Yun-Ju Kim MD, Presenter: Nothing to Disclose

Gye Yeon Lim MD, Abstract Co-Author: Nothing to Disclose

So Young Yoo MD, Abstract Co-Author: Nothing to Disclose

Corticosteroid-induced osteonecrosis (ON) is a frequent complication in children treated for leukemia. Little is known regarding the spontaneous changes of ON during the course of the disease following diagnosis. The purpose of our study was to evaluate using MRI, the spontaneous change in osteonecrosis following diagnosis as well as the factors which might affect those changes in children being treated for leukemia.  

We performed a retrospective analysis of 30 MRI studies done on 16 children diagnosed with osteonecrosis after chemotherapy. Nine of the 16 children with ON underwent follow-up MR scanning and were included in this study. Within a range of 2-25 months, each patient underwent 1-3 follow-up MRI scans. Conservative treatment was chosen during the follow-up period in which we analyzed the number, affected  joints, sites of lesions, and additional characteristics of lesions located in epiphyseal zones(collapse, articular surface extension and joint effusion) as seen on MRI of these patients. Clinical conditions were correlated with these MR findings.

All patients showed bilateral and multifocal involvement. Initial MRI scans revealed lesions at the following sites: knee joints (n=6); hip joints (n=6); shoulder(n=2); pelvic bones (n=2); ankle (n=2); tarsal bone (n=2); and vertebra (n=1). Follow-up MR findings of lesions remained unchanged in four patients, while four patients showed partial or complete spontaneous regression of their lesions. Lesions that did not extend to the articular surface showed complete regression in six patients and unchanged in two patientis. Follow-up MRI showed no further progression of collapse in four of the five patients in whom collapse of femoral head lesions was seen on the initial MR. However, one of these patients had progression of collapse of a femoral head lesion.

The results of our study suggest a greater number of patients showed either no change or spontaneous regression in the osteonecrotic lesions on follow-up examinations. However, further studies with longer follow-up periods and larger series will be needed in order to determine the exact, spontaneous course of ON after diagnosis in patients being treated for leukemia.  

Using MRI, the spontaneous change of osteonecrotic lesions following diagnosis in children being treated for leukemia may show benign course even spontaneous improvement.

Kim, Y, Lim, G, Yoo, S, MRI Follow-up of Osteonecrosis in Children Treated for Leukemia.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11002096.html