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New sensitive, non-invasive procedures are being sought to achieve early diagnosis of avascular necrosis (death of local tissue due to lack of blood supply) of the head of the femur (hip end of the thigh bone); early diagnosis would greatly improve the prognosis of the affected hip. Magnetic resonance imaging (MRI) has been suggested as a tool for early detection of avascular necrosis of the femoral head. The sensitivity of MRI for diagnosing bone necrosis was compared with that of other currently used diagnostic methods, such as X-ray, bone-marrow pressure determination, intramedullary venography, and bone biopsy. (Bone-marrow pressure determinations and intramedullary venography evaluate bone function.) Forty-eight patients, considered to be at high risk for avascular necrosis, were evaluated. Based on the severity of disease, each patient was graded and assigned to one of the four disease stages. MRI revealed abnormal patterns in all patients with stage 2 and stage 3 changes of the femoral head. The X-rays of patients with stage 0 and stage 1 disease did not show abnormal patterns; however, 17 percent of the femoral heads with stage 0 disease and 64 percent of those with stage 1 disease were identified by MRI. Phase II of the research focused on 23 hips that were suspected of necrosis, despite the absence of X-ray evidence. These hips were examined using the more extensive testing procedures listed above, including biopsy. When compared with biopsy results, false-negative and false-positive MRI results occurred in the range of 10 to 15 percent. The overall findings suggest that MRI may be useful in the early diagnosis of avascular necrosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

• The use of computed tomography (CT) was evaluated in 25 patients with multiple myeloma, six with extramedullary plasmacytoma, and two with undiagnosed lesions. We found that CT was useful for (1) patients with multiple myeloma who had bone pain but normal roentgenograms, (2) patients with an M-protein, bone marrow plasmacytosis, and back pain from osteoporosis and compression fractures but an inconclusive diagnosis of multiple myeloma, (3) the determination of extent of tumor, and (4) guidance in needle biopsy.(Arch Intern Med 1985;145:1451-1452)

To the Editor.—The article by Eddy et al1 provides evidence that healthy asymptomatic women between the ages of 40 and 49 years do not show sufficient health or economic benefit from mammography to offset the costs and risks. They contend that the costs for screening this cohort are high and that relatively few lives would be saved. Their data indicate that mammography screening in that decade would carry a risk of radiation-induced cancer of the breast of about 1 in 25 000. They conclude that a more prudent approach is to initiate mammography at age 50 years.The matter of hereditary breast cancer (HBC) was totally ignored in these reports. This is surprising since HBC accounts for approximately 9% of the total breast cancer burden2 and its average age of onset is approximately 44 years.3,4 Indeed, we recently described a subset of HBC that is characterized