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Deferoxamine-Induced Bone Dysplasia in the Distal Femur and Patella of Pediatric Patients and Young Adults

MR Imaging Appearance

¹ Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, N. T., Hong Kong.
² Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
³ Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.

View larger version (148K): [in a new window]   Fig. 1A. —16-year-old girl who underwent chelation therapy for 9 years. Her height was at third percentile at time of MR imaging. Coronal spin-echo T1-weighted image (TR/TE, 450/15) of distal femurs shows interruption of hypointense band between epiphysis and metaphysis by intermediate-signal-intensity focus (black arrow, R) that extends into and merges with hypointense change at metaphysis (white arrow, R) on right side. Hypointense lesion (white arrow, L) is seen in metadiaphyseal region on left side.

View larger version (123K): [in a new window]   Fig. 2A. —10-year-old girl who underwent chelation therapy for 7 years 5 months. Her height was 6 cm below third percentile at time of MR imaging. Coronal spin-echo T1-weighted image (TR/TE, 450/15) of distal femurs shows widening of intermediate-signal-intensity physis at both medial and lateral margins bilaterally (arrows).

View larger version (136K): [in a new window]   Fig. 3A. —13-year-old girl who underwent chelation therapy for 7 years 7 months. Her height was at 10th percentile at time of MR imaging. Coronal spin-echo T1-weighted image (TR/TE, 450/15) of distal femurs shows irregular marked hypointensity (arrows) in both epiphyses.

View larger version (139K): [in a new window]   Fig. 3B. —13-year-old girl who underwent chelation therapy for 7 years 7 months. Her height was at 10th percentile at time of MR imaging. Sagittal spin-echo T1-weighted image (450/15) shows hypointense lesions with subchondral extension (straight arrow) at distal femoral epiphysis. Bony epiphyseal outline appears irregular. Lamellar area of hypointensity (curved arrow) is present in patella.

View larger version (104K): [in a new window]   Fig. 3C. —13-year-old girl who underwent chelation therapy for 7 years 7 months. Her height was at 10th percentile at time of MR imaging. Lateral radiograph shows sclerotic change (straight arrows) in epiphysis. Density (curved arrow) in corresponding part of patella is only faintly increased. Sclerosis is present at proximal tibial metaphysis.

View larger version (129K): [in a new window]   Fig. 3D. —13-year-old girl who underwent chelation therapy for 7 years 7 months. Her height was at 10th percentile at time of MR imaging. Coronal fat-saturated proton density-weighted MR image (2000/20) of right distal femur shows epiphyseal hyperintensity in medial and lateral condyles (straight arrows). Also note blurring of physeal-metaphyseal junction and hyperintensity extending into metaphysis at periphery (curved arrows). Lateral metaphyseal hyperintensity is larger than medial one. Proximal tibial physeal-metaphyseal region is also affected.

View larger version (132K): [in a new window]   Fig. 2B. —10-year-old girl who underwent chelation therapy for 7 years 5 months. Her height was 6 cm below third percentile at time of MR imaging. Fat-saturated proton density-weighted MR image (2000/20) of left distal femur shows increase in signal intensity of juxtaphyseal metaphysis, blurring of physeal-metaphyseal junction (short arrows), and widening of physis at both medial and lateral margins (long arrows). Slightly irregular outline is observed at medial corner of epiphysis facing physis (open arrow).

View larger version (136K): [in a new window]   Fig. 1B. —16-year-old girl who underwent chelation therapy for 9 years. Her height was at third percentile at time of MR imaging. Fat-saturated proton density-weighted MR image (2000/20) of right distal femur shows hyperintense lesion (open arrow) extending from physis into metaphysis marked laterally. Pseudocystic transformation is suggested by hyperintense change (long arrow). Note mixed hyperintensity (thick arrow) and areas of linear hypointensity (small arrows).

View larger version (146K): [in a new window]   Fig. 1C. —16-year-old girl who underwent chelation therapy for 9 years. Her height was at third percentile at time of MR imaging. Coronal fat-saturated proton density-weighted MR image (2000/20) of left distal femur shows hyperintense lesions at both medial and lateral margins of physis and distal metaphysis (open arrows) that are smaller than lesions seen in B. Mixed hyper- and hypointensities are seen at metadiaphyseal region laterally (solid arrow).

View larger version (111K): [in a new window]   Fig. 1D. —16-year-old girl who underwent chelation therapy for 9 years. Her height was at third percentile at time of MR imaging. Radiograph shows sclerosis (arrows) at both distal femoral metaphyses. R = right, L = left.

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