Medical Radiology and Radiation Safety. 2025. Vol. 70. № 4
DOI:10.33266/1024-6177-2025-70-4-82-86
A.M. Zainagutdinova, E.N. Surovtsev, Yu.S. Pyshkina, A.V. Kapishnikov
Avascular Necrosis and Bone Marrow Infarction as a Manifestation of Postcovoid Syndrome
Samara State Medical University, Samara, Russia
Contact person: Yu.S. Pyshkina, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
ABSTRACT
Purpose: To assess the demographic and magnetic resonance imaging (MRI) manifestations of aseptic necrosis and bone marrow infarction in patients before, during, and after the COVID-19 pandemic (2019–2023).
Material and methods: The study included 229 patients diagnosed with aseptic necrosis and bone marrow infarction using MRI between 2019 and 2023. The average age of the participants was 50±10 years. All patients underwent MRI using T2-weighted imaging (WI), T1-WI, PD-FS, T2-WI, and T1-WI with fat suppression. In patients diagnosed with aseptic osteonecrosis, the following MRI signs were recorded: marginal subcortical pathological MRI signal, narrowing of the joint space, joint effusion, bone marrow edema around the necrosis zone. For bone marrow infarction, the following signs were observed: a pathological MRI signal resembling a “geographic map,” heterogeneous increased signal on T2-WI and T1-WI, hyperintensity on STIR, and bone marrow edema around the periphery. Statistical analysis of the data was performed.
Results: The results of the study showed that aseptic necrosis of the joints developed more frequently in young, working-age individuals after the pandemic. An increase in the number of male patients with these pathologies was also noted. The incidence of aseptic necrosis increased by 10 % between 2019 and 2022, while bone marrow infarction increased by 3.5 % between 2019 and 2023. The number of bilateral joint lesions in 2019 was significantly lower (p<0.05) than in the post-COVID period, accounting for 8 % of the total number of patients with aseptic necrosis and bone marrow infarction. An increase in the prevalence of stages II and III of the disease was observed between 2019 and 2023.
Conclusion: The more frequent development of the disease in the most economically active population group (working-age men) with bilateral lesions necessitates the development of preventive measures and a comprehensive rehabilitation program, including potential prosthetic interventions. These measures aim to restore patients’ quality of life and enable them to continue their professional activities.
Keywords: aseptic necrosis, bone marrow infarction, COVID-19, post-COVID syndrome, magnetic resonance imaging
For citation: Zainagutdinova AM, Surovtsev EN, Pyshkina YuS, Kapishnikov AV. Avascular Necrosis and Bone Marrow Infarction as a Manifestation of Postcovoid Syndrome. Medical Radiology and Radiation Safety. 2025;70(4):82–86. (In Russian). DOI:10.33266/1024-6177-2025-70-4-82-86
References
1. Vande Berg B.C., Malghem J., Lecouvet F.E., Noel H., Maldague B. MR Imaging of Bone Infarction and Epiphyseal Osteonecrosis. J Belge Radiol. 1997;80;5:243-50.
2. Торгашин А.Н., Родионова С.С., Шумский А.А., Макаров М.А., Торгашина А.В., Ахтямов И.Ф., Коваленко А.Н., Загородний Н.В., Миронов С.П. Лечение асептического некроза головки бедренной кости. Клинические рекомендации // Научно-практическая ревматология. 2020. Т.58. №6. С. 637-645 [Torgashin A.N., Rodionova S.S., Shumskiy A.A., Makarov M.A., Torgashina A.V., Akhtyamov I.F., Kovalenko A.N., Zagorodniy N.V., Mironov S.P. Treatment of Aseptic Necrosis of the Femoral Head. Clinical Guidelines. Nauchno-Prakticheskaya Revmatologiya = Scientific and Practical Rheumatology. 2020;58;6:637-645 (In Russ.)]. doi: 10.47360/1995-4484-2020-637-645.
3. Панин М.А., Загородний Н.В., Карчебный Н.Н., Садков И.А., Петросян А.С., Закирова А.Р. Современный взгляд на патогенез нетравматического остеонекроза // Вестник травматологии и ортопедии им. Н.Н.Приорова. 2017. №2. С. 69-75 [Panin M.A., Zagorodniy N.V., Karchebnyy N.N., Sadkov I.A., Petrosyan A.S., Zakirova A.R. Modern View on the Pathogenesis of Non-Traumatic Osteonecrosis. Vestnik Travmatologii i Ortopedii Im. N.N.Priorova = Bulletin of Traumatology and Orthopedics Named after N.N.Priorov. 2017;2:69-75 (In Russ.)]. doi: 10.17816/vto201724269-75.
4. Inneh A., Martinez K., Elizee J., Ganguli M., Turan A. COVID-19-Related Bilateral Avascular Necrosis of the Femoral Head. Cureus. 2023;15;8:e44034. doi: 10.7759/cureus.44034.
5. Darraz S., Omar M., Lachkar A., Abdeljaouad N., Yacoubi H. Aseptic Osteonecrosis of the Femoral Head: The Effect of Corticosteroid Therapy and Long COVID Syndrome. Cureus. 2024;16;2:e54327. doi: 10.7759/cureus.54327.
6. Murugesan L., Sivakumar N., Ramamoorthy L., Farooq U. COVID-19-Associated Bilateral Avascular Necrosis of Femoral Head in a Young Male Without Corticosteroid Exposure: a Case Report. Cureus. 2024;16;4:e57525. doi: 10.7759/cureus.57525.
7. Ji H.L., Zhao R., Matalon S., Matthay M.A. Elevated Plasmin(ogen) as a Common Risk Factor for COVID-19 Susceptibility. Physiol Rev. 2020;100;3:1065-1075. doi: 10.1152/physrev.00013.2020.
8. Chen Y., Miao Y., Liu K., Xue F., Zhu B., Zhang C., Li G. Evolutionary Course of the Femoral Head Osteonecrosis: Histopathological – Radiologic Characteristics and Clinical Staging Systems. J Orthop Translat. 2021;32:28-40. doi: 10.1016/j.jot.2021.07.004.
9. Parikh S., Gomez O., Davis T., Lyon Z., Corces A. Avascular Necrosis as a Sequela of COVID-19: a Case Series. Cureus. 2023;15;2:e35368. doi: 10.7759/cureus.35368.
10. Velchov V., Georgiev P., Tserovski S., Tsenkov T., Alexiev V. Corticosteroid-Associated Avascular Necrosis of the Femoral Head in Patients with Severe COVID-19: a Single-Center Study. Med Sci Monit. 2023;29:e940965. doi: 10.12659/MSM.940965.
11. Sakellariou E., Argyropoulou E., Karampinas P., Galanis A., Varsamos I., Giannatos V., Vasiliadis E., Kaspiris A., Vlamis J., Pneumaticos S. A Comprehensive Review of COVID-19-Infection- and Steroid-Treatment-Associated Bone Avascular Necrosis: a Multi-Study Analysis. Diagnostics (Basel). 2024;14;3:247. doi: 10.3390/diagnostics14030247.
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Conflict of interest. The authors declare no conflict of interest.
Financing. The study had no sponsorship.
Contribution. Article was prepared with equal participation of the authors.
Article received: 20.03.2025. Accepted for publication: 25.04.2025.