Departments of Anesthesiology, Critical Care and Pain Medicine.
Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Massachusetts.
Pediatrics. 2023 Aug 1;152(2). doi: 10.1542/peds.2022-061027.
Imaging modalities such as computed tomography (CT) are critical for monitoring musculoskeletal abnormalities in children with rare diseases. However, CT exposes patients to radiation, which limits its utility in the clinical setting, particularly during longitudinal evaluation. Synthetic CT is a novel, noncontrast, and rapid MRI method that can provide CT-like images without any radiation exposure and is easily performed in conjunction with traditional MRI, which detects soft-tissue and bone marrow abnormalities. To date, an evaluation of synthetic CT in pediatric patients with rare musculoskeletal diseases has been lacking. In this case series, the capability of synthetic CT to identify musculoskeletal lesions accurately in 2 rare disease patients is revealed. In Case 1, synthetic CT, in agreement with routine CT, identified an intraosseous lesion in the right femoral neck in a 16-year-old female with fibrous dysplasia, whereas standard-of-care MRIs additionally revealed mild surrounding edema-like bone marrow signal. For Case 2, synthetic CT applied to a 12-year-old female with fibrodysplasia ossificans progressiva revealed heterotopic ossification present along the cervical spine that had caused the fusion of multiple vertebrae. Our evaluation of synthetic CT offers important insights into the feasibility and utility of this methodology in children with rare diseases affecting the musculoskeletal system.
成像方式，如计算机断层扫描（CT），对于监测罕见病儿童的肌肉骨骼异常至关重要。然而，CT 会使患者暴露在辐射下，这限制了其在临床环境中的应用，特别是在纵向评估中。合成 CT 是一种新颖的、非对比的、快速的 MRI 方法，它可以提供类似于 CT 的图像，而不会有任何辐射暴露，并且可以很容易地与传统的 MRI 一起进行，后者可以检测软组织和骨髓异常。迄今为止，在儿科罕见肌肉骨骼疾病患者中，对合成 CT 的评估还很缺乏。在这个病例系列中，揭示了合成 CT 在 2 例罕见疾病患者中准确识别肌肉骨骼病变的能力。在病例 1 中，与常规 CT 一致，合成 CT 识别出 16 岁患有纤维发育不良的女性右侧股骨颈内的骨内病变，而标准护理 MRI 还额外显示出轻度周围类似水肿的骨髓信号。对于病例 2，应用于患有纤维发育不良性骨化性进展的 12 岁女性的合成 CT 显示出沿颈椎存在异位骨化，这导致了多个椎体融合。我们对合成 CT 的评估为这种方法在影响肌肉骨骼系统的罕见疾病儿童中的可行性和实用性提供了重要的见解。
