title: Musculoskeletal MRI findings of juvenile localized scleroderma.
abstract: BACKGROUND
  Juvenile localized scleroderma comprises a group of autoimmune conditions often characterized clinically by an area of skin hardening. In addition to superficial changes in the skin and subcutaneous tissues, juvenile localized scleroderma may involve the deep soft tissues, bones and joints, possibly resulting in functional impairment and pain in addition to cosmetic changes.
  
  
  OBJECTIVE
  There is literature documenting the spectrum of findings for deep involvement of localized scleroderma (fascia, muscles, tendons, bones and joints) in adults, but there is limited literature for the condition in children. We aimed to document the spectrum of musculoskeletal magnetic resonance imaging (MRI) findings of both superficial and deep juvenile localized scleroderma involvement in children and to evaluate the utility of various MRI sequences for detecting those findings.
  
  
  METHODS
  Two radiologists retrospectively evaluated 20 MRI studies of the extremities in 14 children with juvenile localized scleroderma. Each imaging sequence was also given a subjective score of 0 (not useful), 1 (somewhat useful) or 2 (most useful for detecting the findings).
  
  
  RESULTS
  Deep tissue involvement was detected in 65% of the imaged extremities. Fascial thickening and enhancement were seen in 50% of imaged extremities. Axial T1, axial T1 fat-suppressed (FS) contrast-enhanced and axial fluid-sensitive sequences were rated most useful.
  
  
  CONCLUSIONS
  Fascial thickening and enhancement were the most commonly encountered deep tissue findings in extremity MRIs of children with juvenile localized scleroderma. Because abnormalities of the skin, subcutaneous tissues and fascia tend to run longitudinally in an affected limb, axial T1, axial fluid-sensitive and axial T1-FS contrast-enhanced sequences should be included in the imaging protocol.
authors.affiliation: Nemours Children's Health System/Alfred I. duPont Hospital or Children, 1600 Rockland Road, Wilmington, DE, 19803, USA.|Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Eric P
authors.initials: EP
authors.lastname: Eutsler
authors.affiliation: Division of Rheumatology, Department of Pediatrics, Nemours Children's Health System/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.|Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Horton
authors.affiliation: Department of Medical Imaging, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Epelman
authors.affiliation: Department of Pediatrics, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL, USA.
authors.forename: Terri
authors.initials: T
authors.lastname: Finkel
authors.affiliation: Nemours Children's Health System/Alfred I. duPont Hospital or Children, 1600 Rockland Road, Wilmington, DE, 19803, USA. lauren.averill@nemours.org.
authors.forename: Lauren W
authors.initials: LW
authors.lastname: Averill
mesh_terms: D002648:Child; D002675:Child, Preschool; D005121:Extremities / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D012594:Scleroderma, Localized / Q000000981:diagnostic imaging*; D012867:Skin / Q000000981:diagnostic imaging
keywords: Children; Juvenile localized scleroderma; Magnetic resonance imaging; Morphea; Musculoskeletal; Scleroderma