title: Whole-body MRI reveals high incidence of osteonecrosis in children treated for Hodgkin lymphoma.
abstract: Osteonecrosis is a well-recognized complication in patients treated with corticosteroids. The incidence of osteonecrosis in children treated for Hodgkin lymphoma is unknown because prospective whole-body magnetic resonance imaging (MRI) studies are lacking in this patient population. Paediatric patients with newly diagnosed Hodgkin lymphoma who were treated according to a uniform paediatric Hodgkin protocol were eligible for inclusion in this prospective study. Whole-body MRI was performed in all 24 included patients (mean age 15·1 years, 12 girls) both before treatment and after 2 cycles of chemotherapy, and in 16 patients after completion of chemotherapy. Osteonecrosis was identified in 10 patients (41·7%, 95% confidence interval: 22·0-61·4%), with a total of 56 osteonecrotic sites. Osteonecrosis was detected in 8 patients after 2 cycles of OEPA (vincristine, etoposide, prednisone, doxorubicin), and in 2 additional patients after completion of chemotherapy. Epiphyseal involvement of long bones was seen in 4 of 10 children. None of the patients with osteonecrosis had any signs of bone collapse at the times of scanning. Whole-body MRI demonstrates osteonecrosis to be a common finding occurring during therapy response assessment of paediatric Hodgkin lymphoma. Detection of early epiphyseal osteonecrosis could allow for treatment before bone collapse and joint damage may occur.
authors.affiliation: Department of Radiology, University Medical Centre Utrecht-Princess Maxima Centre for Paediatric Oncology, Utrecht, the Netherlands.
authors.forename: Annemieke S
authors.initials: AS
authors.lastname: Littooij
authors.affiliation: Department of Radiology, University Medical Centre Utrecht-Princess Maxima Centre for Paediatric Oncology, Utrecht, the Netherlands.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Kwee
authors.affiliation: Department of Paediatric Radiology, Hospital Materno-Infantil Vall d'Hebron, Barcelona, Spain.
authors.forename: Goya
authors.initials: G
authors.lastname: Enríquez
authors.affiliation: Department of Radiology, VU University Medical Centre, Amsterdam, the Netherlands.
authors.forename: Jonathan I M L
authors.initials: JI
authors.lastname: Verbeke
authors.affiliation: Department of Radiology, IRCCS Giannina Gaslini Hospital, Genoa, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Granata
authors.affiliation: Department of Paediatric Oncology/Haematology, Erasmus MC University Medical Centre-Sophia's Children's Hospital, Rotterdam, the Netherlands.
authors.forename: Auke
authors.initials: A
authors.lastname: Beishuizen
authors.affiliation: Department of Diagnostic Imaging and Intervention, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Charlotte
authors.initials: C
authors.lastname: de Lange
authors.affiliation: Department of Paediatric Radiology, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
authors.forename: Floriana
authors.initials: F
authors.lastname: Zennaro
authors.affiliation: Princess Maxima Centre for Paediatric Oncology, Utrecht, the Netherlands.
authors.forename: Marrie C A
authors.initials: MC
authors.lastname: Bruin
authors.affiliation: Department of Radiology, University Medical Centre Utrecht-Princess Maxima Centre for Paediatric Oncology, Utrecht, the Netherlands.
authors.forename: Rutger A J
authors.initials: RA
authors.lastname: Nievelstein
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D004317:Doxorubicin / Q000627:therapeutic use; D004838:Epiphyses / Q000000981:diagnostic imaging / Q000473:pathology; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D006689:Hodgkin Disease / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D010020:Osteonecrosis / Q000000981:diagnostic imaging* / Q000209:etiology; D011241:Prednisone / Q000627:therapeutic use; D011446:Prospective Studies; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D011241:Prednisone
keywords: Osteonecrosis; late effects; paediatric Hodgkin Lymphoma; whole-body MRI