Lower-limb MRI in the staging and re-staging of osteonecrosis in paediatric patients affected by acute lymphoblastic leukaemia after therapy

Ippolito, Davide; Masetto, Alessandro; Franzesi, Cammillo Talei; Bonaffini, Pietro Andrea; Sala, Alessandra; Biondi, Andrea; Sironi, Sandro

doi:10.1007/s00256-016-2329-3

Cited by 9 publications

(15 citation statements)

References 28 publications

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“…We reported that non-articular osteonecrosis more common than articular osteonecrosis, which agreed with study done by Ippolito D. et al [11], as their study included 45 patients, 13 cases were negative (29 %), 15 patients with non-articular ON (33 %), 12 patients with articular ON (27 %), 5 patients had ON with deformity (11 %).…”

Section: Discussionsupporting

confidence: 92%

Role of MRI in the Detection and Monitoring of Lower Limb Osteonecrosis after Chemotherapy in Pediatric Patients with Acute Lymphoblastic Leukaemia

Maarek

Dawoud

Rafat³

et al. 2020

JAMMR

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Background: Magnetic resonance imaging (MRI) is the technique that demonstrated the highest sensitivity and specificity in the early diagnosis of osteonecrosis. It allows detecting initial typical signal intensity alterations of the bone marrow when other examinations showed nonspecific findings or even no alterations at all. The aim of this study is to assess the role of magnetic resonance imaging in detection and monitoring osteonecrotic lesions in pediatric patient with acute lymphoblastic leukemia after chemotherapy. Materials and Methods: This prospective study was performed on 30 pediatric patients ranged from 4 to 18 years with acute lymphoblastic leukemia on chemotherapy or after 3months from ending chemotherapy with symptoms suspicious for osteonecrosis (i.e., articular pain). All patients were explained about the procedure to be done. MRI study of whole lower limbs was done for all patients. Results: In the present study all patients were symptomatic. 24\30 patients (80%) had hip pain, 25\30 patients (83.3%) had knee pain and 8\30 patients (26.7%) had limping. We reported that knee pain was the most common complaint representing 83.3% of patients. 11\30 patients (36.7%) had no MRI findings. 19\30 patients (63.3%) had different positive findings; 4 patients (13.3%) had non -articular osteonecrosis (ON) only with no joint involvement (bone infarction), 2 patients (6.7%) had avascular necrosis of femoral head epiphysis without bone infarction and 13 patients (43.3%) had combined bone infarction and avascular necrosis with Joint involvement. Follow up by MRI was done for all patients (30 patients), 27 patients showed no change in MRI findings, one patient progressed from avascular necrosis of the femoral head epiphysis without deformity to avascular necrosis of the femoral head epiphysis with deformity. The other two patient showed regressive course. Conclusion: We concluded that MRI study is mandatory for early detection and monitoring of lower limb osteonecrosis in pediatric patients with acute lymphoblastic leukemia under or after chemotherapy. The radiologist and clinician must do MRI lower limbs routinely and follow up MRI after 4-6 months to first MRI due to some patients had regressive or progressive findings.

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Section: Discussionsupporting

confidence: 92%

Role of MRI in the Detection and Monitoring of Lower Limb Osteonecrosis after Chemotherapy in Pediatric Patients with Acute Lymphoblastic Leukaemia

Maarek

Dawoud

Rafat³

et al. 2020

JAMMR

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“…To date, a total of 7 studies have reported on MRI screening for ON in children with ALL (Table 1). 5,[14][15][16][17][18][19] MRI time points differed widely between diagnosis and completion of therapy/follow-up in these studies. There was also significant variation in radiological and clinical classification employed, as well as the number of and time intervals between MRIs, limiting the comparability of these studies considerably.…”

mentioning

confidence: 98%

Osteonecrosis in children and adolescents with acute lymphoblastic leukemia: a therapeutic challenge

et al. 2017

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Osteonecrosis (ON) represents one of the most common and debilitating sequelae of antileukemic treatment in children and adolescents with acute lymphoblastic leukemia (ALL). Systematic screening strategies can focus on early detection and intervention to prevent ON from progressing to stages associated with pain and functional impairment.These strategies hold promise for reducing ON-associated morbidity without the risk of impairing leukemia control. Herein, we critically reviewed clinical data on pharmacological, nonpharmacological/nonsurgical, and surgical (including cellular) treatment options for ON, which are covered in the literature and/or are conceivable based on the supposed underlying ON pathophysiology. Prevention of ON progression is of paramount importance, and attempts seem to be more effective in early (precollapse) disease status than in late-stage (collapse) ON. Based on the results of ongoing prospective magnetic resonance imaging screening studies, which will hopefully identify those patients with a high risk of ON progression and debilitating sequelae, prospective interventional studies are urgently needed. Although there is still a lack of high-quality studies, based on currently available data, core decompression surgery combined with cellular therapies (eg, employing mesenchymal stem cells) appears most promising for preventing joint infraction in children at high risk of developing late-stage ON.

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“…Die Inzidenz der ON bei Kindern und Jugendlichen mit malignen Grunderkrankungen variiert zwischen 1,4 % bis maximal 73,9 % (Lackner et al 2005, Ippolito et al 2016.…”

Section: Inzidenz Symptomatik Und Lokalisationen Der Osteonekrosenunclassified

“…Wie in der vorliegenden Studie fanden auch Ippolito et al bei der Betrachtung von ON in der unteren Extremität keine bevorzugte Lokalisation bezüglich der rechten oder linken Körperseite (Ippolito et al 2016).…”

Section: Allem Beiunclassified

Beitrag der Ganzkörper-MRT in der Beurteilung von Osteonekrosen bei Kindern und Jugendlichen mit onkologischen und hämatologischen Grunderkrankungen

Korch

Kentouche

Renz

et al. 2019

Monatsschr Kinderheilkd

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Lower-limb MRI in the staging and re-staging of osteonecrosis in paediatric patients affected by acute lymphoblastic leukaemia after therapy

Abstract: Our MRI protocol proved to be feasible in evaluating ON in paediatric patients. Studies should be addressed only to symptomatic patients.

Cited by 9 publications

References 28 publications

Role of MRI in the Detection and Monitoring of Lower Limb Osteonecrosis after Chemotherapy in Pediatric Patients with Acute Lymphoblastic Leukaemia

Role of MRI in the Detection and Monitoring of Lower Limb Osteonecrosis after Chemotherapy in Pediatric Patients with Acute Lymphoblastic Leukaemia

Osteonecrosis in children and adolescents with acute lymphoblastic leukemia: a therapeutic challenge

Beitrag der Ganzkörper-MRT in der Beurteilung von Osteonekrosen bei Kindern und Jugendlichen mit onkologischen und hämatologischen Grunderkrankungen

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