Bone Infarction Research Articles

Children and Adolescents With Sickle Cell Disease and Skull Infarction: A Systematic Review.

Skull infarction is an uncommonly reported complication of sickle cell disease. We aimed to characterize the clinical and imaging features of skull infarction in pediatric patients with sickle cell disease. We searched the PubMed database for case reports on skull bone infarction in pediatric patients with sickle cell disease. Out of 67 records retrieved, 15 met inclusion criteria, and a 16th case reported by the senior author was included. We extracted and analyzed clinical and imaging data. The most common symptom at onset was headache (88%). Bilateral skull infarction (50%) and parietal bone involvement (82%) were frequent imaging findings. Epidural hematoma developed in 65% of the cases, 30% of patients required drainage, and exchange infusion was reported in 18%. No fatal outcomes were reported. Skull infarction is a potentially severe complication of sickle cell disease presenting unique clinical challenges. Acute headaches should raise suspicion for this condition and may require additional investigation.

Isolated vertebral bone infarction following lumbar artery embolization- a case report.

To report a rare case of isolated lumbar vertebral body infarction following lumbar artery embolization for suspected retroperitoneal haemorrhage. We present the case of a 75-year-old male who underwent lumbar artery embolization due to a suspected retroperitoneal haemorrhage post-surgery. Magnetic resonance imaging (MRI) was performed to monitor post-embolization severe lumbar pain. Initial MRI two days post-embolization showed no osseous signal changes or epidural abscess. A subsequent MRI 26 days post-embolization was performed because of increasing lumbar back pain and it revealed a new bone infarction at the L3 vertebral body. CT showed embolization deposits within the vertebral body, not present before the procedure. This unique case underscores the importance of considering vertebral body infarction as a potential complication following lumbar artery embolization. MRI was critical in early detection of the bone infarction, while CT confirmed the presence of embolization material. Awareness of this rare complication is crucial for prompt diagnosis and management.

Genomic Insights Into High-Grade Infarct-Associated Bone Sarcomas

Sarcomas rarely develop in bones previously compromised by infarcts. These infarct-associated sarcomas often present as undifferentiated pleomorphic sarcomas (UPS), and their genetic characteristics are poorly understood. High-grade UPS of bone are typically treated with a combination of surgery and chemotherapy, similar to osteosarcoma. We conducted a detailed clinicopathologic and genomic analysis of 6 cases of intraosseous sarcomas arising from histologically and radiographically confirmed bone infarcts. We analyzed 523 genes for sequence-level mutations using next-generation sequencing with the TruSight Oncology 500 panel and utilized whole-genome single nucleotide polymorphism Microarray (OncoScan CNV) to detect copy number alterations and loss of heterozygosity (LOH). Genomic instability was assessed through homologous recombination deficiency (HRD) metrics, incorporating LOH, telomeric allelic imbalance, and large-scale state transitions. Fluorescence in situ hybridization and immunohistochemistry validated the findings. The cohort included 3 men and 3 women, with a median age of 70 years, and tumors located in the femur and tibia. Five of the 6 patients developed distant metastases. Treatment involved surgery and chemotherapy or immune checkpoint inhibitors. Genomic analysis revealed significant complexity and high HRD scores, ranging from 32 to 57 (with a cutoff of 32). Chromosome 12 alterations, including segmental amplification or chromothripsis, were observed in 4 cases. Notably, MDM2 amplification, confirmed by fluorescence in situ hybridization, was detected in 2 cases. Homozygous deletion of CDKN2A/B was observed in all six cases. Tumor mutational burden levels ranged from 2.4 to 7.9 mutations per megabase. Notable pathogenic mutations included H3-3A mutations (p.G35R and p.G35W), and mutations in HRAS, DNMT3A, NF2, PIK3CA, POLE, and TP53, each in one case. These results suggest that high-grade infarct-associated sarcomas of bone, whereas sharing high levels of structural variations with osteosarcoma, may exhibit potentially less frequent TP53 mutations and more common CDKN2A/B deletions. This points to the possibility that the mutation spectrum and disrupted pathways could be distinct from conventional osteosarcoma.

