nach oben

Erschienen in:

04.10.2021 | Scientific Article

Percutaneous CT-guided corticosteroid injection for the treatment of osseous Langerhans cell histocytosis: a three institution retrospective analysis

verfasst von: Connie Y. Chang, Julio Brandao Guimares, Gabby Joseph, Marcelo de Toledo Petrilli, Santiago Lozano-Calderon, Miriam A. Bredella, Thomas M. Link

Erschienen in: Skeletal Radiology | Ausgabe 5/2022

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The aim of this study is to evaluate the safety and effectiveness of CT-guided corticosteroid injection for the treatment of osseous Langerhans cell histiocytosis (LCH) in a multi-institutional study.

Materials and methods

This IRB-approved study included patients from three institutions. We retrospectively reviewed clinical, procedural, and imaging data for corticosteroid injections performed to treat osseous LCH. Location of the lesion, lesion maximum dimension and volume, corticosteroid type and dose, and time interval between injection and change in lesion size/volume and symptoms were recorded. Generalized estimating equations (accounting for multiple lesions per subject) were used to evaluate the association between predictors (dose, maximum lesion dimension, and lesion volume) and outcomes (time to partial and complete radiographic resolution, and time to pain control). This analysis was adjusted by anatomic site.

Results

Forty corticosteroid injections were performed in 36 patients (20 (56%) females, and 16 (44%) males, ages 12 ± 11 (2–57) years). Mean lesion maximum dimension was 3.2 ± 1.7 cm, and volume was 10 ± 17 cm³. Imaging and clinical follow-up were available for 22/40 (55%) and 34/40 (85%) of injections, respectively. All lesions responded to corticosteroid injection. Times to partial and complete imaging resolution were 13 ± 9 and 32 ± 13 weeks, respectively, and time to pain resolution was 22 ± 14 weeks. There were no complications.

Conclusion

CT-guided corticosteroid injection is a safe and effective treatment for LCH. Pain resolution was achieved in all patients and imaging did not show progressive disease in any of the patients.

Kim BE, Koh K-N, Suh JK, et al. Clinical features and treatment outcomes of Langerhans cell histiocytosis: a nationwide survey from Korea histiocytosis working party. J Pediatr Hematol Oncol. 2014;36:125–33. https://doi.org/10.1097/MPH.0000000000000054CrossRefPubMed

Angelini A, Mavrogenis AF, Rimondi E, et al. Current concepts for the diagnosis and management of eosinophilic granuloma of bone. J Orthop Traumatol. 2017;18:83–90. https://doi.org/10.1007/s10195-016-0434-7.CrossRefPubMed

Park H, Nishino M, Hornick JL, Jacobsen ED. Imaging of histiocytosis in the era of genomic medicine. Radiogr Rev Publ Radiol Soc N Am Inc. 2019;39:95–114. https://doi.org/10.1148/rg.2019180054.CrossRef

Mavrogenis AF, Abati CN, Bosco G, Ruggieri P. Intralesional methylprednisolone for painful solitary eosinophilic granuloma of the appendicular skeleton in children. J Pediatr Orthop. 2012;32:416–22. https://doi.org/10.1097/BPO.0b013e3182561153.CrossRefPubMed

Lau LMS, Stuurman K, Weitzman S. Skeletal Langerhans cell histiocytosis in children: permanent consequences and health-related quality of life in long-term survivors. Pediatr Blood Cancer. 2008;50:607–12. https://doi.org/10.1002/pbc.21322.CrossRefPubMed

Titgemeyer C, Grois N, Minkov M, et al. Pattern and course of single-system disease in Langerhans cell histiocytosis data from the DAL-HX 83- and 90-study. Med Pediatr Oncol. 2001;37:108–14. https://doi.org/10.1002/mpo.1178.CrossRefPubMed

Rivera JC, Wylie E, Dell’Orfano S, et al. Approaches to treatment of unifocal langerhans cell histiocytosis: is biopsy alone enough? J Pediatr Orthop. 2014;34:820–4. https://doi.org/10.1097/BPO.0000000000000150.CrossRefPubMed

Scaglietti O, Marchetti PG, Bartolozzi P. Final results obtained in the treatment of bone cysts with methylprednisolone acetate (depo-medrol) and a discussion of results achieved in other bone lesions. Clin Orthop. 1982;(165):33–42. PMID 6804147.

Cohen M, Zornoza J, Cangir A, et al. Direct injection of methylprednisolone sodium succinate in the treatment of solitary eosinophilic granuloma of bone: a report of 9 cases. Radiology. 1980;136:289–93. https://doi.org/10.1148/radiology.136.2.7403498.CrossRefPubMed

10.

