Alessandro Masetto MD, Presenter: Nothing to Disclose

Davide Ippolito MD, Abstract Co-Author: Nothing to Disclose

Pietro Andrea Bonaffini MD, Abstract Co-Author: Nothing to Disclose

Alessandra Silvia Casiraghi, Abstract Co-Author: Nothing to Disclose

Cammillo Roberto Giovanni Leopoldo Talei Franzesi, Abstract Co-Author: Nothing to Disclose

Sandro Sironi MD, Abstract Co-Author: Nothing to Disclose

To evaluate the clinical relevance of screening and monitoring post-treatment lower-limbs osteonecrosis (ON) with MRI in symptomatic and asymptomatic children affected by acute lymphoblastic leukemia (ALL).

We retrospectively evaluated a total of 73 patients (37 males, average age 12.4 years) affected by ALL, treated with chemotherapy and corticosteroids or bone marrow transplantation (BMT) and who underwent a lower limbs MRI examination between June 2007 and February 2014. In 47 patients the first study was performed after the early onset of symptoms referable to ON (bone and articular pain); the remaining 26 patients were asymptomatic and evaluated for screening purposes. The MRI examinations were performed either on a 1.5T (Achieva, Philips) or a 1T magnet (Panorama, Philips) acquiring coronal short tau inversion recovery (STIR) long TE and T1 weighted sequences, from the hips to the ankles. Additional sequences were acquired only in selected cases. The average acquisition time was 18 minutes.

A total of 195 MRI examinations (baseline and follow-up) were evaluated. Among the 47 symptomatic patients, 9/47 (19%) did not demonstrate ON and 13/47 (27%) had bone infarcts; 25/47 (53%) had ON involving at least one joint and 11 of these cases (44%) later collapsed. Considering the remaining 26 asymptomatic patients, 14 (54%) did not demonstrate ON, 7 (27%) had bone infarcts only, while only 5/26 (19%) had ON of one joint; in these 5 patients no joint collapse was observed at follow-up.

Lower-limbs MRI might be employed only in symptomatic ALL patients, who underwent treatment, as quick and feasible imaging technique for the assessment of osteonecrotic lesions. In asymptomatic cases, due to the reduced incidence of ON and subsequent joint collapse, employment of MRI seems not to demonstrate a significant clinical relevance.

Early detection and monitoring of ON is essential for conservative or minimally invasive treatment strategies but MRI should be specifically performed only in patients complaining symptoms.

Masetto, A, Ippolito, D, Bonaffini, P, Casiraghi, A, Talei Franzesi, C, Sironi, S, Role of Lower-limb MRI Screening of Post-treatment Osteonecrosis in Paediatric Patients Affected by Acute Lymphoblastic Leukaemia.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14005589.html