Osteomielite em Pacientes com Doença Falciforme

Objective: identify clinical and laboratory characteristics of osteomyelitis (OM) in 3 patients with sickle cell disease (SCD). Metodology: Retrospective evaluation of medical records of a tertiary University Hospital in São Paulo. Discussion: The cases described were comparable to Weisman, 2020, regarding age and the higher frequency of involvement of long bones, and 2 of the 3 patients are homozygous for SCD. The three patients had leukocytosis similar to those found in the literature (Fontalis et al, 2019), and all showed an increase in CRP as the OM progressed, showing reduction in values ??when treatment started. Pain and local edema were present in the reported cases, and two of them presented pain in different sites, being diagnosed in these cases. In this study, no agent was isolated in blood cultures, as reported by Fontalis 2019. In case 1, the imaging exam showed expected changes, while in cases 2 and 3, the patients had involvement of long bones, the most common sites of previous bone infarction, acute and chronic alterations were found (Al Farii et al., 2020). Conclusion: SCD patients are at increased risk for osteomyelitis. The differential diagnosis between bone infarction related to vaso-occlusive crisis is a challenge, as the initial clinical presentation is similar. Osteomyelitis should be suspected in patients with SCD who present a vaso-occlusive crisis in only one site, with prolonged fever and an increase in inflammatory evidence. Early antibiotic therapy directed at the most frequent agents can avoid complications and allow for better prognosis.

State of the art in the diagnostic evaluation of osteomyelitis: exploring the role of advanced MRI sequences-a narrative review.

Osteomyelitis, a severe bone infection caused mainly by pyogenic organisms, poses diagnostic challenges due to its non-specific magnetic resonance imaging (MRI) manifestations. Conventional MRI, though the imaging modality of choice, often exhibits signal abnormalities with overlapping differential diagnoses, potentially leading to overestimation of infection extent and duration. To address these limitations, advanced MRI sequences, including dynamic contrast-enhanced (DCE) MRI, 1H magnetic resonance spectroscopy (MRS), diffusion-weighted imaging (DWI), and Dixon techniques have emerged as promising alternatives. This narrative review explores the potential role of these sequences in aiding the differential diagnosis of osteomyelitis. We used the PubMed database to search for relevant articles using the MeSH keywords: (osteomyelitis) AND (advanced MRI sequences) and we manually selected the most suitable studies to include in our review. Articles outside of original studies were also included. Only records in English or French were considered. In particular, DWI is useful for characterizing fluid collections, distinguishing bone infarcts, and bacterial skull base osteomyelitis from neoplastic lesions. Moreover, DWI assists in differentiating diabetic foot osteomyelitis (DFO) from Charcot neuro-osteoarthropathy, facilitates the diagnosis of pediatric acute osteoarticular infections, and aids in distinguishing osteomyelitis from Modic I degenerative changes. Additionally, DWI proves valuable in monitoring spinal infections and distinguishing pedal osteomyelitis from other conditions, even in patients with renal impairment. DCE-MRI enhances MRI specificity by assessing contrast uptake over time, providing valuable insights into inflammatory microenvironments. It aids in detecting DFO, differentiating it from acute Charcot arthropathy, and distinguishing osteomyelitis from neuropathic arthropathy. Moreover, DCE-MRI shows potential in assessing response to antibiotic therapy in spinal infections. Dixon acquisition improves image quality and facilitates the detection of bone marrow abnormalities, aiding in the differentiation of diabetic foot from osteomyelitis. It also assists in distinguishing osteomyelitis from neuropathic arthropathy and provides valuable information in evaluating the diabetic foot. Proton MR spectroscopy, a well-established modality, offers metabolic information that can differentiate malignant from benign lesions. The role of advanced MRI techniques in evaluating osteomyelitis remains to be fully defined, and further research is required to explore its potential utility in this context. In conclusion, the incorporation of advanced MRI sequences has shown promise in improving the differential diagnosis of osteomyelitis. Future investigations exploring combinations of these techniques and their clinical applications hold significant potential to enhance diagnostic accuracy and patient outcomes.

