title: Osteonecrosis in an adolescent with non-Hodgkin lymphoma resembling a new metastatic lesion on (18)F-FDG PET/CT.
abstract: Osteonecrosis may result from complications in a variety of pediatric diseases and, in the early stages of healing, may be characterized by inflammation and hyperemia. While traditionally assessed by bone scintigraphy, osteonecrosis may also present upon [F-18]2-fluoro-2-deoxyglucose PET/CT. Differentiation of osteonecrosis from metastatic lesions is important to ensure accurate disease staging and to avoid unnecessary imaging and biopsy. Osteonecrosis typically presents at the interface of weight-bearing joints after prolonged chemotherapy with corticosteroid administration, although prevalence is greater in adults than in children. We describe a case of unilateral osteonecrosis in the tibia of an adolescent lymphoma patient, which first presented on FDG-PET/CT imaging after 2 months of combination chemotherapy with corticosteroid administration. This report should aid in recognizing rapid-onset osteonecrosis with atypical sites of involvement in pediatric patients.
authors.affiliation: Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Terence S
authors.initials: TS
authors.lastname: Hong
authors.forename: Amer
authors.initials: A
authors.lastname: Shammas
authors.forename: Oscar M
authors.initials: OM
authors.lastname: Navarro
authors.forename: Angela
authors.initials: A
authors.lastname: Punnett
mesh_terms: D001859:Bone Neoplasms / Q000175:diagnosis / Q000556:secondary; D003937:Diagnosis, Differential; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D010020:Osteonecrosis / Q000175:diagnosis* / Q000209:etiology*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
references.citation: Med Pediatr Oncol. 1993;21(9):655-60
references.pmid: 8412999
references.citation: Clin Nucl Med. 2001 Jul;26(7):613-4
references.pmid: 11416742
references.citation: Semin Arthritis Rheum. 2002 Oct;32(2):94-124
references.pmid: 12430099
references.citation: J Bone Joint Surg Br. 1997 Mar;79(2):213-9
references.pmid: 9119845
references.citation: Radiographics. 2005 Sep-Oct;25(5):1357-68
references.pmid: 16160116
references.citation: J Clin Oncol. 2000 Sep 15;18(18):3262-72
references.pmid: 10986059
references.citation: Clin Orthop Relat Res. 2003 May;(410):213-24
references.pmid: 12771833
references.citation: Clin Nucl Med. 2007 Jun;32(6):496-7
references.pmid: 17515769