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Whole-joint magnetic resonance imaging to assess osteonecrosis in pediatric patients with acute lymphoblastic lymphoma
- Source :
- Pediatr Blood Cancer
- Publication Year :
- 2020
-
Abstract
- Background Osteonecrosis is a debilitating complication in children and adolescents with acute lymphoblastic leukemia or acute lymphoblastic lymphoma (LLy). An objective screening test to identify patients at risk for symptomatic, extensive joint involvement will help manage osteonecrosis. Methods We performed a prospective, longitudinal pilot study with whole-joint magnetic resonance imaging (MRI) of shoulders, elbows, hips, knees, ankles, and hindfeet to evaluate the incidence and timing of osteonecrosis involving multiple joints in 15 patients with LLy aged 9-21 years at diagnosis. Results Osteonecrosis affecting ≥30% of the epiphysis occurred in eight of 15 patients, with a high prevalence in hips (12 of 26 examined [46%]) and knees (10 of 26 [38%]) post reinduction I and in shoulders (seven of 20 [35%]) post reinduction II. Most osteonecrotic hips and knees with ≥30% epiphyseal involvement became symptomatic and/or underwent surgery (100% and 82%, respectively). All eight patients with ≥30% epiphyseal involvement had multijoint involvement. Seven of these patients had hip or knee osteonecrosis by the end of remission induction, and only these patients developed osteonecrosis that became symptomatic and/or underwent surgery in their hips, knees, shoulders, ankles, and/or feet; all of these joints were associated with epiphyseal abnormalities on post reinduction I imaging. Conclusions MRI screening in adolescent patients with LLy revealed osteonecrosis in multiple joints. Initial screening with hip and knee MRI at the end of induction may identify susceptible patients who could benefit from referrals to subspecialties, more extensive follow-up imaging of other joints, and early medical and surgical interventions.
- Subjects :
- musculoskeletal diseases
Male
medicine.medical_specialty
Adolescent
Shoulders
Lymphoblastic Leukemia
Article
03 medical and health sciences
Remission induction
0302 clinical medicine
Risk Factors
medicine
Humans
Child
medicine.diagnostic_test
business.industry
Incidence (epidemiology)
Incidence
Lymphoblastic lymphoma
Osteonecrosis
Magnetic resonance imaging
Hematology
Precursor Cell Lymphoblastic Leukemia-Lymphoma
medicine.disease
Magnetic Resonance Imaging
Surgery
medicine.anatomical_structure
Oncology
Epiphysis
030220 oncology & carcinogenesis
Pediatrics, Perinatology and Child Health
Female
Joints
Complication
business
030215 immunology
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Pediatr Blood Cancer
- Accession number :
- edsair.doi.dedup.....b413e995cb73446c8ad4018e1e802e6e