Non-Traumatic Epidural Hematoma in Sickle Cell Disease

Non-traumatic epidural hematoma is an extremely rare finding in patients with sickle cell disease. Spontaneous intracranial epidural hemorrhage has been associated with coagulopathy, malignancy, and infection, but few cases secondary to sickle cell disease have been reported in the literature. The mechanism of hemorrhage in these patients is often unclear, although previous cases have suggested associations with vaso-occlusive pain crises, bone infarction, and/or vascular malformations. We report a 9 year old male with sickle cell disease type SS who presented with right shoulder pain, headaches, emesis, and no neurological deficits. CT head revealed large mixed density left frontoparietal epidural hematoma leading to complete left lateral ventricle effacement and 0.5 cm left to right midline shift. He subsequently underwent a left parietal craniotomy for evacuation of epidural hematoma from which he recovered well. The prevalence and proposed pathologic process behind this rare complication will be discussed.

THU468 Finding An Effective Treatment For Osteoporosis In Gaucher Disease

Abstract Disclosure: C. Lesniak: None. M.S. Akula: None. Background: Gaucher disease is a rare autosomal recessive disorder, leading to a deficiency of the enzyme glucocerebrosidase and accumulation of lipid-laden macrophages and dysfunction of multiple organs. The skeletal system is commonly affected resulting in reduced bone mineral density (BMD), marrow infiltration and bone infarction. Enzyme replacement therapy (ERT) has been a mainstay of treatment, and bisphosphonate therapy has been used to help treat osteoporosis, but newer agents are not well studied in this population. Case Description: The patient is a 62 year old female with a history of Gaucher disease Type 1 (GD1) and osteoporosis, treated with alendronate. She was diagnosed with GD1 in childhood and treated with glucocerebrosidase as ERT. She was diagnosed with osteoporosis in 2018 and started on bisphosphonates after a DXA scan showed a T-score at the lumbar spine of −3.2 and -1.4 at the left hip. She denied bone or back pain and has no history of any osteolytic lesions or osteonecrosis. Workup for secondary causes of osteoporosis was negative. She was taking alendronate 70 mg weekly, calcium 1800 mg daily, and vitamin D 4000 IU daily. Labs showed calcium 9.1 mg/dL, TSH 1.530 uIU/mL, PTH 34 pg/mL, and 25-hydroxy vitamin D 38.7 ng/mL. Repeat DXA scan showed worsening osteoporosis with a T-score at the lumbar spine of −3.4 and left hip of −2.5. As her BMD worsened while on alendronate for 3 years, teriparatide was offered as an alternative treatment. Discussion: Gaucher disease is a rare lysosomal storage disorder affecting multiple organs. Up to 90% of patients with GD1 have bone involvement of some kind. DXA scan should be done soon after diagnosis. Reduced BMD in GD1 is common and is associated with increased fracture risk. ERT has been the main management option to treat bone manifestations with improvement in BMD shown after 3-5 years. After 8 years of treatment with ERT, patients have been shown to reach the BMD of the age and sex matched population. In addition to ERT, calcium and vitamin D3 are recommended to increase BMD. There is no standard of treatment for osteoporosis in Gaucher patients, although bisphosphonates have been shown to improve BMD. Had our patient had early DXA scans, treatment may have been initiated sooner. A single case report showed improvement in BMD with the use of teriparatide after bisphosphonate failure. The efficacy of alternative agents, such as teriparatide and romosumab, in treating osteoporosis in patients with Gaucher disease needs to be further investigated. Presentation: Thursday, June 15, 2023

Atypical presentation of chronic myeloid leukemia with e13a2 BCR-ABL1 fusion transcript in a young male

