1
|
Aarnivala H, Giertz M, Michelsen SW, Björklund C, Englund A, Grönroos M, Hjalgrim LL, Huttunen P, Niinimäki T, Penno E, Pokka T, Pöyhönen T, Raittinen P, Ranta S, Svahn JE, Törnudd L, Harila A, Niinimäki R. Radiological follow-up of osteonecrosis lesions in children and adolescents with Hodgkin lymphoma. Br J Haematol 2024. [PMID: 39096138 DOI: 10.1111/bjh.19687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/22/2024] [Indexed: 08/04/2024]
Abstract
Osteonecrosis (ON) is a common complication of glucocorticoid-based Hodgkin lymphoma (HL) treatment, but the natural evolution and prognosis of ON lesions remain poorly understood. We describe the radiological evolution of ON lesions identified in a Nordic population-based cohort of paediatric HL patients. Magnetic resonance images of suspected ON lesions were centrally reviewed to confirm ON diagnosis and grade the ON lesions according to the Niinimäki classification. The study included 202 ON lesions in 46 patients, of which 77 were joint lesions. Follow-up images were available for 146/202 lesions, with a mean follow-up time of 28 months. During follow-up, 71% of the lesions remained stable, 26% improved or resolved, and 3% progressed. A higher ON grade at diagnosis was associated with a lower likelihood of spontaneous resolution. The likelihood for resolution of ON decreased by 50% for each year of added patient age, when adjusted for sex, ON location, and symptoms. Hip ON showed less spontaneous improvement compared with other joints, and the risk for surgery was 13-fold in hip ON. Grades 3-4 joint ON has the potential to either progress or resolve, warranting follow-up in patients with severe symptoms. Research on secondary prevention should be directed at grade 3-4 joint ON.
Collapse
Affiliation(s)
- Henri Aarnivala
- Department of Pediatrics, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Mia Giertz
- Department of Pediatric Oncology and Hematology, Uppsala University Hospital, Uppsala, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Sascha Wilk Michelsen
- Department of Pediatric and Adolescence Medicine, Clinic for Pediatric Oncology and Hematology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Caroline Björklund
- Department of Pediatric Hematology and Oncology, Umeå University Hospital, Umeå, Sweden
| | - Annika Englund
- Department of Pediatric Oncology and Hematology, Uppsala University Hospital, Uppsala, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Marika Grönroos
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Lisa Lyngsie Hjalgrim
- Department of Pediatric and Adolescence Medicine, Clinic for Pediatric Oncology and Hematology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Pasi Huttunen
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Tuukka Niinimäki
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
- Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - Eva Penno
- Department of Diagnostic Radiology, Uppsala University Hospital, Uppsala, Sweden
| | - Tytti Pokka
- Research Service Unit, Oulu University Hospital, Oulu, Finland
| | - Tuuli Pöyhönen
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Päivi Raittinen
- Centre for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | - Susanna Ranta
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Johan E Svahn
- Department of Pediatric Oncology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lisa Törnudd
- Department of Pediatrics, Linköping University Hospital, Linköping, Sweden
| | - Arja Harila
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Riitta Niinimäki
- Department of Pediatrics, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| |
Collapse
|
2
|
Desai VM, Syed AN, Batley M, Wells L, Williams BA. Management of osteonecrosis of the humeral head in the pediatric population: A systematic review. J Child Orthop 2024; 18:432-440. [PMID: 39100979 PMCID: PMC11295367 DOI: 10.1177/18632521241254708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/25/2024] [Indexed: 08/06/2024] Open
Abstract
Purpose Humeral head osteonecrosis in the pediatric patients most often occurs in patients with underlying hemoglobinopathies, exposure to chronic corticosteroids, or after trauma. The purpose of this study was to perform a systematic review evaluating the prevalence, clinical characteristics, and management of humeral head osteonecrosis in the pediatric population. Methods PubMed, Ovid MEDLINE, and Scopus were screened with the terms "osteonecrosis," "avascular necrosis," "pediatric," and "proximal humerus" on January 10, 2024. A total of 218 studies were screened, and 74 studies were evaluated for eligibility. Studies that reported on the prevalence and/or management of pediatric humeral head osteonecrosis were included. The systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Results Twelve studies met inclusion criteria: four retrospective case series, three prospective case series, one retrospective cohort study, one retrospective case-control study, and three case reports. A majority of the studies (67%) discussed chemotherapy-induced osteonecrosis of the humeral head. A total of 77 patients (106 shoulders) with humeral head osteonecrosis were identified. The overall prevalence of osteonecrosis of the humeral head across eight studies examining at-risk populations (underlying hemoglobinopathies or undergoing chemotherapy) was 2%. Intra-articular steroid injections, physical therapy, and activity modification are effective conservative management strategies. Additionally, core decompression and hemiarthroplasty are surgical treatment options. Conclusions The prevalence of osteonecrosis of the humeral head is low even among at-risk populations with associated medical conditions. A variety of conservative and surgical treatment options have been described, but no comparative evaluations of these modalities has been conducted. Level of evidence IV.
