Department of Pediatrics, Division of Allergy, Clinical Immunology and Rheumatology, Universidade Federal de São Paulo, Brazil.
Br J Radiol. 2011 Jul;84(1003):621-8. doi: 10.1259/bjr/34972239. Epub 2010 Nov 16.
This study aimed to estimate the prevalence of osteonecrosis (ON) in juvenile systemic lupus erythematosus (SLE) patients using joint-specific and whole-body MRI; to explore risk factors that are associated with the development of ON; and to evaluate prospectively patients 1 year after initial imaging.
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 joint-specific MRI. Whole-body STIR (short tau inversion recovery) MRI was performed in all patients with ON lesions.
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.
Whole-body STIR MRI may be useful in detecting ON lesions in juvenile SLE patients but larger studies are needed to define its role.
本研究旨在使用关节特异性和全身 MRI 估计幼年系统性红斑狼疮 (SLE) 患者的骨坏死 (ON) 患病率；探讨与 ON 发展相关的危险因素；并在初始成像后 1 年对患者进行前瞻性评估。
在 2 年期间，我们研究了 40 名有类固醇使用史（超过 3 个月）的幼年 SLE 患者（年龄 8-18 岁）。评估了包括疾病活动度、皮质类固醇使用、血管炎、雷诺现象和血脂谱在内的危险因素。所有患者均接受髋关节、膝关节和踝关节的关节特异性 MRI 检查。对有 ON 病变的所有患者均进行全身 STIR（短回波反转恢复）MRI。
关节特异性 MRI 发现 7 名患者（17.5%）存在 ON。全身 STIR MRI 在这 7 名患者中的 6 名中检测到 ON。在研究的危险因素中，ON 组和非 ON 组之间没有显著差异。一名患者存在先前有症状的 ON。在 1 年随访时，1 名患者的 ON 病变已消退，4 名患者稳定，2 名患者体积减小。没有无症状的 ON 患者出现临床表现。
全身 STIR MRI 可能有助于检测幼年 SLE 患者的 ON 病变，但需要更大的研究来确定其作用。
