title: Utility of early screening magnetic resonance imaging for extensive hip osteonecrosis in pediatric patients treated with glucocorticoids.
abstract: OBJECTIVE
  Hip osteonecrosis frequently complicates treatment with glucocorticoids. When extensive (affecting ≥ 30% of the epiphyseal surface), 80% of joints collapse within 2 years, so interventions are needed to prevent this outcome.
  
  
  METHODS
  This prospective cohort magnetic resonance imaging (MRI) screening study included all consecutive children treated for acute lymphoblastic leukemia on a single protocol. Hip MRI was performed at 6.5 and 9 months from diagnosis (early screening) and at completion of chemotherapy (final evaluation) to determine whether screening could identify extensive hip osteonecrosis before symptom development.
  
  
  RESULTS
  Of 498 patients, 462 underwent screening MRI. Extensive asymptomatic osteonecrosis was identified by early screening in 26 patients (41 hips); another four patients (seven hips) were detected after the screening period, such that screening sensitivity was 84.1% and specificity was 99.4%. The number of joints screened to detect one lesion was 20.1 joints for all patients, 4.4 joints for patients older than 10 years, and 198 joints for patients ≤ 10 years old (P < .001). Of the 40 extensive lesions in patients older than 10 years, 19 required total hip arthroplasty and none improved. Of eight extensive lesions in younger patients, none required arthroplasty and four improved.
  
  
  CONCLUSIONS
  In patients age 10 years old or younger who require prolonged glucocorticoid therapy, screening for extensive hip osteonecrosis is unnecessary because their risk is low and lesions tend to heal. In children older than 10 years, early screening successfully identifies extensive asymptomatic lesions in patients who would be eligible for studies of interventions to prevent or delay joint collapse.
authors.affiliation: Sue C. Kaste, Deqing Pei, Cheng Cheng, Michael D. Neel, Raul C. Ribeiro, Monika L. Metzger, Deepa Bhojwani, Hiroto Inaba, Patrick Campbell, Jeffrey E. Rubnitz, Sima Jeha, John T. Sandlund, James R. Downing, Mary V. Relling, Ching-Hon Pui, and Scott C. Howard, St Jude Children's Research Hospital; Sue C. Kaste, University of Tennessee Health Sciences Center, Memphis, TN; and W. Paul Bowman, Cook Children's Medical Center, Fort Worth, TX. skaste@stjude.org.
authors.forename: Sue C
authors.initials: SC
authors.lastname: Kaste
authors.affiliation: Sue C. Kaste, Deqing Pei, Cheng Cheng, Michael D. Neel, Raul C. Ribeiro, Monika L. Metzger, Deepa Bhojwani, Hiroto Inaba, Patrick Campbell, Jeffrey E. Rubnitz, Sima Jeha, John T. Sandlund, James R. Downing, Mary V. Relling, Ching-Hon Pui, and Scott C. Howard, St Jude Children's Research Hospital; Sue C. Kaste, University of Tennessee Health Sciences Center, Memphis, TN; and W. Paul Bowman, Cook Children's Medical Center, Fort Worth, TX.
authors.forename: Deqing
authors.initials: D
authors.lastname: Pei
authors.affiliation: Sue C. Kaste, Deqing Pei, Cheng Cheng, Michael D. Neel, Raul C. Ribeiro, Monika L. Metzger, Deepa Bhojwani, Hiroto Inaba, Patrick Campbell, Jeffrey E. Rubnitz, Sima Jeha, John T. Sandlund, James R. Downing, Mary V. Relling, Ching-Hon Pui, and Scott C. Howard, St Jude Children's Research Hospital; Sue C. Kaste, University of Tennessee Health Sciences Center, Memphis, TN; and W. Paul Bowman, Cook Children's Medical Center, Fort Worth, TX.
authors.forename: Cheng
authors.initials: C
authors.lastname: Cheng
authors.affiliation: Sue C. Kaste, Deqing Pei, Cheng Cheng, Michael D. Neel, Raul C. Ribeiro, Monika L. Metzger, Deepa Bhojwani, Hiroto Inaba, Patrick Campbell, Jeffrey E. Rubnitz, Sima Jeha, John T. Sandlund, James R. Downing, Mary V. Relling, Ching-Hon Pui, and Scott C. Howard, St Jude Children's Research Hospital; Sue C. Kaste, University of Tennessee Health Sciences Center, Memphis, TN; and W. Paul Bowman, Cook Children's Medical Center, Fort Worth, TX.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Neel
authors.affiliation: Sue C. Kaste, Deqing Pei, Cheng Cheng, Michael D. Neel, Raul C. Ribeiro, Monika L. Metzger, Deepa Bhojwani, Hiroto Inaba, Patrick Campbell, Jeffrey E. Rubnitz, Sima Jeha, John T. Sandlund, James R. Downing, Mary V. Relling, Ching-Hon Pui, and Scott C. Howard, St Jude Children's Research Hospital; Sue C. Kaste, University of Tennessee Health Sciences Center, Memphis, TN; and W. Paul Bowman, Cook Children's Medical Center, Fort Worth, TX.
