Detection of multifocal osteonecrosis in an adolescent with dermatomyositis using whole-body MRI
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Osteonecrosis is a well-recognized complication of corticosteroid use resulting in significant morbidity, often requiring surgical intervention. Whole-body MRI is a promising method that allows imaging of the whole patient in a reasonable time without the use of ionizing radiation. This technique has the potential for evaluating nonmalignant multifocal skeletal disease like osteonecrosis. This case highlights the value of whole-body MR in an adolescent with dermatomyositis who developed multifocal osteonecrosis.
KeywordsOsteonecrosis Dermatomyositis Whole-body MRI Adolescent
Osteonecrosis is a debilitating disease affecting patients with autoimmune diseases and corticosteroid use. Severe pain, loss of joint mobility and eventual collapse of the articular surface may necessitate joint replacement [1, 2]. An early diagnosis of osteonecrosis is of great importance for optimal therapeutic management. MRI has reached a high diagnostic level in delineating bone marrow diseases like osteonecrosis . Whole-body MRI can provide excellent image quality, is easy to use and is fast enough for broad clinical use . It can demonstrate extension of osteonecrosis or identify sites that are not visible by joint-specific MRI. This case shows the value of whole-body MRI with reduced imaging time in detecting osteonecrosis sites without compromising image quality.
A 13-year-old girl was diagnosed with dermatomyositis. She was treated with oral glucocorticoids (GC), methylprednisolone pulse therapy, chloroquine, methotrexate and azathioprine.
Whole-body MRI is a fast and accurate modality for detection and monitoring of disease throughout the entire body . The technique has its greatest impact in the evaluation of children with suspected bone marrow or skeletal involvement [3, 4, 5]. Emerging potential applications include the evaluation for osteonecrosis, chronic multifocal recurrent osteomyelitis, myopathies and vascular malformations . Whole-body STIR permits evaluation of the entire skeleton with a single examination within 10–15 min and without the use of ionizing radiation [6, 7]. The joint-specific MR takes 15–20 min to assess a single joint (hips or knees or ankles).
This study demonstrated that osteonecrosis lesions are highly correlated between joint-specific and whole-body MRI. This technique is very useful in determining the extent of necrotic lesions but further studies need to address its use as a screening tool in high-risk patients. Health-care providers need to be aware that osteonecrosis can develop as a complication in DM patients and that whole-body MRI is effective in the evaluation of patients with suspected bone marrow involvement such as osteonecrosis.
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