Figure 2
Imaging data of CRMO involving both distal femurs in patient 2, an 11-year-old girl. (A-E) Pre-treatment imaging: (A) Pre-treatment technetium99nuclear bone scan demonstrates abnormal uptake in both distal femurs with more prominent changes on the left (arrow). (B-C) Anterior-posterior radiographs of both distal femurs demonstrate ill-defined areas of sclerosis (arrows) mixed with small focal lucent areas. Periosteal reaction is noted on the left side. (D) Coronal STIR MRI images obtained 4 months after the bone scan reveal increased signal in the right femur. The left femur reveals post-operational changes on the site of previous bone biopsy (arrow). (E) Post-gadolinium fat-saturated T1 weighted image shows marked enhancement of the right distal femoral lesion, with post-operational changes in the left femur. (F-G) Imaging 10 months after initiation of pamidronate: Complete resolution of the right femoral lesion is demonstrated on STIR image (F) and post-gadolinium fat-saturated T1 weighted image (G). (H) Imaging at clinical relapse: Coronal STIR MRI images reveal increased T2 signal in the right aspect of the sacrum, consistent with inflammation. (I): Imaging 2 months post 1 day pamidronate retreatment: Previously demonstrated abnormal signal on coronal STIR has resolved (arrow).