Magnetic resonance imaging detection of avascular necrosis of the bone in children receiving intensive prednisone therapy for acute lymphoblastic leukemia or non-Hodgkin lymphoma

The purpose of this study was to determine the frequency with which magneti c resonance (NIR) imaging detects avascular necrosis of the bone (AVNB) in children with acute lymphoblastic leukemia (ALL) or advanced stage non-Hodg kin lymphoma (NHL) who receive prednisone during remission induction, reind uction, and maintenance chemotherapy; to assess the clinical significance o f these findings; and to identify factors predictive of AVNB. We prospectiv ely obtained NIR imaging of the hips and knees of 116 children who had comp leted at least 1 year of treatment for ALL or advanced-stage NHL on identic al prednisone-containing regimens between December 1991 and October 1994. N IR imaging findings of AVNB were compared with clinical outcomes, and the e ffect of therapeutic and patient factors on the frequency of AVNB was analy zed. The MR imaging findings of 17 of the 116 participating patients were c onsistent with AVNB. The most common clinical manifestation was joint pain (11 patients). Only one patient had progressive joint deterioration that ne cessitated surgical replacement. Only age 10 years or more at the time of t he primary diagnosis was significantly associated with the development of A VNB (P = 0.004). NIR imaging showed changes consistent with AVNB in approxi mately 15% of this patient population. However, most patients in this study who had NIR imaging signs of AVNB did not experience progressive joint des truction, even with continued prednisone therapy. Therefore, the clinical u sefulness of MR imaging as a screening tool for AVNB in this set of patient s remains uncertain.