Collapse
Affiliation(s)
- Vineet M Desai
- Department of Orthopaedics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Harvard Medical School, Boston, MA, USA
| | - Akbar N Syed
- Department of Orthopaedics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Morgan Batley
- Department of Orthopaedics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lawrence Wells
- Department of Orthopaedics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brendan A Williams
- Department of Orthopaedics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| |
Collapse
|
3
|
[ 18F]FDG PET-MR in the Evaluation and Follow-Up of Incidental Bone Ischemic Lesions in a Mono-Center Cohort of Pediatric Patients Affected by Hodgkin's Lymphoma. Diagnostics (Basel) 2023; 13:diagnostics13030565. [PMID: 36766674 PMCID: PMC9914295 DOI: 10.3390/diagnostics13030565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Hodgkin's lymphoma (HL) is one of the neoplasms with the best prognosis in children, adolescents and young adults, but sufferers are burdened by the possibility of developing adverse effects such as Bone Ischemic Lesions (BILs) which are lesions of the bone caused by the loss of/reduction in blood flow. The main goal of this retrospective study was to evaluate the role of [18F]FDG-PET-MR in the early detection of BILs in a single-center cohort of uniformly treated pediatric HL patients. BILs were assessed through PET-MR images as the appearance of medullary lesion surrounded by a serpiginous, tortuous border. From 2017 to 2022, 10/53 (18.9%) HL patients developed BILs which were mostly (8/10 patients) multifocal. Overall, 30 lesions were identified in the 10 asymptomatic patients, all with the above-mentioned features at MR and with very low [18F]FDG uptake. BILs were incidentally detected during HL therapy (n = 6) and follow-up (n = 4), especially in the long bones (66.7%). No factors correlated with the occurrence of BIL were identified. No patients developed complications. PET-MR is a sensitive combined-imaging technique for detecting BILs that are asymptomatic and self-limiting micro-ischemic lesions. BILs can be monitored by clinical follow-up alone both during and after therapy.
Collapse
|
4
|
Subbu K, Renner JB, Rubin JE. Extensive Osteonecrosis After Glucocorticoids: Clinical Response to Bisphosphonate. JCEM CASE REPORTS 2023; 1:luac006. [PMID: 37908238 PMCID: PMC10578391 DOI: 10.1210/jcemcr/luac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Indexed: 11/02/2023]
Abstract
Osteonecrosis is a devastating complication of long-term glucocorticoid therapy that has been described in both malignant and nonmalignant diseases. Its incidence has been found to greater than 50% using magnetic resonance imaging in asymptomatic patients, thus osteonecrosis is likely underdiagnosed. Recent studies have suggested that treatment with bisphosphonates can improve pain and mobility and decrease bone marrow edema. We describe a patient with acute lymphoblastic leukemia who presented with debilitating osteonecrosis after treatment with prednisone for a total cumulative dose of 5100 mg. Magnetic resonance imaging revealed extensive infarcts of her bilateral tibiae and femora and left humerus, talus, and calcaneus consistent with osteonecrosis that had persisted for more than 2 years. Her severe knee, shoulder, and ankle pain was treated with 1 dose zolendronic acid. Despite a prolonged acute phase reaction, the patient's symptoms improved with near total resolution of pain.
Collapse
Affiliation(s)
- Karthik Subbu
- Division of Endocrinology, Diabetes, and Metabolism, University of North Carolina, NC 27514, USA
| | - Jordan B Renner
- Departments of Radiology and Health Sciences, University of North Carolina, NC 27514, USA
| | - Janet E Rubin
- Division of Endocrinology, Diabetes, and Metabolism, University of North Carolina, NC 27514, USA
| |
Collapse
|
5
|
Childhood lymphoma treatment impacts educational outcomes: a registry study from Sweden. J Cancer Surviv 2022:10.1007/s11764-022-01266-0. [DOI: 10.1007/s11764-022-01266-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
Abstract
Purpose
This study aimed to explore educational outcomes in individuals diagnosed with lymphoma in childhood concerning school grade year 9 and attendance in high school and post-compulsory education. Whether sex or age at diagnosis affected the assessed variables was also explored.
