BACKGROUND: Preconditioning total body irradiation (TBI) prior to bone marrow transplantation (BMT) has been believed to be a safe procedure that does not cause late morbidity; yet, a recent report raises the suspicion that TBI-induced chondroosseous abnormalities do occur. OBJECTIVE: To evaluate the radiological manifestations of TBI-induced skeletal alterations and their orthopaedic morbidity. MATERIALS AND METHODS: Subjects included 11 children with TBI-induced skeletal changes, including 9 in our hospital and 2 in other hospitals. The former were selected from 53 children who had undergone TBI with BMT. Radiographic examinations (n=11), MRI (n=3), CT (n=2), and medical records in the 11 children were retrospectively reviewed. RESULTS: The skeletal alterations included abnormal epiphyseal ossification and metaphyseal fraying (8/11), longitudinal metaphyseal striations (8/11), irregular metaphyseal sclerosis (6/11), osteochondromas (4/11), slipped capital femoral epiphysis (2/10), genu valgum (3/10), and platyspondyly (2/3). MRI demonstrated immature primary spongiosa in the metaphysis. Of the 11 children, 9 had clinical symptoms. CONCLUSION: TBI can induce polyostotic and/or generalized bone changes, mainly affecting the epiphyseal/metaphyseal regions and occasionally the spine. The epi-/metaphyseal abnormalities represent impaired chondrogenesis in the epiphysis and growth plate and abnormal remodelling in the metaphysis. Generalized spine changes may lead to misdiagnosis of a skeletal dysplasia.
BACKGROUND: Preconditioning total body irradiation (TBI) prior to bone marrow transplantation (BMT) has been believed to be a safe procedure that does not cause late morbidity; yet, a recent report raises the suspicion that TBI-induced chondroosseous abnormalities do occur. OBJECTIVE: To evaluate the radiological manifestations of TBI-induced skeletal alterations and their orthopaedic morbidity. MATERIALS AND METHODS: Subjects included 11 children with TBI-induced skeletal changes, including 9 in our hospital and 2 in other hospitals. The former were selected from 53 children who had undergone TBI with BMT. Radiographic examinations (n=11), MRI (n=3), CT (n=2), and medical records in the 11 children were retrospectively reviewed. RESULTS: The skeletal alterations included abnormal epiphyseal ossification and metaphyseal fraying (8/11), longitudinal metaphyseal striations (8/11), irregular metaphyseal sclerosis (6/11), osteochondromas (4/11), slipped capital femoral epiphysis (2/10), genu valgum (3/10), and platyspondyly (2/3). MRI demonstrated immature primary spongiosa in the metaphysis. Of the 11 children, 9 had clinical symptoms. CONCLUSION: TBI can induce polyostotic and/or generalized bone changes, mainly affecting the epiphyseal/metaphyseal regions and occasionally the spine. The epi-/metaphyseal abnormalities represent impaired chondrogenesis in the epiphysis and growth plate and abnormal remodelling in the metaphysis. Generalized spine changes may lead to misdiagnosis of a skeletal dysplasia.
Authors: K Holm; K Nysom; M H Rasmussen; H Hertz; N Jacobsen; N E Skakkebaek; S Krabbe; J Müller Journal: Bone Marrow Transplant Date: 1996-07 Impact factor: 5.483
Authors: Andy T Kwok; Joseph E Moore; Samuel Rosas; Bethany A Kerr; Rachel N Andrews; Callistus M Nguyen; Jingyun Lee; Cristina M Furdui; Boyce E Collins; Michael T Munley; Jeffrey S Willey Journal: Radiat Res Date: 2019-03-29 Impact factor: 2.841
Authors: Ian D Hutchinson; John Olson; Carl A Lindburg; Valerie Payne; Boyce Collins; Thomas L Smith; Michael T Munley; Kenneth T Wheeler; Jeffrey S Willey Journal: Int J Radiat Biol Date: 2014-08-11 Impact factor: 2.694
Authors: Lisa M Madden; Alexander I Ngwube; Shalini Shenoy; Todd E Druley; Robert J Hayashi Journal: J Pediatr Hematol Oncol Date: 2015-03 Impact factor: 1.289