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 NICE NG226 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.
Key References
- NG226 - Osteoarthritis in over 16s: diagnosis and management
- NG234 - Spinal metastases and metastatic spinal cord compression
- NG33 - Tuberculosis
- (Buchan et al., 2012): Imaging of postoperative avascular necrosis of the ankle and foot.
- (Lespasio et al., 2019): Osteonecrosis of the Hip: A Primer.
- (Wongratwanich et al., 2021): Do various imaging modalities provide potential early detection and diagnosis of medication-related osteonecrosis of the jaw? A review.