A novel stage and classification system of ONFH based on the radiologic-histopathological correlation

A novel stage and classification system of ONFH based on the radiologic-histopathological correlation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A novel stage and classification system of ONFH based on the radiologic-histopathological correlation Jinhui Ma, Mengran shen, Bailiang Wang, Debo Yue, Weiguo wang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4152449/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: To explore the influence of the new staging and classification system based on the correlation between MRI and pathological features on the collapse, symptoms and function of femoral head necrosis. Methods: This retrospective study included 100 patients (200 hips) who were diagnosed with bilateral ONFH. According to the degree of fibrosis in the necrotic area in a mid-coronal section on hip MRI, the MRI stage of ONFH can be divided into three types. Based on the level of inflammatory response, the MRI classification of ONFH can be divided into two types (S1 and S2), and S2 can be divided into three subtypes (S2a, S2b, S2c). The radiological evaluations were based on plain X-rays and MRI. The data were analysed using SPSS 26.0 statistical software. Results: There was a significant difference in the collapse rate between Type Ⅰ (7.1% ),Type Ⅱ (66.3% ) and Type Ⅲ (92.1%) (P＜0.001). The collapse rate in S1 (11.1%), S2a (66.7%), S2b (85.3%), S2c (77.8%) was significantly different (P＜0.001). There was also a significant difference in pain level and hip function between MRI staging and classification (P＜0.001). The later the stage, the higher the pain level, and similar results in hip functions. With the aggravation of bone marrow edema, the patient’s pain level increases and hip function decreases. Conclusion: Pathological fibrosis and inflammatory response are important factors that influence ONFH collapse and prognosis. The new MRI stage and classification based on pathology is a supplement to the existing stage and classification. osteonecrosis MRI pathology fibrosis inflammatory response Figures Figure 1 Figure 2 Full Text Additional Declarations No competing interests reported. Tables 1-3 is available in the Supplementary Files section. Supplementary Files Table1PatientDemographics.docx Table2Collapserateindifferentstageandclass.doc Table3Painlevelandhipfunctionindifferents.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4152449","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":287072536,"identity":"1c343ea1-73f9-4b97-996b-49ef0fd2d855","order_by":0,"name":"Jinhui Ma","email":"","orcid":"","institution":"China-Japan Friendship Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jinhui","middleName":"","lastName":"Ma","suffix":""},{"id":287072537,"identity":"755cc7c2-1370-4bc9-8e3d-be15efd77c7c","order_by":1,"name":"Mengran shen","email":"","orcid":"","institution":"Peking University China-Japan Friendship School of Clinical Medicine","correspondingAuthor":false,"prefix":"","firstName":"Mengran","middleName":"","lastName":"shen","suffix":""},{"id":287072538,"identity":"411bd28d-4325-4aae-bf15-7dea4186de30","order_by":2,"name":"Bailiang Wang","email":"","orcid":"","institution":"China-Japan Friendship Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bailiang","middleName":"","lastName":"Wang","suffix":""},{"id":287072539,"identity":"c2ad765a-97f7-4110-8975-3d1f3c7812b1","order_by":3,"name":"Debo Yue","email":"","orcid":"","institution":"China-Japan Friendship Hospital","correspondingAuthor":false,"prefix":"","firstName":"Debo","middleName":"","lastName":"Yue","suffix":""},{"id":287072540,"identity":"0948fa81-3220-4ef8-a139-554e8ddf9302","order_by":4,"name":"Weiguo wang","email":"","orcid":"","institution":"China-Japan Friendship Hospital","correspondingAuthor":false,"prefix":"","firstName":"Weiguo","middleName":"","lastName":"wang","suffix":""},{"id":287072541,"identity":"db6d5606-1d58-4c0d-999c-9005290594a5","order_by":5,"name":"Liming Cheng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYDCCAwxsIEqGjYGxgYGhQkKOn1gtPBAtZyyMJRuI1QLmMLZVJG4gpIXv9uFnDz7uqOXhEzvc9vDrPAnGDQzMDx/dwKNF8lyaueHMM8d52KQT241lt0kwmzOwGRvn4NFicAaomLftGEhLm7TkNgk2ywYgm6CWv3AtcyR4DA4Qo4WxrQasRfJjg4QEQS2SZ9jMJHvbDkBsYTgmYSDZTMAvfGeYn0n8bKuTk5+d/kzyR01dfT9788PH+LRAwWEwyQyOHWbCykGgDkwy/iBO9SgYBaNgFIwwAAAwD0UUOKcbjwAAAABJRU5ErkJggg==","orcid":"","institution":"China-Japan Friendship Hospital","correspondingAuthor":true,"prefix":"","firstName":"Liming","middleName":"","lastName":"Cheng","suffix":""}],"badges":[],"createdAt":"2024-03-23 02:29:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4152449/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4152449/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54314847,"identity":"5f686d7c-bac2-4b10-a4ab-8079ba3d58dc","added_by":"auto","created_at":"2024-04-08 17:41:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":18010867,"visible":true,"origin":"","legend":"\u003cp\u003eMRI stage based on the degree of fibrosis. TypeⅠ: borderline fibrosis; TypeⅡ: partial fibrosis in the necrotic area; TypeⅢ: global fibrosis in the necrotic area.