Case Of the Week (COW) 12 Oct 2014
Answer:
Osteonecrosis.
Findings:
Serpigenous lines of hypointensity in T1 and serpigenous T2, STIR hyperintensity with double line sign(peripheral decreased signal intensity and inner increased signal intensity lines) in the bone marrow of distal femur, proximal tibia - suggestive of osteonecrosis Bakers cyst popliteal fossa.
Discussion:
Patient known case of SLE; on steroids for past two month. X-ray and CT of right knee appears normal. Osteonecrosis is characterized by death of bone marrow and trabecular bone as a result of disruption of vascular supply to the bone. MRI is the gold standard for early detection of Osteonecrosis. Osteonecrosis in SLE: Prevalence of osteonecrosis in SLE patients on corticosteroids is reported to be higher than in non SLE patients on corticosteroids. Osteonecrosis is more common than AVN in SLE. Multifocal involvement is more common in SLE with slight predominance of knee joint involvement. When osteonecrosis is found in one skeletal site screening of other concomitant lesion is recommended. It occurs soon after initiation of corticosteroid therapy mostly within one month. Role of vasculitis and antiphospholipid antibodies in causing osteonecrosis is controversial. Low dose corticosteroid therapy does not protect this condition.
Contributed By:
Dr.RajaLakshmi, Prof.S.Babu Peter
Barnard Institute of Radiology
Answer:
Osteonecrosis.
Findings:
Serpigenous lines of hypointensity in T1 and serpigenous T2, STIR hyperintensity with double line sign(peripheral decreased signal intensity and inner increased signal intensity lines) in the bone marrow of distal femur, proximal tibia - suggestive of osteonecrosis Bakers cyst popliteal fossa.
Discussion:
Patient known case of SLE; on steroids for past two month. X-ray and CT of right knee appears normal. Osteonecrosis is characterized by death of bone marrow and trabecular bone as a result of disruption of vascular supply to the bone. MRI is the gold standard for early detection of Osteonecrosis. Osteonecrosis in SLE: Prevalence of osteonecrosis in SLE patients on corticosteroids is reported to be higher than in non SLE patients on corticosteroids. Osteonecrosis is more common than AVN in SLE. Multifocal involvement is more common in SLE with slight predominance of knee joint involvement. When osteonecrosis is found in one skeletal site screening of other concomitant lesion is recommended. It occurs soon after initiation of corticosteroid therapy mostly within one month. Role of vasculitis and antiphospholipid antibodies in causing osteonecrosis is controversial. Low dose corticosteroid therapy does not protect this condition.
Contributed By:
Dr.RajaLakshmi, Prof.S.Babu Peter
Barnard Institute of Radiology