PMC6710848_01
Characteristic lesions of avascular necrosis on magnetic resonance imaging. Avascular necrosis with geographic-appearing lesions on coronal T1 image of the right distal tibia (A) and sagittal T1-weighted images of the right knee (proximal tibia and distal femur) (B). Coronal T2 magnetic resonance image shows bilateral hyperintensity at the bottom of femoral head (arrows) revealing medullary infarct (C). T2-weighted fat suppressed images yield geographic appearance compatible with avascular necrosis right proximal tibia and distal femur on sagittal (D) and coronal view (E), left proximal tibia and distal femur on sagittal (F) and coronal view (G) respectively.
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At the 4th dose of cyclophosphamide and after a 5.3 g (94.7 mg/kg) cumulative dose of methylprednisolone, a diagnosis of symptomatic multifocal AVN was made by detecting typical geographical lesions on MR imaging although classical radiography was normal (Fig. 1).