Osteonecrosis (ON) is a debilitating side effect of anti-leukemic treatment. Thus far, the role of leukemic infiltration (LI) of bone is unclear. The first 30 children aged ≥10 years, who were enrolled in the ongoing OPAL trial and had MRI studies at diagnosis and at 6 months, were analyzed. MRI revealed extensive LIs in 24 (80%) patients. The signal abnormalities changed back to a physiological signal in 29 out of 30 children at 6 months. Of the 24 children with LIs at diagnosis, 3 (12.5%) developed ON ≥ II, whereas 4 (66.7%) patients without LIs subsequently developed ON ≥ II (p = .016). No differences between children initially presenting with/without LIs were observed concerning age, pubertal stage, white blood count, immunophenotype, and clinical presentation. Initial radiological LI of bone and, thus, single MRI at diagnosis cannot identify children at high risk of developing radiological ON at 6 months into treatment.

Osteonecrosis develops independently from radiological leukemic infiltration of bone in adolescents with acute lymphoblastic leukemia - first findings of the OPAL trial.

Bei der Sonographie werden an geweblichen Grenzflachen reflektierte Schallwellen in elektrische Signale umgewandelt und zur Bildherstellung weiterverarbeitet. Bei einer Rontgenuntersuchung entstehen infolge der Wechselwirkung ionisierender Strahlung mit dem untersuchten Objekt Schwachungsprofile, die als Summations- oder Schnittbild aufgezeichnet werden. Bei der Magnetresonanztomographie (MRT) werden Atomkerne mit einem magnetischen Moment — in der klinischen Bildgebung fast ausschlieslich Wasserstoffprotonen — durch wiederholtes Zu- und Abschalten auserer Magnetfelder zur Resonanz und anschliesenden Relaxation gebracht. Die dabei ausgesandten Signale lassen sich computergestutzt uber geeignete Empfangsspulen so bearbeiten, das Schnittbilder entstehen, die eine Aussage zur Dichte, zur Bewegung und zum Relaxationsverhalten der Kernspins erlauben [3, 4].

Magnetresonanztomographie im Kindesalter

Die magnetische Resonanztomographie (MR-Tomographie, MRT) ermoglicht es zum ersten Mal in der Geschichte der Medizin, das Erscheinungsbild und die Entwicklung des Knochenmarks nichtinvasiv bildgebend zu studieren. Konventionelle Rontgenaufnahmen und Computertomographie (CT) geben hier nur mittelbaren Aufschlus.

Aktuelle Aspekte der radiologischen Diagnostik systemischer Knochenmarkerkrankungen

119 MR-examinations of both tibiae, knees and the lower part of both femur were performed in 41 children suffering from bone marrow disease (27 ALL, 4 AML, 3 NHL, 1 agranulocytosis, 6 anaemia). T1- and T2-spin-echo sequences and a T2-gradient-echo sequence were used. Bone marrow changes in leukaemia were diffuse before therapy and patchy after therapy. Due to their different signal in T2-weighted images, differentiation of the post-therapeutic patchy findings into infiltrations, fibrosis, necrosis and siderosis seems to be possible. In future, MRI will be the method of choice for screening and controlling bone marrow disease if the examination time is shortened by using only a T1-spin-echo sequence and a T2-gradient-echo sequence.

Zur Diagnostik von Knochenmarkläsionen im MR-Tomogramm bei Kindern mit Erkrankungen des hämatopoetischen Systems unter besonderer Berücksichtigung der posttherapeutischen Veränderungen

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Zur Diagnostik von Knochenmarkläsionen im MR-Tomogramm bei Kindern mit Erkrankungen des hämatopoetischen Systems unter besonderer Berücksichtigung der posttherapeutischen Veränderungen