Methods
Data from 174 children born 1988–1996 and diagnosed with lymphoma before age 15 were matched with approximately five controls per patient. The mean time since diagnosis to receiving school year 9 grades was 4.88 years for Hodgkin lymphoma (HL) cases (mean age at diagnosis 10.62, 11.76, and 10.05 years for all, girls, and boys, respectively) and 7.79 years for non-Hodgkin lymphoma (NHL) cases (mean age at diagnosis 7.85, 7.87, and 7.84 years for all, girls, and boys, respectively).
Results
We observed statistically significant differences between cases and controls in physical education, both for failing (p = 0.041) and the highest grade (p = 0.015). Compared with controls, HL cases were three times more likely to fail mathematics, and significantly fewer individuals in the whole lymphoma (p = 0.011) and NHL (p = 0.035) groups attended the third year of high school.
Conclusions
Educational outcomes are impacted for children treated for lymphoma, especially in physical education. Since patients with HL are treated without central nervous system-directed therapy, other factors, such as absence from school, may affect school results. Physical late complications in lymphoma survivors warrant special attention.
Implications for Cancer Survivors
The problems childhood lymphoma survivors face should be known by schools and parents, to enable their management. Children treated for lymphoma should be closely monitored and included in follow-up programs when needed, for example, to support physical activity.
Collapse
|
6
|
Gaunt T, Humphries PD. Whole-body MRI in children: state of the art. BJR Open 2022; 4:20210087. [PMID: 38525168 PMCID: PMC10958622 DOI: 10.1259/bjro.20210087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 06/23/2022] [Accepted: 07/21/2022] [Indexed: 11/05/2022] Open
Abstract
Whole-body magnetic resonance imaging (WBMRI) is an increasingly popular technique in paediatric imaging. It provides high-resolution anatomical information, with the potential for further exciting developments in acquisition of functional data with advanced MR sequences and hybrid imaging with radionuclide tracers. WBMRI demonstrates the extent of disease in a range of multisystem conditions and, in some cases, disease burden prior to the onset of clinical features. The current applications of WBMRI in children are hereby reviewed, along with suggested anatomical stations and sequence protocols for acquisition.
Collapse
Affiliation(s)
- Trevor Gaunt
- Radiology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | |
Collapse
|
7
|
Osteonecrosis in Korean Paediatric and Young Adults with Acute Lymphoblastic Leukaemia or Lymphoblastic Lymphoma: A Nationwide Epidemiological Study. J Clin Med 2022; 11:jcm11092489. [PMID: 35566613 PMCID: PMC9105090 DOI: 10.3390/jcm11092489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/19/2022] [Accepted: 04/27/2022] [Indexed: 02/04/2023] Open
Abstract
Osteonecrosis (ON) is a serious complication of acute lymphocytic leukaemia (ALL) or lymphoblastic lymphoma (LBL) treatment, and there is little information regarding ON in Korean paediatric and young adult patients. This retrospective cohort study assessed the cumulative incidence of and risk factors for ON using national health insurance claims data from 2008 to 2019 in 4861 ALL/LBL patients. The Kaplan–Meier method was used to estimate the cumulative incidence of ON according to age groups; the Cox proportional hazard regression model was used to identify risk factors related to ON development after diagnosing ALL/LBL. A cause-specific hazard model with time-varying covariates was used to assess the effects of risk factors. Overall, 158 (3.25%) patients were diagnosed with ON, among whom 23 underwent orthopaedic surgeries. Older age, radiotherapy (HR = 2.62, 95% confidence interval (CI) 1.87–3.66), HSCT (HR = 2.40, 95% CI 1.74–3.31), steroid use and anthracycline use (HR = 2.76, CI 1.85–4.14) were related to ON in the univariate analysis. In the multivariate analysis, age and steroid and asparaginase use (HR = 1.99, CI 1.30–3.06) were factors associated with ON. These results suggest that Korean patients with ALL/LBL who used steroids and asparaginase should be closely monitored during follow-up, even among young adult patients.
