Utility of early screening magnetic resonance imaging for extensive hip osteonecrosis in pediatric patients treated with glucocorticoids

Sue C. Kaste, Deqing Pei, Cheng Cheng, Michael D. Neel, W. Paul Bowman, Raul C. Ribeiro, Monika L. Metzger, Deepa Bhojwani, Hiroto Inaba, Patrick Campbell, Jeffrey E. Rubnitz, Sima Jeha, John T. Sandlund, James R. Downing, Mary V. Relling, Ching Hon Pui, Scott Howard

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Purpose: Hip osteonecrosis frequently complicates treatment with glucocorticoids. When extensive (affecting ≤ 30% of the epiphyseal surface), 80% of joints collapse within 2 years, so interventions are needed to prevent this outcome. Patients and Methods: This prospective cohort magnetic resonance imaging (MRI) screening study included all consecutive children treated for acute lymphoblastic leukemia on a single protocol. Hip MRI was performed at 6.5 and 9 months from diagnosis (early screening) and at completion of chemotherapy (final evaluation) to determine whether screening could identify extensive hip osteonecrosis before symptom development. Results: Of 498 patients, 462 underwent screening MRI. Extensive asymptomatic osteonecrosis was identified by early screening in 26 patients (41 hips); another four patients (seven hips) were detected after the screening period, such that screening sensitivity was 84.1% and specificity was 99.4%. The number of joints screened to detect one lesion was 20.1 joints for all patients, 4.4 joints for patients older than 10 years, and 198 joints for patients ≤ 10 years old (P < .001). Of the 40 extensive lesions in patients older than 10 years, 19 required total hip arthroplasty and none improved. Of eight extensive lesions in younger patients, none required arthroplasty and four improved. Conclusion: In patients age 10 years old or younger who require prolonged glucocorticoid therapy, screening for extensive hip osteonecrosis is unnecessary because their risk is low and lesions tend to heal. In children older than 10 years, early screening successfully identifies extensive asymptomatic lesions in patients who would be eligible for studies of interventions to prevent or delay joint collapse.

Original languageEnglish (US)
Pages (from-to)610-615
Number of pages6
JournalJournal of Clinical Oncology
Volume33
Issue number6
DOIs
StatePublished - Feb 20 2015

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Osteonecrosis
Glucocorticoids
Hip
Magnetic Resonance Imaging
Pediatrics
Joints
Arthroplasty
Precursor Cell Lymphoblastic Leukemia-Lymphoma

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Utility of early screening magnetic resonance imaging for extensive hip osteonecrosis in pediatric patients treated with glucocorticoids. / Kaste, Sue C.; Pei, Deqing; Cheng, Cheng; Neel, Michael D.; Bowman, W. Paul; Ribeiro, Raul C.; Metzger, Monika L.; Bhojwani, Deepa; Inaba, Hiroto; Campbell, Patrick; Rubnitz, Jeffrey E.; Jeha, Sima; Sandlund, John T.; Downing, James R.; Relling, Mary V.; Pui, Ching Hon; Howard, Scott.

In: Journal of Clinical Oncology, Vol. 33, No. 6, 20.02.2015, p. 610-615.

