Beer M, Stenzel M, Girschick H, Schlegel P-G, Darge K
Institut für Röntgendiagnostik, Universitätsklinikum Würzburg, Oberdurrbacher Strasse 6, Würzburg.
Rofo. 2008 Mar;180(3):238-45. doi: 10.1055/s-2008-1027185.
Use of multidrug chemotherapy poses the risk of avascular osseous necroses in children. Depiction of the whole body, including clinically non-apparent sites is mandatory for starting early and proper treatment, including surgical approaches in lesions near the joints. We analyzed the value of whole-body MRI in the detection of osteonecrosis, (1) in relation to conventional X-ray imaging and clinical symptoms, (2) using different MRI sequences, (3) with follow-up examinations.
5 patients suffering from an oncological disease, 13 to 16 years old (3 x ALL, 1 x medulloblastoma, 1 x CML), and recently developing bone pain were examined with X-ray imaging of the particular region and a whole-body MRI (T2w TIRM, T 1w TSE sequences, pre- and post-contrast GD-DTPA, including fat suppression techniques). Neck/thorax/abdomen/pelvis, and upper and lower extremities were acquired in the coronal plane, and the feet in sagittal orientation. 4 of 5 patients had at least one follow-up examination (in the mean after 10 +/- 4 months).
None of the initial X-ray images revealed an abnormal finding. The whole-body MRI showed in 4 of 5 children bone marrow lesions compatible with osteonecrosis. The locations were around the knee joints (n = 3) and the tibiae/ankle joints (n = 4). In addition to the symptomatic sites, MRI revealed additional lesions at the following sites: humerus (n = 5), hip joints (n = 4), knee joints (n = 6), ankle joints (n = 4). The size varied from small focal lesions to lesions measuring 90 % of the whole transverse diameter of the bone. The lesions were able to be detected most easily with heavily T 2-weighted (TIRM) sequences, and the diagnosis was most easily established using the non-enhanced TSE T 1-weighted sequences. As a consequence of the results of the whole-body MRI, all patients with lesions compatible with osteonecrosis received symptomatic (n = 2) or specific (n = 2) therapy. In the follow-up examinations, a higher number of patients showed no changes in the lesions as to size and distribution. 2 patients showed partial resolution of the osteonecroses.
Whole-body MR imaging allows early diagnosis of symptomatic as well as clinically non-apparent osteonecroses. It can be used in planning and monitoring surgical and pharmacological therapies.
多药化疗会给儿童带来缺血性骨坏死的风险。为了尽早开始并进行恰当治疗，包括对关节附近病变采取手术方法，对全身进行成像检查（包括临床未出现症状的部位）是必不可少的。我们分析了全身磁共振成像（MRI）在检测骨坏死方面的价值，（1）与传统X线成像及临床症状的关系，（2）使用不同的MRI序列，（3）进行随访检查。
对5例患有肿瘤疾病、年龄在13至16岁（3例急性淋巴细胞白血病、1例髓母细胞瘤、1例慢性粒细胞白血病）且近期出现骨痛的患者，进行了特定部位的X线成像及全身MRI检查（T2加权脂肪抑制反转恢复序列（T2w TIRM）、T1加权快速自旋回波序列（T1w TSE），静脉注射钆喷酸葡胺（GD-DTPA）前后成像，包括脂肪抑制技术）。在冠状面采集颈/胸/腹/骨盆以及上肢和下肢的图像，在矢状面采集足部图像。5例患者中有4例至少进行了一次随访检查（平均在10±4个月后）。
最初的X线图像均未显示异常发现。全身MRI显示，5例儿童中有4例存在与骨坏死相符的骨髓病变。病变部位在膝关节周围（3例）和胫骨/踝关节周围（4例）。除了有症状的部位外，MRI还在以下部位发现了其他病变：肱骨（5例）、髋关节（4例）、膝关节（6例）、踝关节（4例）。病变大小从小的局灶性病变到占骨横径90%的病变不等。在重T2加权（TIRM）序列中最容易检测到这些病变，而使用非增强TSE T1加权序列最容易确诊。基于全身MRI的结果，所有骨坏死病变患者均接受了对症治疗（2例）或特异性治疗（2例）。在随访检查中，更多患者的病变在大小和分布方面没有变化。2例患者的骨坏死部分得到缓解。
全身磁共振成像能够早期诊断有症状以及临床未出现症状的骨坏死。它可用于规划和监测手术及药物治疗。