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4152449/v1/3a227ae666bdb64219bdb139.png"},{"id":54314845,"identity":"386fce2d-20d7-4a29-8f4a-5334440472d9","added_by":"auto","created_at":"2024-04-08 17:41:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":18635099,"visible":true,"origin":"","legend":"\u003cp\u003eMRI classification based on the level of inflammatory response. S1: pathological stable type; S2a: partial edema of the femoral head and neck; S2b, global edema of the femoral head and neck; S2c: extensive edema of the proximal femur.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4152449/v1/c87d36e40ee9bad789fa697b.png"},{"id":108977265,"identity":"cda9cbca-324d-462b-b77f-6c3463520f61","added_by":"auto","created_at":"2026-05-11 11:31:08","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5281676,"visible":true,"origin":"","legend":"","description":"","filename":"AnovelstageandclassificationsystemofONFHbasedontheradiologichistopathologicalcorrelation.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4152449/v1_covered_187c376f-4e76-4089-b4bf-3a00f3279b3d.pdf"},{"id":54314843,"identity":"125bd508-3477-47e5-9cce-5b4378440a6e","added_by":"auto","created_at":"2024-04-08 17:41:08","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":12590,"visible":true,"origin":"","legend":"","description":"","filename":"Table1PatientDemographics.docx","url":"https://assets-eu.researchsquare.com/files/rs-4152449/v1/0e44a591e7c781fb6a13a112.docx"},{"id":54314844,"identity":"ad9e9bf2-4364-4641-be1f-f2c7567cae1d","added_by":"auto","created_at":"2024-04-08 17:41:08","extension":"doc","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":36352,"visible":true,"origin":"","legend":"","description":"","filename":"Table2Collapserateindifferentstageandclass.doc","url":"https://assets-eu.researchsquare.com/files/rs-4152449/v1/dab3d5e6c929e77f6c7e3e15.doc"},{"id":54314846,"identity":"364ea6f8-1032-44e9-ac2a-0b4c021c31df","added_by":"auto","created_at":"2024-04-08 17:41:08","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":12752,"visible":true,"origin":"","legend":"","description":"","filename":"Table3Painlevelandhipfunctionindifferents.docx","url":"https://assets-eu.researchsquare.com/files/rs-4152449/v1/aa752a503e2f577710228dc0.docx"}],"financialInterests":"\u003cp\u003eNo competing interests reported.\u003c/p\u003e\n\u003cp\u003eTables 1-3 is available in the Supplementary Files section.\u003c/p\u003e","formattedTitle":"A novel stage and classification system of ONFH based on the radiologic-histopathological correlation","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"osteonecrosis, MRI, pathology, fibrosis, inflammatory response","lastPublishedDoi":"10.21203/rs.3.rs-4152449/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4152449/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: To explore the influence of the new staging and classification system based on the correlation between MRI and pathological features on the collapse, symptoms and function of femoral head necrosis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: This retrospective study included 100 patients (200 hips) who were diagnosed with bilateral ONFH. According to the degree of fibrosis in the necrotic area in a mid-coronal section on hip MRI, the MRI stage of ONFH can be divided into three types. Based on the level of inflammatory response, the MRI classification of ONFH can be divided into two types (S1 and S2), and S2 can be divided into three subtypes (S2a, S2b, S2c). The radiological evaluations were based on plain X-rays and MRI. The data were analysed using SPSS 26.0 statistical software.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: There was a significant difference in the collapse rate between Type Ⅰ (7.1% ),Type Ⅱ (66.3% ) and Type Ⅲ (92.1%) (P＜0.001). The collapse rate in S1 (11.1%), S2a (66.7%), S2b (85.3%), S2c (77.8%) was significantly different (P＜0.001). There was also a significant difference in pain level and hip function between MRI staging and classification (P＜0.001). The later the stage, the higher the pain level, and similar results in hip functions. With the aggravation of bone marrow edema, the patient’s pain level increases and hip function decreases.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: Pathological fibrosis and inflammatory response are important factors that influence ONFH collapse and prognosis. The new MRI stage and classification based on pathology is a supplement to the existing stage and classification.\u003c/p\u003e","manuscriptTitle":"A novel stage and classification system of ONFH based on the radiologic-histopathological correlation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-08 17:41:03","doi":"10.21203/rs.3.rs-4152449/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"194f79b0-22ac-4607-b1c5-36adfb78f075","owner":[],"postedDate":"April 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-09T07:41:26+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-08 17:41:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4152449","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4152449","identity":"rs-4152449","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}