The Usefulness of T1-Weighted Magnetic Resonance Images for Diagnosis of Acute Leukemia Manifesting Musculoskeletal Symptoms prior to Appearance of Peripheral Blood Abnormalities.
The patients with acute leukemia occasionally present with musculoskeletal symptoms initially, including bone pain, joint pain, muscular pain, and functional impairment. Without abnormal findings of peripheral blood cell counts or smear, the correct diagnosis tends to be delayed. Magnetic resonance imaging is often performed to examine musculoskeletal abnormalities; it can simultaneously reveal the bone marrow composition with high anatomical resolution and excellent soft tissue contrast. We present 4 pediatric patients who were initially diagnosed with acute pyogenic osteomyelitis or arthritis, based on the elevated white blood cell counts and/or C-reactive protein in addition to the localized high signal intensity on T2-weighted magnetic resonance images. Finally, they were diagnosed with B-cell precursor acute lymphoblastic leukemia by bone marrow examination. The period between the onset of musculoskeletal symptoms and the diagnosis of leukemia ranged from 20 days to 6 months. In all cases, the T1-weighted magnetic resonance images taken prior to detection of peripheral blood abnormality revealed diffuse low signal intensity of the bone marrow in regions adjacent or contralateral to localized musculoskeletal symptoms. These findings should raise the suspicion of leukemia even without abnormalities in peripheral blood.
Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan.
Toshihide
0000-0003-3999-9379
T
Yoshikawa
Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan; Department of Human Resource Development for Cancer, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan.
Akihiko
A
Tanizawa
Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan.
Koji
K
Suzuki
Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan; Department of Pediatrics, Japanese Red Cross Fukui Hospital, 2-4-1 Tsukimi, Fukui 918-8011, Japan.
Nanae
N
Tanaka
Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan.
Taihei
T
Hayashi
Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan.
Masayo
M
Tsuda
Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan.
Genrei
G
Ohta
Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan; Department of Pediatrics, The Japan Baptist Hospital, 47 Kitashirakawayamanomoto-cho, Sakyo-ku, Kyoto 606-8273, Japan.
Naoko
N
Kikuchi
Department of Pediatrics, Japan Community Health Care Organization, Kanazawa Hospital, 8-15 Okimachi, Kanazawa 920-0013, Japan.
Hiroyuki
H
Okamoto
Department of Pediatrics, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui 910-0846, Japan.
Takehiko
T
Sakai
Department of Pediatrics, Japanese Red Cross Fukui Hospital, 2-4-1 Tsukimi, Fukui 918-8011, Japan.
Yoshihiro
Y
Taniguchi
Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan.
Yusei
0000-0002-4488-0308
Y
Ohshima