Chronic myeloid leukemia (CML) is usually a disease of the elderly population characterized by a clonal hematopoietic progenitor cell disorder propelled by the product of the breakpoint cluster region-Abelson murine leukemia (BCR-ABL) chimeric gene, known as the Philadelphia chromosome. It occurs due to a balanced reciprocal translocation between the long arms of chromosomes 9 and 22, which codes for tyrosine kinase. The incidence of CML increases with age, and the median age of diagnosis in Western countries is 64 years. The most common finding at presentation is abdominal pain due to splenomegaly which is present in about half of the patients. We present a rare case of CML in the chronic phase where a young 23-year-old male presented with complaints of severe bilateral lower limb bone pain restricting mobility at the hip joint for 1 year. The upper end of the femur showed heterogeneous areas of bone infarct on the technetium 99 m-methylene diphosphonate bone scan. He was treated with imatinib mesylate, and he entered remission within 5 months of starting therapy. This case highlights the atypical presentation of the chronic phase of CML with the e13a2 BCR-ABL fusion transcript in a young patient and the complete recovery achieved with standard therapy.

Medullary Infarction of Bilateral Tibia - A Rare Presentation of Tuberculosis: A Case Report with Review of Literature

Background: Bony infarction or osteonecrosis is a rare, painful condition, reported in the setting of trauma, chronic steroid exposure, radiation, malignancies, and sickle cell anemia, diagnosed radiologically by its characteristic features in magnetic resonance imaging (MRI). The present case highlights the challenges in the diagnosis and management of an adolescent boy, who presented with medullary infarction of bilateral tibia. Clinical Description: A 15-year-old boy presented with severe pain in bilateral lower limbs, restricting his ability to stand and walk independently. There were no signs of inflammation or restriction of movements at the joints of the lower limb. Routine investigations were largely normal. The MRI of left tibia showed bone infarct in the middle shaft. Further investigations for the known causes of bone infarct were noncontributory. Considering a remote possibility that tuberculous endarteritis may cause such an infarct, tuberculin test was done which was positive. The chest X-ray was normal. Management and Outcome: Therapeutic trial of antitubercular drugs (2HRZE+10HRE) was given. The child showed a significant improvement in leg pain by 2 weeks of the start of therapy. On follow-up, he demonstrated complete resolution of the disease in X-ray and MRI. Conclusion: Tuberculosis endarteritis leading to bony infarction is an extremely rare phenomenon but biologically plausible. By reporting this case, we would like to convey that clinicians may consider bone infarct as a rare cause of unexplained, incapacitating limb pain in children, which, in the absence of known contributory factors, may be due to tuberculosis.

Vertebrae compression fracture due to osteonecrosis as initial sign of childhood acute lymphoblastic leukemia: A case report

BACKGROUND: Acute lymphoblastic leukemia (ALL) is the most common cancer in children. Manifestations of ALL vary from pallor, organomegaly, fever, and pancytopenia. Bone pain caused by vertebrae fracture is an uncommon manifestation of ALL, approximately only 16% of all bone pain occurrences. Fractures in ALL could occur at diagnosis and following treatment initiation. This case report described vertebrae compression fracture due to osteonecrosis as the initial sign of childhood acute lymphoblastic leukemia. CASE: An 8-year-10-month girl was referred to an orthopedic because of worsened low back pain since 1 month before, with no history of trauma. The pain was throbbing and radiated to the lower extremities. The patient was non-ambulant due to the pain. Physical examination revealed the visual analog scale was 8, tenderness in the spine, decreased strength, and range of movement in the lower extremities. There was no organomegaly in this patient. Serial laboratory examination revealed mild pancytopenia (leukopenia, mild normochromic normocytic anemia, mild thrombocytopenia) with dominancy of lymphocytes (68.1-81.9%). No blast was found in the peripheral blood smear. Magnetic Resonance Imaging of the spine revealed compression of the vertebral corpus with a pincer fracture and bone infarction. Bone marrow aspiration showed ALL-L2 with lymphoblast 50%. The patient started chemotherapy with ALL standard risk protocols and got zoledronic acid during the treatment. The patient's condition gradually improved, and able to undergo chemotherapy protocol. No side effects of zoledronic acid occurred. CONCLUSION: Vertebrae compression fracture without trauma and pancytopenia can be an early symptom of ALL. Zoledronic acid can be given concurrently with chemotherapy for bone mineralization.