Collapse
|
8
|
Beitrag der Ganzkörper-MRT in der Beurteilung von Osteonekrosen bei Kindern und Jugendlichen mit onkologischen und hämatologischen Grunderkrankungen. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-019-0723-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
9
|
Zadig P, von Brandis E, Lein RK, Rosendahl K, Avenarius D, Ording Müller LS. Whole-body magnetic resonance imaging in children - how and why? A systematic review. Pediatr Radiol 2021; 51:14-24. [PMID: 32588094 PMCID: PMC7796873 DOI: 10.1007/s00247-020-04735-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/03/2020] [Accepted: 05/20/2020] [Indexed: 12/16/2022]
Abstract
Whole-body magnetic resonance imaging (MRI) is increasingly being used for a number of indications. Our aim was to review and describe indications and scan protocols for diagnostic value of whole-body MRI for multifocal disease in children and adolescents, we conducted a systematic search in Medline, Embase and Cochrane for all published papers until November 2018. Relevant subject headings and free text words were used for the following concepts: 1) whole-body, 2) magnetic resonance imaging and 3) child and/or adolescent. Included were papers in English with a relevant study design that reported on the use and/or findings from whole-body MRI examinations in children and adolescents. This review includes 54 of 1,609 papers identified from literature searches. Chronic nonbacterial osteomyelitis, lymphoma and metastasis were the most frequent indications for performing a whole-body MRI. The typical protocol included a coronal STIR (short tau inversion recovery) sequence with or without a coronal T1-weighted sequence. Numerous studies lacked sufficient data for calculating images resolution and only a few studies reported the acquired voxel volume, making it impossible for others to reproduce the protocol/images. Only a minority of the included papers assessed reliability tests and none of the studies documented whether the use of whole-body MRI affected mortality and/or morbidity. Our systematic review confirms significant variability of technique and the lack of proven validity of MRI findings. The information could potentially be used to boost attempts towards standardization of technique, reporting and guidelines development.
Collapse
Affiliation(s)
- Pia Zadig
- Department of Radiology, University Hospital of North Norway, Sykehusvegen 38, 9019, Tromsø, Norway.
- University of Tromsø - The Arctic University of Norway, Tromso, Norway.
| | | | | | - Karen Rosendahl
- Department of Radiology, University Hospital of North Norway, Sykehusvegen 38, 9019, Tromsø, Norway
- University of Tromsø - The Arctic University of Norway, Tromso, Norway
| | - Derk Avenarius
- Department of Radiology, University Hospital of North Norway, Sykehusvegen 38, 9019, Tromsø, Norway
- University of Tromsø - The Arctic University of Norway, Tromso, Norway
| | - Lil-Sofie Ording Müller
- Department of Radiology and Intervention, Unit for Paediatric Radiology, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
10
|
Boontanapibul K, Steere JT, Amanatullah DF, Huddleston JI, Maloney WJ, Goodman SB. Initial Presentation and Progression of Secondary Osteonecrosis of the Knee. J Arthroplasty 2020; 35:2798-2806. [PMID: 32527695 DOI: 10.1016/j.arth.2020.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/24/2020] [Accepted: 05/11/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Early detection and intervention are critical to maintaining the native articular cartilage before collapse in secondary osteonecrosis of the knee (SOK). We conducted a retrospective study documenting the initial stage of presentation and the progression of SOK. METHODS Our database was reviewed for patients younger than 65 years of age diagnosed with atraumatic SOK between 2002 and 2018. Demographic data, plain radiographs as well as MRI at initial evaluation, and initial treatment were classified and analyzed. RESULTS One hundred four patients with 164 knees were identified. Mean age was 39 ± 16 years. Females (64%) with bilateral disease (58%) predominated. Seventy-five percent of patients had a history of corticosteroid use, of which 41% were diagnosed with hematologic malignancy and lupus. Fifteen percent of patients had a history of ethanol abuse. At initial presentation, 55% of patients were diagnosed with Ficat-Arlet stage I/II, while 45% were diagnosed with Ficat-Arlet stage III/IV. We found a significant difference in the mean age of patients at early stage of SOK with corticosteroid use (31 ± 12 years of age) when compared to ethanol use (43 ± 13 years of age, P = .02). Treatments included observation (57%), joint preservation surgery (20%), and total knee arthroplasty (23%). CONCLUSION Nearly half of patients presented at late stage compromising the potential for joint preservation. The difference in age of referral by over a decade, based on etiology of SOK, suggests a strong provider-based referral or screening bias may be present. Hence, a multidisciplinary approach to earlier detection and referral may be a more effective strategy for preventing the progression of SOK.
