    • signal analogous to that of fluid/edema
  • stage D
    • T1: hypointense
    • T2: hypointense
    • signal analogous to that of fibrosis

This classification was described by D G Mitchell et al. in 1987 1.

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