Distribution and imaging features of pelvic bone destruction in children

Abstract

Objective To explore the distribution and imaging manifestations of pelvic bone destruction to improve the diagnostic level of pelvic bone destruction in children. Methods Retrospective analysis was performed for the clinical data of 41 children with pelvic bone destruction confirmed by surgically and pathological at two children's hospitals from August 2008 to September 2018. In conjunctions with postoperative pathological diagnosis, the distribution and imaging findings were analyzed. Results There were 29 boys and 12 girls with an average age of treatment (6.2±2.2)(11 moths to 13 years). The initial symptoms included hip pain (n=16), limping (n=11), hip pain with low fever (n=9) and unintentional radiographic findings (n=4). The locations of lesion were iliac bone (n=33), ischium (n=4), pubis (n=2), sacrum (n=1) and iliac & sacrum (n=1). The average duration of disease was (12.6±4.3)(2-30) days. Routine DR films of anterior/posterior pelvis (n=41), spiral CT scan with three-dimensional reconstruction (n=36) and sagittal, axial and coronal MRI scans (n=26) were performed. The major imaging findings were osteolytic bone destruction (n=27), mixed bone destruction (n=10), inflated bone destruction (n=4), distinct lesion boundary (n=21) and blurred boundary (n=20). There were associated soft tissue mass or swelling of different sizes (n=12) and periosteal reaction (n=7). Histopathological diagnoses included Langerhans cell histiocytosis (n=16), iliac metastasis of neuroblastoma (n=9), osteomyelitis (n=5), Ewing's sarcoma (n=3), tuberculosis (n=2), giant cell tumor of bone (n=1), chondroma (n=1), bone cyst (n=1), peripheral primitive neuroectodermal tumor (n=1), fibrous dysplasia of bone (n=1) and non-Hawking's lymphoma (n=1). Conclusions For various types of pelvic bone destruction in children, bony destruction is located predominantly in iliac wing. Langerhans cell histiocytosis and neuroblastoma are the most common iliac tumors in childhood. Imaging manifestations have certain characteristics of iliac osteolytic destruction. However, the specificity of imaging manifestations is not high so that histopathology is required for making a definite diagnosis. Key words: Ilium; Destruction of bone; Imaging diagnosis; Child