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Children who have been successfully treated for acute lymphoblastic leukemia (ALL) may need to routinely undergo MRI examination to determine if their ankle bones have started to develop osteonecrosis (bone degeneration), according to a St. Jude study led by Sue Kaste, DO, of Radiological Sciences.
The study was a retrospective examination of the MRI images of 15 children treated at St. Jude between 1993 and 2003. The investigators found that 20 ankles among 11 of these children treated with corticosteroids to suppress their runaway white blood cell growth had evidence of osteonecrosis of the ankle seen on MRI scans. The results of the study were published in the January 2005 issue of Clinical Orthopedics and Related Research.
Although physicians have long known about the role of corticosteroids in the development of bone fractures and osteonecrosis in other weight-bearing joints such as the hips and knees, this study was the first to show that the problem occurs in ankles.
The successes of hip and knee replacement surgery have not been duplicated in ankles, according to the St. Jude researchers. Therefore, early detection and intervention to prevent progression and collapse of the ankle are essential.
“Children are routinely examined to determine if their hips and knees have suffered osteonecrosis,” Kaste says. “Our findings suggest that a larger study should also be done to more accurately assess the true incidence of osteonecrosis of the ankle after chemotherapy for ALL.”
Other authors of the study include Casey Chollet; Lunetha Britton; Michael Neel, MD; and Melissa Hudson, MD.
Last update: March 2005