MRT-Verlaufsbeurteilung aseptischer Knochennekrosen (AON) bei Kindern mit chemotherapierter maligner Grunderkrankung

Zusammenfassung.

Ziel: Evaluation des MRT-Verlaufs von chemotherapieassoziierten aseptischen Knochennekrosen (AON) bei Kindern mit unterschiedlichen malignen Grunderkrankungen. Material und Methode: Retrospektive Auswertung von 72 MRT-Untersuchungen bei 20 Kindern (3,2 - 18,4 Jahre), bei denen unter Chemotherapie AON auftraten. 8 Kinder wurden ausschließlich mit einer Gelenkentlastung behandelt, 12 Kinder erhielten zusätzlich eine hyperbare Sauerstofftherapie (HBO). Im Abstand von 3 - 76 Monaten wurden pro Patient 1 - 6 MRT-Verlaufskontrollen durchgeführt. Die Bildgebung umfasste multiplanare Spin-Echo- sowie fettunterdrückte Inversion-Recovery-Sequenzen. Die Bewertung der Osteonekrosen erfolgte in Abhängigkeit vom Schweregrad des Befundes durch zwei Radiologen nach einem Scoresystem (1 - 6 Punkte). Ergebnisse: Die am häufigsten von AON betroffenen Knochenareale waren neben den Fußwurzelknochen (26,4 %) die Hüft- (23,6 %) und Kniegelenke (19,4 %). Der durchschnittliche Ausgangsscore lag bei 3,1 Punkten. Im Kontrollzeitraum konnte eine statistisch signifikante (p < 0,05) mittlere Zunahme des Scorewertes um 0,6 Punkte im Vergleich zum Startwert nachgewiesen werden. Für die Beobachtungsintervalle a: < 6 Monate, b: 6 - 12 Monate und c: > 12 Monate betrugen die mittleren Scores a: 3,3, b: 3,7 und c: 4,5 Punkte. Bei 5 der 20 Kinder wurden im Beobachtungszeitraum Operationen der betroffenen Skelettregion durchgeführt. Schlussfolgerung: Bei fortgeschrittenen Ausgangsbefunden zeigen chemotherapieassoziierte AON kernspintomographisch trotz konservativer Therapiemaßnahmen einen progredienten Verlauf, der häufig in einem Gelenkkollaps endet. Frühe Befunde entstehender AON werden MR-morphologisch durch eine konservative Therapie günstig beeinflusst.

Purpose: The aim of the study was to evaluate by MRI the course of aseptic osteonecrosis (AON) after chemotherapy in children with different malignancies. Material and Methods: Retrospective analysis of 72 MRI studies in 20 children (age: 3.2 - 18.4 years) presenting with AON after chemotherapy. 8 children were treated exclusively with relief of weightbearing structures, whereas 12 children were additionally treated with hyperbaric oxygen therapy (HBO). Within a range of 3 - 76 months each patient received 1 - 6 follow-up exams. The acquired series included multi planar spin-echo as well as fatt-suppressed inversion recovery sequences. The MRI examinations were evaluated by a point-score system (1 - 6) by two radiologists. Results: AON was most commonly seen in the pedal bones (26.4 %), in the hip (23.6 %), and in the knee joints (19.4 %). Initial findings revealed an average score of 3.1 points. Based upon these initial findings, subsequent analyses show a statistically significant (p < 0.05) score increase of 0.6 score-points. For the observed intervals a: < 6 months, b: 6 - 12 months, and c: > 12 months the mean scores were: a: 3.3, b: 3.7, and c: 4.5 points. During the observed time period 5 patients were surgically treated in the affected bone areas. Conclusion: The majority of chemotherapy associated AON which initially present with advanced findings showed in MRI a progression with frequent destruction of the joint surface over their further course. More discrete forms of AON, especially osteoedema, can be positively influenced by conservative therapy.

Schlüsselwörter:

Kind, Skelettsystem - Chemotherapie, Komplikation - Knochen, Nekrose - Knochen, MRT

Key words:

Children, skeletal system - chemotherapy, complications - bones, necrosis - bones, MR

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