MAGNETIC RESONANCE Osteonecrosis detected by whole body magnetic resonance in patients with Hodgkin Lymphoma treated by BEACOPP Domenico Albano 1 & Caterina Patti 2 & Ludovico La Grutta 1 & Emanuele Grassedonio 1 & Antonino Mulè 2 & Giuseppe Brancatelli 1 & Roberto Lagalla 1 & Massimo Midiri 1 & Massimo Galia 1 Received: 23 September 2015 /Revised: 9 July 2016 /Accepted: 27 July 2016 # European Society of Radiology 2016 Abstract Objectives The purpose of our retrospective review of pro- spectively acquired Whole Body Magnetic Resonance (WB- MRI) scans was to assess the incidence of osteonecrosis in patients who received different chemotherapies. Methods We evaluated the WB-MRI scans performed on 42 patients with Hodgkin Lymphoma treated by three chemother- apy regimens (6ABVD, 2ABVD + 4BEACOPP, 2ABVD + 8BEACOPP), excluding patients with the main risk factors for osteonecrosis. Results Six out of seven patients (86 %) who received eight BEACOPP and one out of five patients (20 %) treated by four BEACOPP presented osteonecrosis, with a statistically signif- icant difference of frequency between the two groups of pa- tients (p < 0.05); no injury has been reported in patients treated by only ABVD. Among a total of 48 osteonecrotic lesions observed, 48 % were detected in the knee; multifocal osteonecrosis were detected in six out of seven patients (86 %). Conclusions The development of osteonecrosis is strictly re- lated to the chemotherapy protocol adopted and the number of cycles received, with a strong correlation between the dose of corticosteroids included in the BEACOPP scheme and this complication. WB-MRI can be considered as a helpful tool that allows detecting earlier osteonecrotic lesions in patients treated with corticosteroids. Key Points • Osteonecrosis is a possible complication of patients with Lymphoma treated by chemotherapy. • Osteonecrosis is related to the corticosteroids included with- in the BEACOPP protocol. • WB-MRI allows detecting osteonecrotic lesions in patients treated with corticosteroids. Keywords Magnetic resonance imaging . Whole body imaging . Lymphoma . Osteonecrosis . BEACOPP Abbreviations HL Hodgkin Lymphoma ABVD Doxorubicin, Bleomycin, Vinblastine and Dacarbazine BEACOPP Bleomycin, Etoposide, Doxorubicin, Cyclophosphamide, Vincristine, Procarbazine, Prednisone WB-MRI Whole Body Magnetic Resonance FDG-PET/ CT Fluorodeoxyglucose-Positron Emission Tomography/Computed tomography ON Osteonecrosis Introduction The treatment of patients with Hodgkin Lymphoma (HL) has led to the progressive achievement of high survival rates over recent years, due to the introduction of effective chemotherapy regimens integrated with more sophisticated and targeted ra- diotherapy techniques [1, 2]. ABVD (Doxorubicin, Bleomycin, Vinblastine and Dacarbazine) has been considered for a long time the standard treatment for advanced-stage HL patients [3], due to well- * Domenico Albano albanodomenico@me.com 1 Department of Radiology, DIBIMED, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy 2 Department of Hematology I, Azienda Ospedali Riuniti Villa Sofia-Cervello, Viale Strasburgo 233, 90146 Palermo, Italy Eur Radiol DOI 10.1007/s00330-016-4535-8