title: The use of joint-specific and whole-body MRI in osteonecrosis: a study in patients with juvenile systemic lupus erythematosus.
abstract: OBJECTIVE
  This study aimed to estimate the prevalence of osteonecrosis (ON) in juvenile systemic lupus erythematosus (SLE) patients using joint-specific and whole-body MRI; to explore risk factors that are associated with the development of ON; and to evaluate prospectively patients 1 year after initial imaging.
  
  
  METHODS
  Within a 2 year period, we studied 40 juvenile SLE patients (aged 8-18 years) with a history of steroid use of more than 3 months duration. Risk factors including disease activity, corticosteroid use, vasculitis, Raynaud's phenomenon and lipid profile were evaluated. All patients underwent MRI of the hips, knees and ankles using joint-specific MRI. Whole-body STIR (short tau inversion recovery) MRI was performed in all patients with ON lesions.
  
  
  RESULTS
  Osteonecrosis was identified in 7 patients (17.5 %) upon joint-specific MRI. Whole-body STIR MRI detected ON in 6 of these 7 patients. There was no significant difference between the ON and non-ON groups in the risk factors studied. One patient had pre-existing symptomatic ON. At 1 year follow-up, the ON lesions had resolved in one patient, remained stable in four and decreased in size in two. No asymptomatic patients with ON developed clinical manifestations.
  
  
  CONCLUSIONS
  Whole-body STIR MRI may be useful in detecting ON lesions in juvenile SLE patients but larger studies are needed to define its role.
authors.affiliation: Department of Pediatrics, Division of Allergy, Clinical Immunology and Rheumatology, Universidade Federal de São Paulo, Brazil. taniacaroline@uol.com.br
authors.forename: T C M
authors.initials: TC
authors.lastname: Castro
authors.forename: H
authors.initials: H
authors.lastname: Lederman
authors.forename: M T A
authors.initials: MT
authors.lastname: Terreri
authors.forename: W I
authors.initials: WI
authors.lastname: Caldana
authors.forename: S C
authors.initials: SC
authors.lastname: Kaste
authors.forename: M O
authors.initials: MO
authors.lastname: Hilário
mesh_terms: D000293:Adolescent; D000843:Ankle Joint; D002648:Child; D005260:Female; D006801:Humans; D007719:Knee Joint; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D010020:Osteonecrosis / Q000175:diagnosis*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D051598:Whole Body Imaging / Q000379:methods*