title: Widespread osteonecrosis in children with leukemia revealed by whole-body MRI.
abstract: BACKGROUND
  Confirmation of early long-bone epiphyseal osteonecrosis in pediatric patients with leukemia allows for medical and surgical intervention before articular surface collapse. MRI detects early osteonecrosis, but multiple focused MR images are required to capture all lesions.
  
  
  OBJECTIVE
  We determined whether whole-body MRI (WB-MRI) could (1) assist in diagnosing long-bone epiphyseal and other osteonecroses, (2) characterize articular surface involvement, and (3) detect preferential sites for osteonecrosis.
  
  
  METHODS
  We retrospectively reviewed prospectively collected data on all 11 pediatric patients newly diagnosed with leukemia who had musculoskeletal pain develop that persisted 4 weeks or more during leukemia treatment. All were screened for osteonecrosis by WB-MRI, which consisted of a one-time scan of the entire body. Osteonecrosis was defined as circumscribed lesions with a distinct rim of low signal intensity in the normally high-intensity marrow on T1-weighted images and high signal intensity in the normally low-intensity marrow on short-tau inversion recovery images.
  
  
  RESULTS
  WB-MRI confirmed osteonecrosis in nine of 11 patients. All patients had multisite lesions; eight had long-bone epiphyseal lesions, which comprised 66 of 129 (51%) of all lesions. Osteonecrosis involving greater than 50% of the epiphyseal surface was present in 57% of distal femoral and proximal tibial lesions. All humeral and femoral head lesions involved more than 1/3 of the medial surface volume but were asymptomatic. No articular collapse was present. All osteonecrotic lesions were more common in the lower extremities.
  
  
  CONCLUSIONS
  WB-MRI confirmed early epiphyseal osteonecrosis, with quantification of articular surface involvement. Lower limbs were preferentially affected, but asymptomatic humeral head osteonecrosis was present in five of nine patients.
  
  
  METHODS
  Level IV, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Division of Pediatric Rheumatology, Department of Pediatrics, Alberta Children's Hospital and University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8, Canada. paivi.miettunen@albertahealthservices.ca
authors.forename: Paivi Maria
authors.initials: PM
authors.lastname: Miettunen
authors.forename: Lucie
authors.initials: L
authors.lastname: Lafay-Cousin
authors.forename: Gregory M T
authors.initials: GM
authors.lastname: Guilcher
authors.forename: Alberto
authors.initials: A
authors.lastname: Nettel-Aguirre
authors.forename: Vijay
authors.initials: V
authors.lastname: Moorjani
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D058070:Asymptomatic Diseases; D002648:Child; D002675:Child, Preschool; D004838:Epiphyses / Q000187:drug effects / Q000473:pathology; D005260:Female; D005269:Femur / Q000187:drug effects / Q000473:pathology; D006801:Humans; D006811:Humerus / Q000187:drug effects / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D010020:Osteonecrosis / Q000139:chemically induced / Q000175:diagnosis*; D010146:Pain / Q000139:chemically induced; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013977:Tibia / Q000187:drug effects / Q000473:pathology; D051598:Whole Body Imaging / Q000379:methods*
chemical_list: D000305:Adrenal Cortex Hormones; D000970:Antineoplastic Agents