title: Magnetic resonance imaging is the preferred method to assess treatment-related skeletal changes in children with brain tumors.
abstract: OBJECTIVE
  To evaluate the growing skeleton for potential altered skeletalgenesis associated with antiangiogenesis therapy.
  
  
  METHODS
  Knee radiographs and magnetic resonance imaging (MRI) were prospectively obtained on patients enrolled on two consecutive clinical trials using vandetanib, a potent oral (VEGF receptor 2) VEGFR-2 inhibitor alone or combined with dasatinib, a multiple tyrosine kinase inhibitor, in children with newly diagnosed diffuse intrinsic pontine glioma (DIPG).
  
  
  RESULTS
  Fifty-nine patients (32 females) underwent 119 MRIs; 51 patients underwent 89 radiographs of the knees. The median age at enrollment was 6.2 years (range, 2.4-17.6 years). The dose of vandetanib ranged from 50 to 145 mg/m(2) /day. The median treatment duration was 205 days. Only two patients have not experienced disease progression after 18 and 60 months from diagnosis. MRI identified clinically significant premature physeal fusion in both knees of one patient, focal physeal thickening in one, osteonecrosis in eight patients (present at enrollment in one), and bony spicules crossing the physis in two patients (bilateral in one). MRI follow-up period averaged 5.3 months (range, 0-25.5 months; median, 3.5 months). Radiographs delineated normally fused physes in two patients but no cases of premature physeal fusion, osteonecrosis or bony spicules.
  
  
  CONCLUSIONS
  As MRI provided greater information than radiographs, and thus would be a more sensitive test to assess skeletalgenesis in pediatric patients.
authors.affiliation: Department of Radiological Sciences, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MSN #220, Memphis, Tennessee 38105, USA. sue.kaste@stjude.org
authors.forename: Sue C
authors.initials: SC
authors.lastname: Kaste
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kaufman
authors.forename: Amar
authors.initials: A
authors.lastname: Gajjar
authors.forename: Alberto
authors.initials: A
authors.lastname: Broniscer
mesh_terms: D000293:Adolescent; D000328:Adult; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D020295:Brain Stem Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D000069439:Dasatinib; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D010020:Osteonecrosis / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000503:physiopathology; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D011743:Pyrimidines / Q000008:administration & dosage / Q000009:adverse effects*; D011799:Quinazolines / Q000008:administration & dosage / Q000009:adverse effects*; D011859:Radiography; D013844:Thiazoles / Q000008:administration & dosage / Q000009:adverse effects*; D040301:Vascular Endothelial Growth Factor Receptor-2 / Q000037:antagonists & inhibitors
chemical_list: D020533:Angiogenesis Inhibitors; D010880:Piperidines; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D011799:Quinazolines; D013844:Thiazoles; D040301:Vascular Endothelial Growth Factor Receptor-2; D000069439:Dasatinib; C452423:vandetanib
keywords: VEGF; antiangiogenesis agents; chemotherapy; magnetic resonance imaging; pediatric brain tumors; skeletalgenesis