Gaucher disease type 3 presenting with deformation of inferior limbs and bone infarction: A case report

Introduction: Gaucher disease (GD) is a lysosomal storage disorder characterized by the accumulation of glucocerebroside in various cells throughout the body. Bone infarction is a common and fearsome complication. Case Report: We present the case of a 5-year-old child diagnosed with Gaucher disease type 3, who exhibited deformation of the inferior limbs and bone pain. Upon evaluation, radiographic examination of the limbs revealed a characteristic triangular appearance of the metaphysis and a serpiginous sclerotic area. A magnetic resonance imaging was performed to confirm the diagnosis of bone infarction. Conclusion: Gaucher disease is a complex genetic disorder. Bone involvement is a significant manifestation causing pain, bone crises, deformities. Various imaging techniques can help for an accurate diagnosis and for a timely intervention and prevention of the disease progression.

Analysis of oral radiographic images in patients with osteomyelitis accompanied by systemic sickle cell anemia

Infections in the jawbone present many complications to both doctors and patients. One systemic factor that increases the risk of disorders in the oral cavity is sickle cell anemia (SCA). Patients with SCA also have an increased risk of orthopedic mani-festations such as osteomyelitis. Osteomyelitis features vary in their radiographic appearance, which can be panoramic, peri-apical, and occlusal, or additional modalities. This article reviews the radiographs of osteomyelitis in the oral cavity with risk fac-tors such as SCA, using the literature review method. The step is to collect information from several sources from the literature. It was found that panoramic, periapical, and computed tomography (CT) radiographs are the most commonly used radiographs and are able to describe the characteristics of osteomyelitis in SCA patients specifically. It was concluded that the typical pic-ture of CT examination type is associated bone sequestra which is a typical picture of osteomyelitis with SCA. While on pa-noramic and periapical radiographs a diffuse radiolucent picture and bone resorption are found and other radiographic feat-ures can be found in the form of small radiopaque areas and bone infarcts around the apex of the associated teeth.

The Role of Non-genetic Therapies to Reduce the Incidence of Sickle Cell Crisis: A Systematic Review.

Sickle cell anemia is a hemoglobinopathy that causes complications such as Vaso-Occlusive Crisis (VOC), stroke, priapism, Acute Chest Syndromes (ACS), and bone infarcts due to blood vessel occlusion, resulting in hypoxia, ischemia, and inflammation. Preventing these incidents improves the quality of life and lowers mortality rates in Sickle Cell Disease (SCD) patients. This systematic review aims to describe the drugs, their mechanisms of action, dosages, changes in hemoglobin parameters, decrease in VOCs, delay the time for the next VOC, decrease in the length of hospital stay, and side effects associated with these drugs. This review adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines. For this review, we searched the PubMed, Google Scholar, and Cochrane databases and screened them for full free texts published in English and studied in humans in the last five years beginning in 2018. Randomized clinical trials (RCT), observational studies, meta-analyses, systemic reviews, and traditional reviews were all included in the search. According to the type of study, quality assessment tools are used, and eight papers are chosen. Full-text articles from these papers are studied, analyzed, and tabulated. We discussed seven interventions that are used to treat sickle cell disease. Voxelotor, crizanlizumab, L-glutamate, long-term blood transfusions, Zinc (Zn), Niprisan®, and Ciklavit* were found to reduce the number and severity of VOC. We discovered that VOCs containing L -glutamate reduced the length of hospitalization. Magnesium (Mg) did not affect the number and severity of VOCs. This review includes a few articles for the study. Future papers on this subject should include a large sample size and many papers. More clinical trials are required to evaluate the dosages and outcomes of using these drugs in combination to prevent VOCs.

Unusual Diffuse and Heterogeneous FDG Uptake in Appendicular Bone Marrow Space in a Patient with Acute Lymphoblastic Leukemia.

