Abstract
BackgroundMultifocal osteonecrosis (ON) is defined as ON involving three or more distinct anatomical sites. We investigated the clinical characteristics and utility of whole-body bone scans (WBBS) in patients with multifocal ON.MethodsA total of 254 patients with ON confirmed by magnetic resonance imaging (MRI) or X-rays of the hips or other anatomic regions were evaluated using WBBS and divided into those with multifocal disease and those with oligofocal disease; their clinical characteristics were then compared. All data were analyzed retrospectively both visually and quantitatively (via uptake grading and defect scoring). Associations between the MRI Association Research Circulation Osseous (ARCO) classification and bone scan photon defects and uptake grade were assessed. Factors associated with multifocal ON were identified using logistic regression.ResultsOf the 254 ON patients, 26 (10.2%) had multifocal ON. Their mean age (42.8 ± 14.3 years) was less than that of patients with oligofocal ON (50.9 ± 15.4 years; p = 0.011). Comorbidities, corticosteroid use, and treatment with immunosuppressive agents were more frequent in patients with multifocal ON. Age (odds ratio [OR] = 0.964, p = 0.013), the presence of a comorbidity (OR = 3.387, p = 0.006), present corticosteroid use (OR = 5.696, p < 0.001), and treatment with immunosuppressive agents (OR = 3.447, p = 0.004) were significantly associated with multifocal ON. The MRI ARCO classification was not associated with photon defects in the bone scans of those with femoral ON. However, the ARCO classification was significantly associated with uptake grade.ConclusionsWBBS may be an additional tool for evaluating ON patients with risk factors for multiple ON, such as younger age, corticosteroid use, and comorbidities.
Highlights
Multifocal osteonecrosis (ON) is defined as ON involving three or more distinct anatomical sites
Subjects We identified 294 patients among the computerized medical records held at Ajou University Hospital with the diagnostic code for ON and test code for whole-body bone scans (WBBS); 40 patients were excluded because their diagnosis was not confirmed to ON and magnetic resonance imaging (MRI) findings were negative
In the other two patients, multifocal ON was confirmed by multifocal site evaluation by MRI or X-rays, with negative results on WBBS
Summary
Multifocal osteonecrosis (ON) is defined as ON involving three or more distinct anatomical sites. Osteonecrosis (ON) is a serious disease that causes joint pain and significant physical disability. Various joints can be affected, including the shoulders, knees, and ankles, but the most commonly affected site is the hip [1, 2]. Excessive alcohol intake, corticosteroid treatment, and rheumatic and malignant diseases contribute to the development of ON [4]. Multifocal ON, which ON involves three or more distinct anatomical sites [5], is rare, being seen in only approximately 3% of all ON patients [5]. Corticosteroid use is a known risk factor for multifocal ON [5, 6], as are certain comorbidities, including
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