Magnetic resonance imaging of renal osteodystrophy in children

Olmastroni, M.; Seracini, D; Lavoratti, Giancarlo; Marín, E.; Masi, A; Vichi, G

doi:10.1007/s002470050258

Cited by 20 publications

(7 citation statements)

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“…Olmastroni et al demonstrated in a pilot study using bone MRI (0.5 T) in a cohort of 14 children and adolescents (among them six undergoing hemodialysis and eight with CKD on conservative therapy) that there was a thickening of cortical bone in seven patients, with a thickening of trabeculae in three [28].…”

Section: Discussionmentioning

confidence: 97%

Bone assessment in children with chronic kidney disease: data from two new bone imaging techniques in a single-center pilot study

et al. 2011

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Bone damage in children with chronic kidney disease (CKD) is a challenge for pediatric nephrologists. Areal measurements of bone mineral density (BMD) by dual x-ray absorptiometry (DXA) have been routinely performed to assess bone mass but recent international guidelines have concluded that DXA was of less value in CKD. The aim of this study is to evaluate bone quality in CKD children using new bone imaging techniques in a pilot cross-sectional single-center study. We performed bone imaging (high-resolution peripheral quantitative computed tomography, HR-pQCT, XtremeCT, Scanco Medical AG, Switzerland), to assess compartmental volumetric BMD and trabecular microarchitecture in 22 CKD children and 19 controls. In seven younger patients (i.e., under 10 years of age), we performed bone texture analysis (BMA, D3A Medical Systems, France) in comparison to 15 healthy prepubertal controls. Among older children, CKD patients had significantly lower height and body weight without significant impairment of BMD and microarchitecture than healthy controls. In univariate analysis, there were significant correlations between cortical BMD and glomerular filtration rate (r= -0.46), age (r=0.60) and body mass index (r=0.67). In younger children, bone texture parameters were not different between patients and controls. Our results did not show significant differences between healthy controls and CKD children for compartmental bone densities and microarchitecture, but the small sample size and the heterogeneity of the CKD group require caution in the interpretation. Novel bone imaging techniques seem feasible in children, and further longitudinal studies are required to thoroughly explore long-term cardiovascular and bone consequences of phosphate-calcium metabolism deregulation during CKD.

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Section: Discussionmentioning

confidence: 97%

Bone assessment in children with chronic kidney disease: data from two new bone imaging techniques in a single-center pilot study

et al. 2011

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“…In patients with chronic renal insufficiency including osteosclerosis, brown tumors, skeletal deformity, fatty marrow inversion, osteonecrosis, transient bone marrow edema and occult stress fracture, MRI is helpful in the evaluation of bone marrow abnormalities (2, 3). Ito et al (5) reported that in chronic renal failure, T1 relaxation time was related to the cellular histologic findings of the vertebrae.…”

Section: Discussionmentioning

confidence: 99%

“…The prolonged T1 relaxation time of the vertebrae observed in cases involving osteosclerosis was due to hypercellularity, the presence of thickened or many small irregular trabeculae, or peritrabecular fibrosis. Olmastroni et al (3) reported that the thickened irregular trabeculae in the proximal femoral metaphyses were observed in three of 14 patients with renal osteodystrophy who underwent MR. Trabecular bone thickening was clearly demonstrated by MR as very low signal intensity cortical sleeves or medullary streaks.…”

Section: Discussionmentioning

confidence: 99%

“…They encompass a range of conditions which includes secondary hyperparathyroidism, osteosclerosis, osteoporosis, osteomalacia, soft-tissue and vascular calcification, amyloid deposition, tendon rupture, infection, and avascular necrosis (1, 2). While the various characteristic imaging features seen in chronic renal insufficiency have been reported, only a few studies (1-3) have described the bone marrow pattern revealed by MR imaging in renal osteodystrophy.…”

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confidence: 99%

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MR Imaging of Medullary Streaks in Osteosclerosis: A Case Report

et al. 2000

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“…[84] patterns of ROD, but these studies drew attention to the usefulness Studies that assessed iPTH levels, bone formation and resorpof bone density monitoring during the course of treatment in a tion markers, and calcium and phosphorus levels confirmed the given patient. Other imaging methods such as magnetic limitations of precisely evaluating the osteodystrophy pattern on resonance [105] or bone scintigraphy [106] may prove to be more the basis of non-invasive examinations only. For the comprehenuseful in the assessment of and differentiation between patterns of sive evaluation of the skeletal status, it is recommended to perform bone changes in ROD.…”

Section: Radiologic Investigationsmentioning

confidence: 98%

Minimizing Bone Abnormalities in Children with Renal Failure

Ziółkowska

2006

Pediatric Drugs

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Renal osteodystrophy (ROD), a metabolic bone disease accompanying chronic renal failure (CRF), is a major clinical problem in pediatric nephrology. Growing and rapidly remodeling skeletal systems are particularly susceptible to the metabolic and endocrine disturbances in CRF. The pathogenesis of ROD is complex and multifactorial. Hypocalcemia, phosphate retention, and low levels of 1,25 dihydroxyvitamin D(3) related to CRF result in disturbances of bone metabolism and ROD. Delayed diagnosis and treatment of bone lesions might result in severe disability. Based on microscopic findings, renal bone disease is classified into two main categories: high- and low-turnover bone disease. High-turnover bone disease is associated with moderate and severe hyperparathyroidism. Low-turnover bone disease includes osteomalacia and adynamic bone disease. The treatment of ROD involves controlling serum calcium and phosphate levels, and preventing parathyroid gland hyperplasia and extraskeletal calcifications. Serum calcium and phosphorus levels should be kept within the normal range. The calcium-phosphorus product has to be <5 mmol(2)/L(2) (60 mg(2)/dL(2)). Parathyroid hormone (PTH) levels in children with CRF should be within the normal range, but in children with end-stage renal disease PTH levels should be two to three times the upper limit of the normal range. Drug treatment includes intestinal phosphate binding agents and active vitamin D metabolites. Phosphate binders should be administered with each meal. Calcium carbonate is the most widely used intestinal phosphate binder. In children with hypercalcemic episodes, sevelamer, a synthetic phosphate binder, should be introduced. In children with CRF, ergocalciferol (vitamin D(2)), colecalciferol (vitamin D(3)), and calcifediol (25-hydroxyvitamin D(3)) should be used as vitamin D analogs. In children undergoing dialysis, active vitamin D metabolites alfacalcidol (1alpha-hydroxy-vitamin D(3)) and calcitriol (1,25 dihydroxyvitamin D(3)) are applied. In recent years, a number of new drugs have emerged that hold promise for a more effective treatment of bone lesions in CRF. This review describes the current approach to the diagnosis and treament of ROD.

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Magnetic resonance imaging of renal osteodystrophy in children

Abstract: MRI is a potentially useful tool for evaluating the bone changes of renal osteodystrophy.

Cited by 20 publications

References 8 publications

Bone assessment in children with chronic kidney disease: data from two new bone imaging techniques in a single-center pilot study

Bone assessment in children with chronic kidney disease: data from two new bone imaging techniques in a single-center pilot study

MR Imaging of Medullary Streaks in Osteosclerosis: A Case Report

Minimizing Bone Abnormalities in Children with Renal Failure

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