Detection of multifocal osteonecrosis in an adolescent with dermatomyositis using whole-body MRI

Abstract

Osteonecrosis is a well-recognized complication of corticosteroid use resulting in significant morbidity, often requiring surgical intervention. Whole-body MRI is a promising method that allows imaging of the whole patient in a reasonable time without the use of ionizing radiation. This technique has the potential for evaluating nonmalignant multifocal skeletal disease like osteonecrosis. This case highlights the value of whole-body MR in an adolescent with dermatomyositis who developed multifocal osteonecrosis.

Widespread Osteonecrosis in Children With Leukemia Revealed by Whole-body MRI

“…However, because we used an MRI definition of osteonecrosis that is characterized by the presence of the classic band sign and has been validated by histology correlation [8], we presume the osteonecrotic lesions in our patients are consistent with those reported in the literature. Similarly, after initiation of our study, other studies have emerged confirming the utility of WB-MRI in detecting osteonecrosis in various pediatric disorders, such as juvenile lupus [4], juvenile dermatomyositis [5], and hematologic malignancies [1]. Second, at the time of study onset, osteonecrosis was considered a rare complication of ALL therapy.…”

“…Whole-body MRI (WB-MRI) is an imaging technique that can analyze the entire skeleton with a single diagnostic test [6,17] and has emerged as the preferred imaging modality for evaluation of patients with suspected osteonecrosis in various disorders [6,9,17]. In patients with juvenile systemic lupus erythematosus and juvenile dermatomyositis [4,5], WB-MRI has confirmed multisite osteonecrosis, exclusively located in the lower limbs. In pediatric patients with hematologic malignancies there is one previous study using WB-MRI, which confirmed osteonecrosis in upper and lower extremities [1].…”

“…Although we used a comprehensive MRI technique with T-1 weighted and STIR images, Castro et al [5] (Table 4) reported that WB-STIR sequences alone with short imaging times of 10 to 15 minutes compare favorably with joint-specific MRI (15-20 minutes required to assess one joint). WB-STIR may become the ideal imaging modality of choice in the future, especially for younger patients who would benefit from shorter sedation times.…”

An efficacy analysis of whole-body magnetic resonance imaging in the diagnosis and follow-up of polymyositis and dermatomyositis

“…To the best of our knowledge, there has been no report assessing the value of WBMRI in diagnosing extra muscular manifestations (ILD, systemic malignancies) in PM / DM cases. So far, the use of WBMRI in the diagnosis of osteonecrosis in PM / DM patients has been limited only to the case report [12], and we are not aware of any report documenting WBMRI for the diagnosis of extra muscular manifestations (ILD, systemic malignancies).…”

Maladies systémiques et vascularites

“…L'examen est centré sur les zones présentant un déficit musculaire (ceintures pelviennes, scapulaires, etc .) Cet examen permettrait, en outre, de dépister les complications asymptomatiques de la corticothérapie (ostéonécrose aseptique) [57] . Cet examen permettrait, en outre, de dépister les complications asymptomatiques de la corticothérapie (ostéonécrose aseptique) [57] .…”