authors.forename: W Paul
authors.initials: WP
authors.lastname: Bowman
authors.affiliation: Sue C. Kaste, Deqing Pei, Cheng Cheng, Michael D. Neel, Raul C. Ribeiro, Monika L. Metzger, Deepa Bhojwani, Hiroto Inaba, Patrick Campbell, Jeffrey E. Rubnitz, Sima Jeha, John T. Sandlund, James R. Downing, Mary V. Relling, Ching-Hon Pui, and Scott C. Howard, St Jude Children's Research Hospital; Sue C. Kaste, University of Tennessee Health Sciences Center, Memphis, TN; and W. Paul Bowman, Cook Children's Medical Center, Fort Worth, TX.
authors.forename: Raul C
authors.initials: RC
authors.lastname: Ribeiro
authors.affiliation: Sue C. Kaste, Deqing Pei, Cheng Cheng, Michael D. Neel, Raul C. Ribeiro, Monika L. Metzger, Deepa Bhojwani, Hiroto Inaba, Patrick Campbell, Jeffrey E. Rubnitz, Sima Jeha, John T. Sandlund, James R. Downing, Mary V. Relling, Ching-Hon Pui, and Scott C. Howard, St Jude Children's Research Hospital; Sue C. Kaste, University of Tennessee Health Sciences Center, Memphis, TN; and W. Paul Bowman, Cook Children's Medical Center, Fort Worth, TX.
authors.forename: Monika L
authors.initials: ML
authors.lastname: Metzger
authors.affiliation: Sue C. Kaste, Deqing Pei, Cheng Cheng, Michael D. Neel, Raul C. Ribeiro, Monika L. Metzger, Deepa Bhojwani, Hiroto Inaba, Patrick Campbell, Jeffrey E. Rubnitz, Sima Jeha, John T. Sandlund, James R. Downing, Mary V. Relling, Ching-Hon Pui, and Scott C. Howard, St Jude Children's Research Hospital; Sue C. Kaste, University of Tennessee Health Sciences Center, Memphis, TN; and W. Paul Bowman, Cook Children's Medical Center, Fort Worth, TX.
authors.forename: Deepa
authors.initials: D
authors.lastname: Bhojwani
authors.affiliation: Sue C. Kaste, Deqing Pei, Cheng Cheng, Michael D. Neel, Raul C. Ribeiro, Monika L. Metzger, Deepa Bhojwani, Hiroto Inaba, Patrick Campbell, Jeffrey E. Rubnitz, Sima Jeha, John T. Sandlund, James R. Downing, Mary V. Relling, Ching-Hon Pui, and Scott C. Howard, St Jude Children's Research Hospital; Sue C. Kaste, University of Tennessee Health Sciences Center, Memphis, TN; and W. Paul Bowman, Cook Children's Medical Center, Fort Worth, TX.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Inaba
authors.affiliation: Sue C. Kaste, Deqing Pei, Cheng Cheng, Michael D. Neel, Raul C. Ribeiro, Monika L. Metzger, Deepa Bhojwani, Hiroto Inaba, Patrick Campbell, Jeffrey E. Rubnitz, Sima Jeha, John T. Sandlund, James R. Downing, Mary V. Relling, Ching-Hon Pui, and Scott C. Howard, St Jude Children's Research Hospital; Sue C. Kaste, University of Tennessee Health Sciences Center, Memphis, TN; and W. Paul Bowman, Cook Children's Medical Center, Fort Worth, TX.