Collapse
Affiliation(s)
- Krit Boontanapibul
- Stanford University Medical Center Outpatient Center, Redwood City, CA; Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Joshua T Steere
- Stanford University Medical Center Outpatient Center, Redwood City, CA
| | | | | | - William J Maloney
- Stanford University Medical Center Outpatient Center, Redwood City, CA
| | - Stuart B Goodman
- Stanford University Medical Center Outpatient Center, Redwood City, CA
| |
Collapse
|
11
|
Albano D, Bruno A, Patti C, Micci G, Midiri M, Tarella C, Galia M. Whole‐body magnetic resonance imaging (WB‐MRI) in lymphoma: State of the art. Hematol Oncol 2019; 38:12-21. [DOI: 10.1002/hon.2676] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 08/31/2019] [Accepted: 09/03/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Domenico Albano
- Section of Radiological Sciences, Department of Biomedicine, Neurosciences and Advanced DiagnosticsUniversity of Palermo Palermo Italy
- IRCCS Istituto Ortopedico Galeazzi, Unit of Diagnostic and Interventional Radiology Milan Italy
| | - Alberto Bruno
- Section of Radiological Sciences, Department of Biomedicine, Neurosciences and Advanced DiagnosticsUniversity of Palermo Palermo Italy
| | - Caterina Patti
- Department of Hematology IAzienda Ospedaliera Ospedali Riuniti Villa Sofia‐Cervello Palermo Italy
| | - Giuseppe Micci
- Section of Radiological Sciences, Department of Biomedicine, Neurosciences and Advanced DiagnosticsUniversity of Palermo Palermo Italy
| | - Massimo Midiri
- Section of Radiological Sciences, Department of Biomedicine, Neurosciences and Advanced DiagnosticsUniversity of Palermo Palermo Italy
| | - Corrado Tarella
- Hemato‐Oncology DivisionIEO, European Institute of Oncology IRCCS Milan Italy
- Dip. Sc. SaluteUniversity of Milan Milan Italy
| | - Massimo Galia
- Section of Radiological Sciences, Department of Biomedicine, Neurosciences and Advanced DiagnosticsUniversity of Palermo Palermo Italy
| |
Collapse
|
12
|
Sato AY, Cregor M, McAndrews K, Li T, Condon KW, Plotkin LI, Bellido T. Glucocorticoid-Induced Bone Fragility Is Prevented in Female Mice by Blocking Pyk2/Anoikis Signaling. Endocrinology 2019; 160:1659-1673. [PMID: 31081900 PMCID: PMC6591015 DOI: 10.1210/en.2019-00237] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 05/02/2019] [Indexed: 12/16/2022]
Abstract
Excess of glucocorticoids (GCs) is a leading cause of bone fragility, and therapeutic targets are sorely needed. We report that genetic deletion or pharmacological inhibition of proline-rich tyrosine kinase 2 (Pyk2) prevents GC-induced bone loss by overriding GC effects of detachment-induced bone cell apoptosis (anoikis). In wild-type or vehicle-treated mice, GCs either prevented osteoclast apoptosis or promoted osteoblast/osteocyte apoptosis. In contrast, mice lacking Pyk2 [knockout (KO)] or treated with Pyk2 kinase inhibitor PF-431396 (PF) were protected. KO or PF-treated mice were also protected from GC-induced bone resorption, microarchitecture deterioration, and weakening of biomechanical properties. In KO and PF-treated mice, GC increased osteoclasts in bone and circulating tartrate-resistant acid phosphatase form 5b, an index of osteoclast number. However, bone surfaces covered by osteoclasts and circulating C-terminal telopeptides of type I collagen, an index of osteoclast function, were not increased. The mismatch between osteoclast number vs function induced by Pyk2 deficiency/inhibition was due to osteoclast detachment and anoikis. Further, GC prolongation of osteoclast lifespan was absent in KO and PF-treated osteoclasts, demonstrating Pyk2 as an intrinsic osteoclast-survival regulator. Circumventing Pyk2 activation preserves skeletal integrity by preventing GC effects on bone cell survival (proapoptotic for osteoblasts/osteocytes, antiapoptotic for osteoclasts) and GC-induced bone resorption. Thus, Pyk2/anoikis signaling as a therapeutic target for GC-induced osteoporosis.
