Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Aug 28, 2016; 8(8): 750-756
Published online Aug 28, 2016. doi: 10.4329/wjr.v8.i8.750
Relative volume measured with magnetic resonance imaging is an articular collapse predictor in hematological pediatric patients with femoral head osteonecrosis
Davide Ippolito, Alessandro Masetto, Cammillo Talei Franzesi, Pietro A Bonaffini, Alessandra Casiraghi, Sandro Sironi
Davide Ippolito, Alessandro Masetto, Cammillo Talei Franzesi, Pietro A Bonaffini, Alessandra Casiraghi, Sandro Sironi, Department of Diagnostic Radiology, School of Medicine, San Gerardo Hospital, University of Milano-Bicocca, 20900 Monza, Italy
Author contributions: Ippolito D is the guarantor of integrity of entire study; Ippolito D contributed to manuscript final version approval; Ippolito D and Masetto A contributed to study concepts; Ippolito D, Masetto A, Talei Franzesi C contributed to study design; Ippolito D, Masetto A, Talei Franzesi C contributed to data acquisition; Ippolito D, Masetto A, Talei Franzesi C and Bonaffini PA contributed to manuscript preparation; Ippolito D, Masetto A and Bonaffini PA contributed to clinical studies; Ippolito D and Bonaffini PA contributed to manuscript editing; Ippolito D and Sironi S contributed to manuscript definition of intellectual content; Masetto A and Casiraghi A contributed to data analysis and interpretation; Talei Franzesi C and Bonaffini PA contributed to literature research; Casiraghi A made statistical analysis; all authors contributed to manuscript revision and review.
Institutional review board statement: The study was reviewed and approved by the H. San Gerardo Institutional Review Board.
Informed consent statement: Every patient gave his informed consent, as required by our Institution.
Conflict-of-interest statement: All the authors are aware of the content of the manuscript and have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Davide Ippolito, MD, Department of Diagnostic Radiology, School of Medicine, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy. davide.atena@tiscalinet.it
Telephone: +39-02-64488265 Fax: +39-02-64488299
Received: January 26, 2016
Peer-review started: January 27, 2016
First decision: March 23, 2016
Revised: April 10, 2016
Accepted: May 31, 2016
Article in press: June 2, 2016
Published online: August 28, 2016
Processing time: 212 Days and 12.5 Hours
Abstract
AIM

To assess the potential value of femoral head (FH) volume measurements to predict joint collapse, as compared to articular surface involvement, in post-treatment osteonecrosis (ON) in pediatric patients affected by lymphoproliferative diseases.

METHODS

Considering 114 young patients with lymphoproliferative diseases undergone a lower-limbs magnetic resonance imaging (MRI) examination between November 2006 and August 2012 for a suspected post-treatment ON, we finally considered a total of 13 cases (7 males, mean age 15.2 ± 4.8 years), which developed a FH ON lesions (n = 23). The MRI protocol included coronal short tau inversion recovery and T1-weighted sequences, from the hips to the ankles. During the follow-up (elapsed time: 9.2 ± 2 mo), 13/23 FH articular surface (FHS) developed articular deformity. The first MRI studies with diagnosis of ON were retrospectively analyzed, measuring FH volume (FHV), FHS, ON volume (ONV) and the articular surface involved by ON (ONS). The relative involvement of FHS, in terms of volume [relative volume (RV): ONV/FHV] and articular surface [relative surface (RS): ONS/FHS], was then calculated.

RESULTS

By using receiver operating characteristic curve analysis (threshold of 23% of volume involvement), RV predicted articular deformity in 13/13 FHS [sensitivity 100%, specificity 90%, accuracy 95%, positive predictive value (PPV) 93%, negative predictive value (NPV) 100%]. Considering a threshold of 50% of articular involvement, RS predicted articular deformity in 10/13 femoral heads (sensitivity 77%, specificity 100%, accuracy 87%, PPV 100%, NPV 77%).

CONCLUSION

RV might be a more reliable parameter than RS in predicting FH deformity and could represent a potential complementary diagnostic tool in the follow-up of femoral heads ON lesions.

Keywords: Osteonecrosis, Volume, Articular surface, Lymphoproliferative diseases, Femoral head, Magnetic resonance imaging

Core tip: Osteonecrosis can affect different bone segments but the most common sites are the weight-bearing joints of the lower limbs (hips and knees), with potential evolution to disability. To date magnetic resonance imaging represents the standard imaging method in the assessment of bone necrotic lesions [osteonecrosis (ON)], replacing other techniques in diagnostic work-up of initial ON, allowing also the detection of early bone marrow changes. Our preliminary data show that the volume of the necrotic portion of the femoral head might be a parameter highly predictive of future collapse of femoral head affected by osteonecrosis also in young patients treated for haematological malignancies.