Osteonecrosis of the humeral head

Case contributed by Bahman Rasuli
Diagnosis almost certain


Chronic left shoulder pain.

Patient Data

Age: 30 years
Gender: Female

Osteonecrosis of the humeral head is delineated by a serpiginous peripheral /outer dark (sclerosis) and inner bright (granulation tissue) on T2WI (double line sign) involving the entire superior medial portion.

There is no evidence of subchondral collapse.

Case Discussion

MR imaging is a highly sensitive and valuable diagnostic tool for detecting osteonecrosis in the humeral head.

In the early stages, sclerosis - which can be either focal or diffuse - arises from subchondral microfracture without articular collapse. It typically appears in the superior portion of the humeral head and is seen as a hypointense signal on T1-weighted images. On PD fat sat, STIR, and T2-weighted images, a double line sign can be observed, indicating lines of alternating high and low signal intensity. The inner line, which appears as a hypersignal, corresponds to hyperemic granulation tissue, while the outer dark band corresponds to fibrosis or sclerosis. As the condition progresses, fragmentation and articular collapse may occur.

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