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

Authors: Naeem Ahmed, MBBS, BSc, FRCR, Priya Sriskandarajah, MBBS, BSc, MRCP, Christian Burd, FRCR, Angela Riddell, BSc, MBBS, FRCS, FRCR, MD, Kevin Boyd, MBBS, BSc, MRCP FRCPath PhD, Martin Kaiser, MD, RWTH 2 and Christina Messiou, MD, BMedSci, BMBS, MRCP, F


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.