Diagnostic Imaging Of Limbs In Children With Acute Leukemia

Objective: To evaluate X-ray and MRI features of Limbs in childhood acute leukemia which manifested osteoarticular pains.Materials and Methods: Thirteen children with acute leukemia in our pediatric hematology ward were collected, all were pathologically diagnosed by bone marrow aspiration and complained of bone and joint pain in the first visit. Conventional X-ray and MRI examinations of algesic sites were performed before clinical treatment and within 1 week when reached inducer remission. MR images were obtained with the use of SE-T1WI, SE-T2WI and T2WI-fat suppressed sequences and symmetria bilateralis was requested while scaning. X-ray and MRI manifestations were evaluated and compared.Result: All 13 patients had received X-ray examinations, 6 had normal x-ray findings, whereas the other 7 (12 sites) showed various abnormalities including radiolucent metaphyseal bands(5 sites), periosteal reaction(3 sites), osteapenia(2 sites), mixed lesions(lysis-sclerosis)(1 site), and permeative pattern(3 sites). The number of patients for MRI examinations was 8 (11 sites), 6 (9 sites) showed bone marrow infiltration and bone marrow necrosis accompanied by normal X-ray findings, another 2 (2 sites) showed bone marrow infiltration associated with radiographic abnormalities of periosteal reaction and radiolucent metaphyseal bands. BMI was prompted by diffuse hypointensity on T1WI that was slightly lower than the surrounding muscle signal and hyperintensity on T2WI that was lower than the adjacent fat signal, while homogeneous or heterogeneous high signal on T2WI-fat suppression. BMN on the central of BMI was registered as imhomogeneous geographic pattern of long T1 hypointense and long T2 hyperintense surrounded by peripheral rim of double-line sign. Four cases was followed within 1 week when reached inducer remission by treatment,MR images manifested reduced sizes of BMI lesion associated with increased signal intensity on T1WI , and disappearance of double-line sign on BMN accompanied by signal homogenization. While the radiograph before and after treatment of the same cases did not differ significantly.Conclusion: All the AL children with chief complaint of osteoarticular pains showed limbs bone marrow abnormality on MRI , but only about half the quantity on radiogram. X-ray abnormalities manifest Only when bone architecture was disordered, while MRI can detect the BMI and BMN near the onset of disease without bony structures anomalism, prompted much earller and more comprehensive observations. And MRI reviews might can be a indicator of therapeutic effect for AL children with osteoarticular disorder.