Collapse
Affiliation(s)
- Amy Y Sato
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Meloney Cregor
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kevin McAndrews
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Troy Li
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Keith W Condon
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Lilian I Plotkin
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Teresita Bellido
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
- Division of Endocrinology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
- Indiana Center for Musculoskeletal Health, Indianapolis, Indiana
- Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana
- Correspondence: Teresita Bellido, PhD, Department of Anatomy and Cell Biology and Department of Medicine, Endocrinology, Indiana University School of Medicine, 635 Barnhill Drive, MS5045A, Indianapolis, Indiana 46202. E-mail:
| |
Collapse
|
13
|
Safdar NM, Rigsby CK, Iyer RS, Alazraki AL, Anupindi SA, Bardo DME, Brown BP, Chan SS, Chandra T, Dillman JR, Dorfman SR, Garber MD, Lam HFS, Nguyen JC, Siegel A, Widmann RF, Karmazyn B. ACR Appropriateness Criteria ® Acutely Limping Child Up To Age 5. J Am Coll Radiol 2018; 15:S252-S262. [PMID: 30392594 DOI: 10.1016/j.jacr.2018.09.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/07/2018] [Indexed: 11/19/2022]
Abstract
Imaging plays in important role in the evaluation of the acutely limping child. The decision-making process about initial imaging must consider the level of suspicion for infection and whether symptoms can be localized. The appropriateness of specific imaging examinations in the acutely limping child to age 5 years is discussed with attention in each clinical scenario to the role of radiography, ultrasound, nuclear medicine, computed tomography, and magnetic resonance imaging. Common causes of limping such as toddler's fracture, septic arthritis, transient synovitis, and osteomyelitis are discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
| | - Cynthia K Rigsby
- Panel Chair, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ramesh S Iyer
- Panel Vice-Chair, Seattle Children's Hospital, Seattle, Washington
| | | | | | | | - Brandon P Brown
- Riley Hospital for Children Indiana University, Indianapolis, Indiana
| | | | | | | | | | - Matthew D Garber
- Wolfson Children's Hospital, Jacksonville, Florida; American Academy of Pediatrics
| | - H F Samuel Lam
- Sutter Medical Center Sacramento, Sacramento, California; American College of Emergency Physicians
| | - Jie C Nguyen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alan Siegel
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Roger F Widmann
- Hospital for Special Surgery, New York, New York; American Academy of Orthopaedic Surgeons
| | - Boaz Karmazyn
- Specialty Chair, Riley Hospital for Children Indiana University, Indianapolis, Indiana
| |
Collapse
|
14
|
Greer MLC. Whole-body magnetic resonance imaging: techniques and non-oncologic indications. Pediatr Radiol 2018; 48:1348-1363. [PMID: 30078041 DOI: 10.1007/s00247-018-4141-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 02/11/2018] [Accepted: 04/16/2018] [Indexed: 01/07/2023]
Abstract
Whole-body MRI is increasingly utilized for assessing oncologic and non-oncologic diseases in infants, children and adolescents. Focusing on the non-oncologic indications, this review covers technical elements required to perform whole-body MRI, the advantages and limitations of the technique, and protocol modifications tailored to specific indications. Rheumatologic diseases account for the majority of non-oncologic whole-body MRI performed in pediatric patients at the author's institution. Whole-body MRI helps in establishing the diagnosis, documenting disease extent and severity, and monitoring treatment response in enthesitis-related arthritis (ERA) and chronic recurrent multifocal osteomyelitis (CRMO). Other non-oncologic indications for whole-body MRI include osteomyelitis (usually pyogenic), pyrexia of unknown origin, neuromuscular disorders, inherited and inflammatory myopathies such as juvenile dermatomyositis and polymyositis, avascular necrosis, and fat/storage disorders. Use of whole-body MRI in postmortem imaging is rising, while whole-body MRI in non-accidental injury is considered to be of limited value. Imaging findings for a range of these indications are reviewed with whole-body MRI examples.