We describe a case of F-18-2-fluoro-2-deoxyglucose (FDG) uptake in the appendicular bones on a positron emission tomography/computed tomography (PET/CT) scan in a 20-year-old woman with a diagnosis of acute lymphoblastic leukemia. An FDG PET/CT was performed on this patient because of fever of unknown origin, revealing diffuse and heterogeneous FDG uptake in the bone marrow space of both humeri, femurs, and tibiae. The patient underwent magnetic resonance imaging, which demonstrated bone infarction with heterogeneous high, intermediate, and dark signal intensities on T1- and T2-weighted images in the same areas.

Lesioni ossee simmetriche e drepanocitosi

An 8-year-old boy suffering from sickle cell disease (SCD) was admitted to emergency unit complaining of moderate-to-severe pain in his lower limbs. He received chronic transfusion therapy and hydroxyurea. Apparently, he had never experienced vaso-occlusive crises (VOC) before. At presentation he suffered pain in his left lower limb with mild functional limitation. Standard radiography was negative. Blood tests were consistent with chronic haemolytic anaemia, normal blood cell count and slight increase in inflammation markers. Blood cultures were negative. In the suspicion of a VOC, hydration and antalgic therapy with intravenous acetaminophen and ibuprofen were administered. Due to a poor clinical response, lower limbs MRI was performed and, interestingly, it revealed bilateral symmetrical tibial bone infarctions and analgesics were switched to tramadol in continuous infusion resulting in good pain control. He was discharged after nine days of hospitalization with complete remission of symptoms. <br> SCD is a spectrum of hereditary haemoglobinopathies identified by abnormal haemoglobin S (HbS) molecule. Painful crisis are the most frequent complications and VOCs virtually affect every patient with SCD. MRI can be useful to identify skeletal abnormalities, even in the pain free period and to distinguish acute infarction from acute osteomyelitis. When available, all SCD patients suffering from significant acute bone pain should undergo an MRI study of the painful region as the initial imaging investigation because, even in patients who have never experienced VOCs, there may already be bone lesions at the first painful crisis.

5597199 AGEING WITH SICKLE CELL ANEMIA AND HOW TO FACE IT

Background: Sickle Cell Anemia, a hereditary monogenic disorder is caused by homozygous sickle mutation (Hb SS). Sickle erythrocytes promote vaso-occlusion and haemolysis, which are two major hallmarks of the disease. Vaso-occlusive crisis results from the sickle red cells obstructing and reducing blood flow to the vital organs leading to ischemia, necrosis and pain(2). Data show that other blood cells i.e. leukocytes and thrombocytes are involved in this process as well, and the process starts from up regulation of P-selectin which contributes in cellular interaction and vaso-occlusion later on(3,4). All these cells stick together and can’t easily move through the blood vessels. This situation can block small blood vessels and the movement of healthy, normal oxygen-carrying blood(5,6). Repeated episodes lead to bone and organ infarction and necrosis; organs damage occur over time. Hemochromatosis occurs as well, as a result of blood transfusions or/and persistent hemolysis. Patients suffering from this kind of anemia feel exhausted and need strictly monitoring for every health issues they represent, especially when they get older(8). Because of this pathologic condition’s complexity, the best method of treatment is a combined approach(1). Sickle Cell Disease is a very polymorphous disease and its severity varies largely in each patient, thats why the management has to be in a personalized model(7). Aims: To give an overview and our considerations related to Sickle Cell Disease in Albania Methods: To achieve the goal of treating and managing medically people living with Sickle Cell Disorder, we monitor every single sign and laboratory fluctuation happening to these patients in every clinical visit. F.A. is a female with Sickle Cell Disorder, 41 years old, diagnosed in early infancy and since then she has been treated with blood transfusions initially(in her hometown until 19 years old) and later on with pure red blood cells and iron chelation therapy in our clinic. This treatment was performed once per month. She was receiving Hydroxycarbamide as well. She started to be non compliant to ICT (iron chelation therapy) and as a consequence she has been presented with very high value of ferritin level (above 5000 ng/ml). On 2013 she gave birth to a baby. A severe haemolysis was seen over time, she was put in transfusions twice per month. No changes in ultrasound or images. Two years ago she demonstrated a severe anaemia, arterial hypertension and proteinuria. She was diagnosed with Chronic Kidney Disease grade 3. Since then she had a personalised supportive therapy and this year was put in dialysis. Results: According to our experience and our point of view Sickle Cell Disease seems to have a moderate burden in our country. A new era of novel drugs seem to encourage and realize better achievement in SCD management. Sharing best experiences and our clinical cases between us, may affect positively the quality and management of these diseases. Summary: A better understanding and a strictly monitoring of patients suffering from Sickle Cell Disease could help health professionals and patients themselves to cooperate and develop new modalities towards managing these polymorphous conditions.

