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. 2011 Jul;84(1003):621-8.
doi: 10.1259/bjr/34972239. Epub 2010 Nov 16.

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

T C M Castro  1 , H Lederman, M T A Terreri, W I Caldana, S C Kaste, M O Hilário
Affiliations

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

T C M Castro et al. Br J Radiol. 2011 Jul.

Abstract

Objective: 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.

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 joint-specific 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.

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Figures

Figure 1
Figure 1
Measurement of the index of necrotic extent on (a) coronal and (b) sagittal T1 weighted images of a femoral head.(a) The necrotic arc angle in the coronal plane. (b) The necrotic arc angle in the sagittal plane. The index of necrotic extent is 8.04 (<40).
Figure 2
Figure 2
Coronal T2 weighted fat-suppressed image of the left knee showing an osteonectrotic lesion.
Figure 3
Figure 3
Coronal T2 weighted fat-suppressed images of the left knee showing areas of osteonectrosis (arrows). The same patient’s right ankle is seen in Figure 4.
Figure 4.Coronal
Figure 4.Coronal
Coronal T2 weighted fat-suppressed image of the right ankle showing an osteonectrotic lesion. The same patient’s left knee is seen in Figure 3.
Figure 5
Figure 5
Coronal T2 weighted-suppressed image of the right knee showing areas of osteonectrosis (arrows).
Figure 6
Figure 6
Whole-body short tau inversion recovery image showing the same osteonectrotic lesions seen in Figure 4 (arrows).
Figure 7
Figure 7
Whole-body short tau inversion recovery image of the patient whose right knee is shown in Figure 5 showing areas of osteonectrosis in the distal femur and proximal tibia (arrows).
See this image and copyright information in PMC

References

    1. Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg 1995;77:459–74 - PubMed
    1. Mankin HJ. Nontraumatic necrosis of bone (osteonecrosis). N Engl J Med 1992;326:1473–9 - PubMed
    1. Assouline-Dayan Y, Chang C, Greenspan A, Shoenfeld Y, Gershwin ME. Pathogenesis and natural history of osteonecrosis. Semin Arthritis Rheum 2002;32:92–124 - PubMed
    1. Wang GJ, Sweet DE, Reger SI, Thompson RC. Fat-cell changes as a mechanism of avascular necrosis of the femoral head in cortisone-treated rabbits. J Bone Joint Surg Am 1977;59:729–35 - PubMed
    1. Glueck CJ, Freiberg R, Glueck HI, Henderson C, Welch M, Tracy T, et al. Hypofibrinolysis: a common, major cause of osteonecrosis. Am J Hematol 1994;45:156–66 - PubMed

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