Collapse
Affiliation(s)
- Mary-Louise C Greer
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON,, M5G 1X8, Canada. .,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
15
|
Abstract
Glucocorticoids (GC), produced and released by the adrenal glands, regulate numerous physiological processes in a wide range of tissues. Because of their profound immunosuppressive and anti-inflammatory actions, GC are extensively used for the treatment of immune and inflammatory conditions, the management of organ transplantation, and as a component of chemotherapy regimens for cancers. However, both pathologic endogenous elevation and long-term use of exogenous GC are associated with severe adverse effects. In particular, excess GC has devastating effects on the musculoskeletal system. GC increase bone resorption and decrease formation leading to bone loss, microarchitectural deterioration and fracture. GC also induce loss of muscle mass and strength leading to an increased incidence of falls. The combined effects on bone and muscle account for the increased fracture risk with GC. This review summarizes the advance in knowledge in the last two decades about the mechanisms of action of GC in bone and muscle and the attempts to interfere with the damaging actions of GC in these tissues with the goal of developing more effective therapeutic strategies.
Collapse
Affiliation(s)
- Amy Y Sato
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana, 46202
| | - Munro Peacock
- Department of Medicine, Division of Endocrinology, Indiana University School of Medicine, Indianapolis, Indiana, 46202
| | - Teresita Bellido
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana, 46202.,Department of Medicine, Division of Endocrinology, Indiana University School of Medicine, Indianapolis, Indiana, 46202.,Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, 46202
| |
Collapse
|
16
|
Galia M, Albano D, Tarella C, Patti C, Sconfienza LM, Mulè A, Alongi P, Midiri M, Lagalla R. Whole body magnetic resonance in indolent lymphomas under watchful waiting: The time is now. Eur Radiol 2017; 28:1187-1193. [PMID: 29018927 DOI: 10.1007/s00330-017-5071-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 07/26/2017] [Accepted: 09/11/2017] [Indexed: 12/26/2022]
Abstract
ᅟ: The indolent non-Hodgkin lymphomas (i-NHLs) are characterised by 'indolent' clinical behaviour with slow growth and prolonged natural history. The watchful waiting (WW) strategy is a frequently employed treatment option in these patients. This implies a strict monitoring by imaging examinations, including 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) and CT. A major concern is radiation exposure due to regularly monitoring by conventional imaging procedures. Several studies have demonstrated the reliability of whole-body magnetic resonance imaging (WB-MRI) for lymphoma staging. WB-MRI could be useful for active surveillance in i-NHLs providing the suspect of disease progression that can be then confirmed by additional diagnostic procedures, including 18F-FDG-PET/CT. The directive 2013/59 by the European Union claims that if a radiation-free imaging technique allows obtaining the same diagnostic results, it should be invariably used. In this setting, WB-MRI may be considered a reasonable option in i-NHLs under WW, replacing imaging modalities that cause exposure to ionising radiations. This will help to reduce the cancer risk in i-NHL patients for whom chemo-/radiotherapy remain the usual treatment options following the usually long WW phase. The scientific community should raise the awareness of the risk of ionising radiations in i-NHLs and the emphasise the need for establishing the proper place of WB-MRI in lymphoma imaging. KEY POINTS • Watchful waiting is a reasonable option in patients with indolent non-Hodgkin lymphomas. • Imaging is crucial to monitor patients with indolent non-Hodgkin lymphomas. • CT and 18 F-FDG-PET/CT are commonly used, implying a substantial radiation exposure. • WB-MRI is highly reliable in lymphoma staging. • WB-MRI may be considered to monitor indolent non-Hodgkin lymphomas under watchful waiting.
Collapse
Affiliation(s)
- Massimo Galia
- Department of Radiology, Di.Bi.Med., University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Domenico Albano
- Department of Radiology, Di.Bi.Med., University of Palermo, Via del Vespro 127, 90127, Palermo, Italy.
| | - Corrado Tarella
- Hemato-Oncology Division, European Institute of Oncology, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
| | - Caterina Patti
- Department of Hematology I, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Viale Trabucco 180, 90146, Palermo, Italy
| | - Luca Maria Sconfienza
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy
| | - Antonino Mulè
- Department of Hematology I, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Viale Trabucco 180, 90146, Palermo, Italy
| | - Pierpaolo Alongi
- Department of Radiological Sciences, Nuclear Medicine Unit, Fondazione Istituto G. Giglio, Contrada Pietrapollastra-Pisciotto, 90015, Cefalù, Italy
| | - Massimo Midiri
- Department of Radiology, Di.Bi.Med., University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Roberto Lagalla
- Department of Radiology, Di.Bi.Med., University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| |
Collapse
|