[Whole-body MR imaging in children with suspected osteonecrosis after intensive chemotherapy: preliminary results].
OBJECTIVE
Use of multidrug chemotherapy poses the risk of avascular osseous necroses in children. Depiction of the whole body, including clinically non-apparent sites is mandatory for starting early and proper treatment, including surgical approaches in lesions near the joints. We analyzed the value of whole-body MRI in the detection of osteonecrosis, (1) in relation to conventional X-ray imaging and clinical symptoms, (2) using different MRI sequences, (3) with follow-up examinations.


METHODS
5 patients suffering from an oncological disease, 13 to 16 years old (3 x ALL, 1 x medulloblastoma, 1 x CML), and recently developing bone pain were examined with X-ray imaging of the particular region and a whole-body MRI (T2w TIRM, T 1w TSE sequences, pre- and post-contrast GD-DTPA, including fat suppression techniques). Neck/thorax/abdomen/pelvis, and upper and lower extremities were acquired in the coronal plane, and the feet in sagittal orientation. 4 of 5 patients had at least one follow-up examination (in the mean after 10 +/- 4 months).


RESULTS
None of the initial X-ray images revealed an abnormal finding. The whole-body MRI showed in 4 of 5 children bone marrow lesions compatible with osteonecrosis. The locations were around the knee joints (n = 3) and the tibiae/ankle joints (n = 4). In addition to the symptomatic sites, MRI revealed additional lesions at the following sites: humerus (n = 5), hip joints (n = 4), knee joints (n = 6), ankle joints (n = 4). The size varied from small focal lesions to lesions measuring 90 % of the whole transverse diameter of the bone. The lesions were able to be detected most easily with heavily T 2-weighted (TIRM) sequences, and the diagnosis was most easily established using the non-enhanced TSE T 1-weighted sequences. As a consequence of the results of the whole-body MRI, all patients with lesions compatible with osteonecrosis received symptomatic (n = 2) or specific (n = 2) therapy. In the follow-up examinations, a higher number of patients showed no changes in the lesions as to size and distribution. 2 patients showed partial resolution of the osteonecroses.


CONCLUSIONS
Whole-body MR imaging allows early diagnosis of symptomatic as well as clinically non-apparent osteonecroses. It can be used in planning and monitoring surgical and pharmacological therapies.
Beer
M
M
Institut für Röntgendiagnostik, Universitätsklinikum Würzburg, Oberdurrbacher Strasse 6, Würzburg. beer@roentgen.uni-wuerzburg.de
Stenzel
M
M
Girschick
H
H
Schlegel
P-G
PG
Darge
K
K
D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002528:Cerebellar Neoplasms / Q000188:drug therapy; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008527:Medulloblastoma / Q000188:drug therapy; D010020:Osteonecrosis / Q000139:chemically induced* / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D010146:Pain / Q000209:etiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy; D011859:Radiography; D016032:Randomized Controlled Trials as Topic; D051598:Whole Body Imaging
D000970:Antineoplastic Agents; D003287:Contrast Media; D019786:Gadolinium DTPA