Research output: Contribution to journalArticle

Kaste, SC, Pei, D, Cheng, C, Neel, MD, Bowman, WP, Ribeiro, RC, Metzger, ML, Bhojwani, D, Inaba, H, Campbell, P, Rubnitz, JE, Jeha, S, Sandlund, JT, Downing, JR, Relling, MV, Pui, CH & Howard, S 2015, 'Utility of early screening magnetic resonance imaging for extensive hip osteonecrosis in pediatric patients treated with glucocorticoids', Journal of Clinical Oncology, vol. 33, no. 6, pp. 610-615. https://doi.org/10.1200/JCO.2014.57.5480
Kaste, Sue C. ; Pei, Deqing ; Cheng, Cheng ; Neel, Michael D. ; Bowman, W. Paul ; Ribeiro, Raul C. ; Metzger, Monika L. ; Bhojwani, Deepa ; Inaba, Hiroto ; Campbell, Patrick ; Rubnitz, Jeffrey E. ; Jeha, Sima ; Sandlund, John T. ; Downing, James R. ; Relling, Mary V. ; Pui, Ching Hon ; Howard, Scott. / Utility of early screening magnetic resonance imaging for extensive hip osteonecrosis in pediatric patients treated with glucocorticoids. In: Journal of Clinical Oncology. 2015 ; Vol. 33, No. 6. pp. 610-615.
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abstract = "Purpose: Hip osteonecrosis frequently complicates treatment with glucocorticoids. When extensive (affecting ≤ 30{\%} of the epiphyseal surface), 80{\%} of joints collapse within 2 years, so interventions are needed to prevent this outcome. Patients and Methods: This prospective cohort magnetic resonance imaging (MRI) screening study included all consecutive children treated for acute lymphoblastic leukemia on a single protocol. Hip MRI was performed at 6.5 and 9 months from diagnosis (early screening) and at completion of chemotherapy (final evaluation) to determine whether screening could identify extensive hip osteonecrosis before symptom development. Results: Of 498 patients, 462 underwent screening MRI. Extensive asymptomatic osteonecrosis was identified by early screening in 26 patients (41 hips); another four patients (seven hips) were detected after the screening period, such that screening sensitivity was 84.1{\%} and specificity was 99.4{\%}. The number of joints screened to detect one lesion was 20.1 joints for all patients, 4.4 joints for patients older than 10 years, and 198 joints for patients ≤ 10 years old (P < .001). Of the 40 extensive lesions in patients older than 10 years, 19 required total hip arthroplasty and none improved. Of eight extensive lesions in younger patients, none required arthroplasty and four improved. Conclusion: In patients age 10 years old or younger who require prolonged glucocorticoid therapy, screening for extensive hip osteonecrosis is unnecessary because their risk is low and lesions tend to heal. In children older than 10 years, early screening successfully identifies extensive asymptomatic lesions in patients who would be eligible for studies of interventions to prevent or delay joint collapse.",
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AU - Kaste, Sue C.

AU - Pei, Deqing

AU - Cheng, Cheng

AU - Neel, Michael D.

AU - Bowman, W. Paul

AU - Ribeiro, Raul C.

AU - Metzger, Monika L.

AU - Bhojwani, Deepa

AU - Inaba, Hiroto

AU - Campbell, Patrick

AU - Rubnitz, Jeffrey E.

AU - Jeha, Sima

AU - Sandlund, John T.

AU - Downing, James R.

AU - Relling, Mary V.

AU - Pui, Ching Hon

AU - Howard, Scott

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N2 - Purpose: Hip osteonecrosis frequently complicates treatment with glucocorticoids. When extensive (affecting ≤ 30% of the epiphyseal surface), 80% of joints collapse within 2 years, so interventions are needed to prevent this outcome. Patients and Methods: This prospective cohort magnetic resonance imaging (MRI) screening study included all consecutive children treated for acute lymphoblastic leukemia on a single protocol. Hip MRI was performed at 6.5 and 9 months from diagnosis (early screening) and at completion of chemotherapy (final evaluation) to determine whether screening could identify extensive hip osteonecrosis before symptom development. Results: Of 498 patients, 462 underwent screening MRI. Extensive asymptomatic osteonecrosis was identified by early screening in 26 patients (41 hips); another four patients (seven hips) were detected after the screening period, such that screening sensitivity was 84.1% and specificity was 99.4%. The number of joints screened to detect one lesion was 20.1 joints for all patients, 4.4 joints for patients older than 10 years, and 198 joints for patients ≤ 10 years old (P < .001). Of the 40 extensive lesions in patients older than 10 years, 19 required total hip arthroplasty and none improved. Of eight extensive lesions in younger patients, none required arthroplasty and four improved. Conclusion: In patients age 10 years old or younger who require prolonged glucocorticoid therapy, screening for extensive hip osteonecrosis is unnecessary because their risk is low and lesions tend to heal. In children older than 10 years, early screening successfully identifies extensive asymptomatic lesions in patients who would be eligible for studies of interventions to prevent or delay joint collapse.

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