Detection of avascular necrosis on routine diffusion-weighted whole body MRI in patients with multiple myeloma

Abstract

Objective: Current therapies for multiple myeloma, which include corticosteroids, increase risk of avascular necrosis. The aim of this study was to assess incidental detection of femoral head avascular necrosis on routine whole body MRI including diffusion weighted MRI. Methods: All whole body MRI studies, performed on patients with known multiple myeloma between 1 January 2010 to 1 May 2017 were assessed for features of avascular necrosis. Results: 650 whole body MR scans were analysed. 15 patients (6.6%) had typical MR features of avascular necrosis: 2/15 (13.3%) had femoral head collapse, 4/15 (26.7%) had bilateral avascular necrosis and 9/15 (60%) were asymptomatic. Conclusion: This is the first report of avascular necrosis detected on routine whole body MRI in patients with multiple myeloma. Targeted review of femoral heads in multiple myeloma patients undergoing whole body MR is recommended, including in patients without symptoms. Advances in knowledge: Whole body MR which includes diffusion-weighted MRI is extremely sensitive for evaluation of bone marrow. Although whole body MRI is primarily used for evaluation of multiple myeloma disease burden, it also presents an unique opportunity to evaluate the femoral heads for signs of avascular necrosis which can predate symptoms.

Whole-body MRI: a practical guide for imaging patients with malignant bone disease

“…In addition, review of both low and high b-value DW-MRI can detect CT-occult pathological fractures and avascular necrosis. 49 Fat/water (Dixon) imaging…”

Avascular Necrosis Due to Corticosteroid Therapy in Covid-19 as a Syndemic

“…The clinical presentation of AVNFH is nonspecific, thus a high index of suspicion is crucial to diagnose this entity. AVNFH may be painless at early stages, but it becomes painful with the progression [18,26]. The patients with progressive course of the condition mostly complain of thigh/groin pain radiating to the anterior knee [8,16,17].…”

“…Plain radiographs can be without changes in the early stages of AVNFH, delaying early diagnosis and treatment [16,18]. MRI is the most valuable diagnostic test, confirming AVN with up to 100% sensitivity and specificity [26][27][28]. It is the most recommended imaging method for the investigation of early AVNFH and accompanying asymptomatic contralateral disease [18,26].…”

“…MRI is the most valuable diagnostic test, confirming AVN with up to 100% sensitivity and specificity [26][27][28]. It is the most recommended imaging method for the investigation of early AVNFH and accompanying asymptomatic contralateral disease [18,26]. Some treatments have been proposed to preserve the affected joint and delay the joint replacement.…”

“…Some treatments have been proposed to preserve the affected joint and delay the joint replacement. These treatments include off-loading measurements, appropriate exercise, adequate dietary intake of calcium and vitamin D, use of biphosphonates, HBOT, osteotomy, core decompression with or without bone grafting, and stem cell transplantation [2,4,8,17,20,26]. Delaying joint replacement and avoiding recurrent surgical interventions are particularly important for young patients given the fact that joint prostheses have approximately 10 years of life [8].…”