The use of joint-specific and whole-body MRI in osteonecrosis: a study in patients with juvenile systemic lupus erythematosus

Abstract

Objective: This study aimed to estimate the prevalence of osteonecrosis (ON) in juvenile systemic lupus erythematosus (SLE) patients using joint-specific and wholebody MRI; to explore risk factors that are associated with the development of ON; and to evaluate prospectively patients 1 year after initial imaging. Method: Within a 2 year period, we studied 40 juvenile SLE patients (aged 8-18 years) with a history of steroid use of more than 3 months duration. Risk factors including disease activity, corticosteroid use, vasculitis, Raynaud's phenomenon and lipid profile were evaluated. All patients underwent MRI of the hips, knees and ankles using jointspecific MRI. Whole-body STIR (short tau inversion recovery) MRI was performed in all patients with ON lesions. Results: Osteonecrosis was identified in 7 patients (17.5 %) upon joint-specific MRI. Whole-body STIR MRI detected ON in 6 of these 7 patients. There was no significant difference between the ON and non-ON groups in the risk factors studied. One patient had pre-existing symptomatic ON. At 1 year follow-up, the ON lesions had resolved in one patient, remained stable in four and decreased in size in two. No asymptomatic patients with ON developed clinical manifestations. Conclusion: Whole-body STIR MRI may be useful in detecting ON lesions in juvenile SLE patients but larger studies are needed to define its role.

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].…”

“…High prevalence of lower limb involvement also was reported in previous studies of childhood leukemia [12,21], although these findings are limited by the fact that the studies focused primarily on the lower limbs. WB-MRI has allowed a more comprehensive assessment of skeletal involvement and these studies suggest greater involvement of the knee area by osteonecrosis in patients with juvenile systemic lupus erythematosus (JSLE) compared with adult patients with lupus [4]. Castro et al suggested that pediatric populations could be predisposed to knee trauma and exacerbation of osteonecrosis, because children and adolescents participate in physical activities that are more intense than those in which the adult population participates [4].…”

“…WB-MRI has allowed a more comprehensive assessment of skeletal involvement and these studies suggest greater involvement of the knee area by osteonecrosis in patients with juvenile systemic lupus erythematosus (JSLE) compared with adult patients with lupus [4]. Castro et al suggested that pediatric populations could be predisposed to knee trauma and exacerbation of osteonecrosis, because children and adolescents participate in physical activities that are more intense than those in which the adult population participates [4]. We found that humeral head lesions occurred in greater than 50% of our patients (all asymptomatic) in comparison to none in patients with JSLE and juvenile dermatomyositis who also had WB-MRI performed (Table 4).…”

Maladies systémiques et vascularites

“…Elles apparaissent très rapidement après l'introduction du traitement (6 e mois) [56] . Elles apparaissent très rapidement après l'introduction du traitement (6 e mois) [56] .…”