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Imaging using MRI and CT tracked VBON across different vertebral levels and time points, including an L1 fluid-filled intravertebral cleft on a May 2024 MRI without collapse, alongside earlier 2019 lesions evolving from fluid to gas phase and chronic collapse at T12. The report emphasizes MRI and CT as educational tools to distinguish early osteonecrosis from neoplastic or osteoporotic fractures.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/vertebral-body-osteonecrosis-evolving-imaging-features-over-time/406627/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/vertebral-body-osteonecrosis-evolving-imaging-features-over-time/406627.png","ImageObject",300,407,{"name":92,"@type":93},"Marglet","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Who is described in the case report and what symptoms prompted imaging?","Question",{"text":112,"@type":113},"A 55-year-old woman with multiple myeloma, osteoporosis, and long-term corticosteroid therapy developed progressively worsening lumbar pain. Neurological examination was normal.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What did the May 2024 MRI show in the L1 vertebral body?",{"text":117,"@type":113},"The MRI showed a well-defined altered-signal area in L1 that was hypointense on T1 and hyperintense on T2 and STIR. It included a horizontal fluid-filled intravertebral cleft without collapse.",{"name":119,"@type":110,"acceptedAnswer":120},"How did prior lesions change over time according to retrospective comparison?",{"text":121,"@type":113},"Retrospective comparison with earlier MRI/CT from 2019 demonstrated earlier VBON at L4 progressing from fluid to gas phase, with chronic collapse at T12.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},406627,1790767207,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},2336477982702,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Radiology Ca s e Reports 21 (2026) 1049 – 1054  \nAvailable online [at](at www.sciencedirect.com)[ www.sciencedirect.com](at www.sciencedirect.com)  \njournal [homepage:](homepage: www.elsevier.com/locate/radcr)[ www.elsevier.com/locate/radcr](homepage: www.elsevier.com/locate/radcr)  \n| Case Report\u003Cbr>Vertebral body osteonecrosis: Evolving imaging features over time ✩\u003Cbr>Federica Masino, MDa,b, Valentina Cianci, MDb, Chiara Locorotondo, MDb, Andrea Torrente, MDb, Gabriele Fanigliulo, MDb, Antonio Serinelli, TSRMb, Marina Balbino, MDa, Manuela Montatore, MDa,b, Eluisa Muscogiuri, MDb,^, Giuseppe Guglielmi, MDa,c,d,^,∗\u003Cbr>a Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Viale L. Pinto 1, Foggia, FG 71122, Italy\u003Cbr>b Radiology Unit,“A. Perrino” Hospital, Strada Statale 7 per Mesagne, Brindisi, BR 72100, Italy c Radiology Unit,“Dimiccoli” Hospital, Viale Ippocrate 15, Barletta, BT 70051, Italy\u003Cbr>d Radiology Unit,“IRCCS Casa Sollievo della Sofferenza” Hospital, Viale Cappuccini 1, San Giovanni Rotondo, FG 71013, Italy |  |  |\n| --- | --- | --- |\n| a r t i c l e i n f o |  | a b s t r a c t |\n| Article history:\u003Cbr>Received 7 September 2025 Revised 12 November 2025 Accepted 18 November 2025 |  | We report the case of a 55-year-old woman with a history of multiple myeloma, osteoporosis, and long-term corticosteroid therapy, who presented with progressively worsening back pain. Imaging was pivotal for diagnosis and management. Magnetic resonance imaging (MRI) and computed tomography (CT) documented vertebral body osteonecrosis (VBON) occurring at different times and vertebral levels. In May 2024, MRI showed a fluid-filled intravertebral cleft within the L1 vertebral body, without collapse. Retrospective comparison with prior examinations (MRI and CT from 2019) demonstrated earlier VBON lesions at L4, progressing from fluid to gas phase, and a chronic collapse at T12 . This case emphasizes the multifocal and temporal nature of VBON and highlights the teaching value of imaging, particularly MRI and CT, in distinguishing early osteonecrosis from neoplastic or purely osteoporotic fractures.\u003Cbr>© 2025 The Authors. Published by Elsevier Inc. on behalf of University of Washington.\u003Cbr>This is an open access article under the CC BY-NC-ND license\u003Cbr>([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)) |\n| Keywords:\u003Cbr>Vertebral osteonecrosis Kummel disease Imaging diagnosis Multiple myeloma |  |  |\n\ntern of cell death [1]. The femoral and humeral heads, femoral condyles, distal end of the tibia, vertebral bodies, carpal and tarsal bones, metacarpals, and mandible are among the skeletal places where it can occur. The data available on vertebral body ON (VBON) is insufficient, inconsistent, and mostly  \n✩ Competing Interests: The authors have declared that no competing interests exist.  \n∗ Corresponding author.  \nE-mail address: [giuseppe.guglielmi@unifg.it](giuseppe.guglielmi@unifg.it) (G. Guglielmi).  \n^ co-last authors.  \n[https://doi.org/10.1016/j.radcr.2025.11.052](https://doi.org/10.1016/j.radcr.2025.11.052)  \n1930-0433/© 2025 The Authors. Published by Elsevier Inc. on behalf of University of Washington. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/))  \nFig. 1 – 1.5T MRI images: (A) Sagittal T1-weighted image showed vertebral body collapse at T12 (yellow arrow) and L4 (red arrow). The L1 vertebral body (green arrow) appeared markedly hypointense. (B) Sagittal T2-weighted image and (C) sagittal Short Tau Inversion Recovery (STIR) image demonstrated bone marrow edema in the surrounding trabecular bone at L1 vertebral body (green arrow) and a fluid component (green arrowhead). (D) Axial T2-weighted image confirmed the fluid signal component (green arrowhead) within the L1 vertebral body. Diagnostic interpretation: The horizontal orientat","cbCaisGtErMQASEB","https://ap.wps.com/l/cbCaisGtErMQASEB","pdf",1668448,"English","# Case presentation\n## Imaging methods and findings\n## Diagnostic interpretation and clinical significance","[{\"question\":\"Who is described in the case report and what symptoms prompted imaging?\",\"answer\":\"A 55-year-old woman with multiple myeloma, osteoporosis, and long-term corticosteroid therapy developed progressively worsening lumbar pain. Neurological examination was normal.\"},{\"question\":\"What did the May 2024 MRI show in the L1 vertebral body?\",\"answer\":\"The MRI showed a well-defined altered-signal area in L1 that was hypointense on T1 and hyperintense on T2 and STIR. It included a horizontal fluid-filled intravertebral cleft without collapse.\"},{\"question\":\"How did prior lesions change over time according to retrospective comparison?\",\"answer\":\"Retrospective comparison with earlier MRI/CT from 2019 demonstrated earlier VBON at L4 progressing from fluid to gas phase, with chronic collapse at T12.\"}]","Vertebral body osteonecrosis: Evolving imaging features over time | PDF",1790566794,15]