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MRI of Knee Osteonecrosis in Children with Leukemia and Lymphoma: Part 2, Clinical and Imaging Patterns

Evguenia J. Karimova1, Shesh N. Rai1, David Ingle2, Amy C. Ralph2, Xin Deng1, Michael D. Neel1, Scott C. Howard1, Ching-Hon Pui1 and Sue C. Kaste1

1 Department of Radiological Sciences, Division of Diagnostic Imaging, St. Jude Children's Research Hospital, 332 N Lauderdale St., Memphis, TN 38105.
2 University of Tennessee College of Medicine, Memphis, TN.


Figure 1
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  		Fig. 1A —10-year-old girl with acute lymphoblastic leukemia. Coronal T1-weighted unenhanced MR image of knees (A) and diagram (B) show osteonecrosis as geographic areas of decreased signal. Right knee: A = Distal femoral diaphysis, not visible on this image. B = Distal femoral metaphysis, osteonecrotic lesion present. C = Medial distal femoral epiphysis, osteonecrotic lesion not involving articular surface. D = Lateral distal femoral epiphysis, osteonecrotic lesion involving 25-50% of articular surface. E = Medial proximal tibial epiphysis, osteonecrotic lesion involving < 25% of articular surface. F = Lateral proximal tibial epiphysis, osteonecrotic lesion involving < 25% of articular surface. G = Proximal tibial metaphysis, osteonecrotic lesion present. H = Proximal tibial diaphysis, osteonecrotic lesion present. Left knee: A' = Distal femoral diaphysis, not visible on this image. B' = Distal femoral metaphysis, osteonecrotic lesion present. C' = Medial distal femoral epiphysis, osteonecrotic lesion not involving articular surface. D' = Lateral distal femoral epiphysis, osteonecrotic lesion involving 25-50% of articular surface. E' = Medial proximal tibial epiphysis, osteonecrotic lesion not involving articular surface. F' = Lateral proximal tibial epiphysis, osteonecrotic lesion not involving articular surface. G' = Proximal tibial metaphysis, osteonecrotic lesion present. H' = Proximal tibial diaphysis, osteonecrotic lesion present.

 

Figure 2
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  		Fig. 1B —10-year-old girl with acute lymphoblastic leukemia. Coronal T1-weighted unenhanced MR image of knees (A) and diagram (B) show osteonecrosis as geographic areas of decreased signal. Right knee: A = Distal femoral diaphysis, not visible on this image. B = Distal femoral metaphysis, osteonecrotic lesion present. C = Medial distal femoral epiphysis, osteonecrotic lesion not involving articular surface. D = Lateral distal femoral epiphysis, osteonecrotic lesion involving 25-50% of articular surface. E = Medial proximal tibial epiphysis, osteonecrotic lesion involving < 25% of articular surface. F = Lateral proximal tibial epiphysis, osteonecrotic lesion involving < 25% of articular surface. G = Proximal tibial metaphysis, osteonecrotic lesion present. H = Proximal tibial diaphysis, osteonecrotic lesion present. Left knee: A' = Distal femoral diaphysis, not visible on this image. B' = Distal femoral metaphysis, osteonecrotic lesion present. C' = Medial distal femoral epiphysis, osteonecrotic lesion not involving articular surface. D' = Lateral distal femoral epiphysis, osteonecrotic lesion involving 25-50% of articular surface. E' = Medial proximal tibial epiphysis, osteonecrotic lesion not involving articular surface. F' = Lateral proximal tibial epiphysis, osteonecrotic lesion not involving articular surface. G' = Proximal tibial metaphysis, osteonecrotic lesion present. H' = Proximal tibial diaphysis, osteonecrotic lesion present.

 

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