Objective To investigate the predictive value of perfusion imaging parameters of multi-slice spiral computed tomography (MSCT) for the poor prognosis in patients with osteonecrosis of the femoral head (ONFH).

Methods A total of 118 patients with ONFH who were treated in a hospital from May 2022 to May 2023 were selected as the research subjects. All patients received 3D printing guide plate assisted with curettage of necrotic focus combined with ceramic rod implantation. According to the one-year follow-up results, patients were divided into a good prognosis group (n＝94) and a poor prognosis group (n＝24). Baseline data and MSCT perfusion imaging parameters (mean transit time MTT, blood flow BF, blood volume BV) were compared between the two groups. The correlations of MTT, BF and BV with the severity and prognosis of ONFH were analyzed. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of MSCT perfusion imaging parameters for the prognosis of ONFH patients.

Results There were significant differences in the necrosis site, necrosis volume and Association Research Circulation Osseous (ARCO) staging between the two groups (P＜0.05). The MTT was shorter, BF was less and BV was less in the poor prognosis group than those in the good prognosis group (P＜0.001). MTT, BF and BV were negatively correlated with necrosis volume and ARCO staging (P＜0.001). Decreased MTT, BF, and BV were independent risk factors for poor prognosis in ONFH patients (P＜0.001). The AUC of the combination of these three parameters for predicting poor prognosis was 0.918, which was significantly better than that of independent parameter (P＜0.05).

Conclusions The parameters of MSCT perfusion imaging are closely related to the condition and prognosis of ONFH patients, and are help of predicting the prognosis of ONFH patients.