Which imaging modalities are most effective for confirming a diagnosis of avascular necrosis in primary care?

For confirming a diagnosis of avascular necrosis (AVN), particularly in primary care where initial assessment and referral are key, Magnetic Resonance Imaging (MRI) is considered the most sensitive and specific imaging modality ¹ (Lespasio et al., 2019). MRI can detect avascular necrosis in its early stages, often before changes are visible on plain radiographs (Lespasio et al., 2019). While plain radiographs are frequently the initial imaging investigation for joint pain, they have limited sensitivity for early AVN (Lespasio et al., 2019). Computed Tomography (CT) scans can also be used, particularly for assessing the extent of bone destruction and for surgical planning, and are relevant in specific types of osteonecrosis such as medication-related osteonecrosis of the jaw (Wongratwanich et al., 2021). However, for early diagnosis and confirmation, MRI remains superior (Lespasio et al., 2019).