The Role of Whole-Body Magnetic Resonance Imaging in Assessing Extrapulmonary Metastases in Osteosarcoma Staging and Restaging: A Pilot Study.

The aim of the study is to investigate the role of whole-body magnetic resonance imaging (MRI) in assessing extrapulmonary metastases in primary osteosarcoma staging. We retrospectively reviewed medical data to identify primary osteosarcoma patients with available preoperative whole-body MRI obtained in the staging or restaging. Histopathology was the reference test for assessing the diagnostic performance, if available. Otherwise, oncology board decisions were used as the reference. In addition, the benefits of whole-body MRI to F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) and bone scintigraphy were investigated. In all, 36 patients with osteosarcoma (24 staging, 12 restaging) with a mean age of 16.36 ± 5.63 years (range, 9-29 years) were included in the study. The median follow-up duration was 26.61 months (interquartile range, 33.3 months). Of 36 patients, 8 had skeletal, 1 had a lymph node, and 1 had a subcutaneous metastasis. Whole-body MRI correctly identified all patients with metastatic disease but incorrectly classified a bone infarct in one patient as a skeletal metastasis, equating a scan-level sensitivity, specificity, accuracy, negative predictive value, and positive predictive value of 100%, 96.3%, 97.3%, 100%, and 90.91%. Whole-body MRI contributed to bone scintigraphy by identifying a skeletal metastasis in one patient and positron emission tomography-computed tomography by ruling out a skeletal metastasis in another. Whole-body MRI could accurately identify extrapulmonary metastases in primary osteosarcoma patients for staging or restaging. In addition, it might contribute to the standard whole-body imaging methods.

Bone Marrow Changes and Lesions of Diabetic Foot and Ankle Disease: Conventional and Advanced Magnetic Resonance Imaging.

Diabetic foot and ankle complications contribute to substantial mortality and morbidity. Early detection and treatment can lead to better patient outcomes. The primary diagnostic challenge for radiologists is distinguishing Charcot's neuroarthropathy from osteomyelitis. Magnetic resonance imaging (MRI) is the preferred imaging modality for assessing diabetic bone marrow alterations and for identifying diabetic foot complications. Several recent technical advances in MRI, such as the Dixon technique, diffusion-weighted imaging, and dynamic contrast-enhanced imaging, have led to improved image quality and increased capability to add more functional and quantitative information.We discuss the bone marrow abnormalities encountered in daily radiologic assessment: osteopenia, reactive bone marrow edema-like signal, insufficiency fractures, Charcot's neuroarthropathy, osteomyelitis, serous marrow atrophy, digital ischemia, and bone infarcts, along with their pathophysiology and the conventional and advanced imaging techniques used for a comprehensive marrow evaluation.

Femoral shaft fracture complicating Gaucher disease in adult

Gaucher's disease is a rare disease of progressive evolution characterized by a lysosomal storage disorder. It is rarely responsible for femoral fracture. Patients with Gaucher disease may present with musculoskeletal complications, including osteopenia, medullary bone infarcts, and avascular necrosis. We report a case of femur fracture due to gaucher disease in a 28-year-old woman who underwent two operations for pathological femoral fractures.

Corticosterapie-induced bone infarction: About an observation and review of the literature

Corticosterapie-induced bone infarction: About an observation and review of the literature