Potential pitfalls of magnetic resonance imaging in the diagnosis of avascular necrosis

Magnetic resonance (MR) imaging and radionuclide (RN) bone scans were performed in two patients with collagen vascular disease (CVD) to evaluate hip pains. In both patients RN bone scans demonstrated decreased radioactivity in the femoral heads, whereas, MR imaging was normal. Because early changes of avascular necrosis (AVN) frequently present as decreased radioactivity in the femoral head, special attempts were made to detect this decreased activity using pinhole collimator imaging. The diagnosis of AVN was confirmed surgically by venous pressure measurements. Abnormal RN bone scans representing decreased flow due to vasculitis in patients with CVD, may be more sensitive in the diagnosis of AVN before structural changes can be detected on MR studies.