authors.forename: Patrick
authors.initials: P
authors.lastname: Campbell
authors.affiliation: Sue C. Kaste, Deqing Pei, Cheng Cheng, Michael D. Neel, Raul C. Ribeiro, Monika L. Metzger, Deepa Bhojwani, Hiroto Inaba, Patrick Campbell, Jeffrey E. Rubnitz, Sima Jeha, John T. Sandlund, James R. Downing, Mary V. Relling, Ching-Hon Pui, and Scott C. Howard, St Jude Children's Research Hospital; Sue C. Kaste, University of Tennessee Health Sciences Center, Memphis, TN; and W. Paul Bowman, Cook Children's Medical Center, Fort Worth, TX.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Rubnitz
authors.affiliation: Sue C. Kaste, Deqing Pei, Cheng Cheng, Michael D. Neel, Raul C. Ribeiro, Monika L. Metzger, Deepa Bhojwani, Hiroto Inaba, Patrick Campbell, Jeffrey E. Rubnitz, Sima Jeha, John T. Sandlund, James R. Downing, Mary V. Relling, Ching-Hon Pui, and Scott C. Howard, St Jude Children's Research Hospital; Sue C. Kaste, University of Tennessee Health Sciences Center, Memphis, TN; and W. Paul Bowman, Cook Children's Medical Center, Fort Worth, TX.
authors.forename: Sima
authors.initials: S
authors.lastname: Jeha
authors.affiliation: Sue C. Kaste, Deqing Pei, Cheng Cheng, Michael D. Neel, Raul C. Ribeiro, Monika L. Metzger, Deepa Bhojwani, Hiroto Inaba, Patrick Campbell, Jeffrey E. Rubnitz, Sima Jeha, John T. Sandlund, James R. Downing, Mary V. Relling, Ching-Hon Pui, and Scott C. Howard, St Jude Children's Research Hospital; Sue C. Kaste, University of Tennessee Health Sciences Center, Memphis, TN; and W. Paul Bowman, Cook Children's Medical Center, Fort Worth, TX.
authors.forename: John T
authors.initials: JT
authors.lastname: Sandlund
authors.affiliation: Sue C. Kaste, Deqing Pei, Cheng Cheng, Michael D. Neel, Raul C. Ribeiro, Monika L. Metzger, Deepa Bhojwani, Hiroto Inaba, Patrick Campbell, Jeffrey E. Rubnitz, Sima Jeha, John T. Sandlund, James R. Downing, Mary V. Relling, Ching-Hon Pui, and Scott C. Howard, St Jude Children's Research Hospital; Sue C. Kaste, University of Tennessee Health Sciences Center, Memphis, TN; and W. Paul Bowman, Cook Children's Medical Center, Fort Worth, TX.
authors.forename: James R
authors.initials: JR
authors.lastname: Downing
authors.affiliation: Sue C. Kaste, Deqing Pei, Cheng Cheng, Michael D. Neel, Raul C. Ribeiro, Monika L. Metzger, Deepa Bhojwani, Hiroto Inaba, Patrick Campbell, Jeffrey E. Rubnitz, Sima Jeha, John T. Sandlund, James R. Downing, Mary V. Relling, Ching-Hon Pui, and Scott C. Howard, St Jude Children's Research Hospital; Sue C. Kaste, University of Tennessee Health Sciences Center, Memphis, TN; and W. Paul Bowman, Cook Children's Medical Center, Fort Worth, TX.
authors.forename: Mary V
authors.initials: MV
authors.lastname: Relling
authors.affiliation: Sue C. Kaste, Deqing Pei, Cheng Cheng, Michael D. Neel, Raul C. Ribeiro, Monika L. Metzger, Deepa Bhojwani, Hiroto Inaba, Patrick Campbell, Jeffrey E. Rubnitz, Sima Jeha, John T. Sandlund, James R. Downing, Mary V. Relling, Ching-Hon Pui, and Scott C. Howard, St Jude Children's Research Hospital; Sue C. Kaste, University of Tennessee Health Sciences Center, Memphis, TN; and W. Paul Bowman, Cook Children's Medical Center, Fort Worth, TX.
authors.forename: Ching-Hon
authors.initials: CH
authors.lastname: Pui
authors.affiliation: Sue C. Kaste, Deqing Pei, Cheng Cheng, Michael D. Neel, Raul C. Ribeiro, Monika L. Metzger, Deepa Bhojwani, Hiroto Inaba, Patrick Campbell, Jeffrey E. Rubnitz, Sima Jeha, John T. Sandlund, James R. Downing, Mary V. Relling, Ching-Hon Pui, and Scott C. Howard, St Jude Children's Research Hospital; Sue C. Kaste, University of Tennessee Health Sciences Center, Memphis, TN; and W. Paul Bowman, Cook Children's Medical Center, Fort Worth, TX.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Howard
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005271:Femur Head Necrosis / Q000139:chemically induced* / Q000175:diagnosis*; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000473:pathology; D011446:Prospective Studies
chemical_list: D005938:Glucocorticoids