Capanna R, Springfield DS, Ruggieri P, et al. Direct cortisone injection in eosinophilic granuloma of bone: a preliminary report on 11 patients. J Pediatr Orthop. 1985;5:339–42. https://doi.org/10.1097/01241398-198505000-00016.CrossRefPubMed

11.

Harris GJ, Woo KI. Eosinophilic granuloma of the orbit: a paradox of aggressive destruction responsive to minimal intervention. Trans Am Ophthalmol Soc. 2003;101:93–103; discussion 103-105.PubMedPubMedCentral

12.

Egeler RM, Thompson RC, Voûte PA, Nesbit ME. Intralesional infiltration of corticosteroids in localized Langerhans’ cell histiocytosis. J Pediatr Orthop. 1992;12:811–4. https://doi.org/10.1097/01241398-199211000-00021.CrossRefPubMed

13.

Nauert C, Zornoza J, Ayala A, Harle TS. Eosinophilic granuloma of bone: diagnosis and management. Skeletal Radiol. 1983;10:227–35. https://doi.org/10.1007/BF00357895.CrossRefPubMed

14.

Ruff S, Chapman GK, Taylor TK, Ryan MD. The evolution of eosinophilic granuloma of bone: a case report. Skeletal Radiol. 1983;10:37–9. https://doi.org/10.1007/BF00355390.CrossRefPubMed

15.

Fradis M, Podoshin L, Ben-David J, Grishkan A. Eosinophilic granuloma of the temporal bone. J Laryngol Otol. 1985;99:475–9. https://doi.org/10.1017/s0022215100097073.CrossRefPubMed

16.

Wirtschafter JD, Nesbit M, Anderson P, McClain K. Intralesional methylprednisolone for Langerhans’ cell histiocytosis of the orbit and cranium. J Pediatr Ophthalmol Strabismus. 1987;24:194–7.CrossRef

17.

Jones LR, Toth BB, Cangir A. Treatment for solitary eosinophilic granuloma of the mandible by steroid injection: report of a case. J Oral Maxillofac Surg. 1989;47:306–9. https://doi.org/10.1016/0278-2391(89)90238-3.CrossRefPubMed

18.

Putters TF, de Visscher JGAM, van Veen A, Spijkervet FKL. Intralesional infiltration of corticosteroids in the treatment of localised langerhans’ cell histiocytosis of the mandible Report of known cases and three new cases. Int J Oral Maxillofac Surg. 2005;34:571–5. https://doi.org/10.1016/j.ijom.2004.10.020.CrossRefPubMed

19.

Yasko AW, Fanning CV, Ayala AG, et al. Percutaneous techniques for the diagnosis and treatment of localized Langerhans-cell histiocytosis (eosinophilic granuloma of bone). J Bone Joint Surg Am. 1998;80:219–28. https://doi.org/10.2106/00004623-199802000-00009.CrossRefPubMed

20.

Kindy-Degnan NA, Laflamme P, Duprat G. Allaire GS (1991) Intralesional steroid in the treatment of an orbital eosinophilic granuloma. Arch Ophthalmol. 1960;109:617–8. https://doi.org/10.1001/archopht.1991.01080050023015.CrossRef

21.

Rimondi E, Mavrogenis AF, Rossi G, et al. CT-guided corticosteroid injection for solitary eosinophilic granuloma of the spine. Skeletal Radiol. 2011;40:757–64. https://doi.org/10.1007/s00256-010-1045-7.CrossRefPubMed

22.

Maria Postini A, del Prever AB, Pagano M, et al. Langerhans cell histiocytosis: 40 years’ experience. J Pediatr Hematol Oncol. 2012;34:353–8. https://doi.org/10.1097/MPH.0b013e318257a6ea.CrossRefPubMed

23.

Abdelaal AHK, Sedky M, Gohar S, et al. Skeletal involvement in children with Langerhans cell histiocytosis: healing, complications, and functional outcome. SICOT J. 2020;6:28. https://doi.org/10.1051/sicotj/2020024.CrossRefPubMedPubMedCentral

24.

R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. 2019.

25.

Arenzana-Seisdedos F, Barbey S, Virelizier JL, et al. Histiocytosis X. Purified (T6+) cells from bone granuloma produce interleukin 1 and prostaglandin E2 in culture. J Clin Invest. 1986;77:326–9. https://doi.org/10.1172/JCI112296.CrossRefPubMedPubMedCentral

26.

Gonzalez-Crussi F, Hsueh W, Wiederhold MD. Prostaglandins in histiocytosis-X. PG synthesis by histiocytosis-X cells. Am J Clin Pathol. 1981;75:243–53. https://doi.org/10.1093/ajcp/75.2.243.CrossRefPubMed

27.

Marusić A, Raisz LG. Cortisol modulates the actions of interleukin-1 alpha on bone formation, resorption, and prostaglandin production in cultured mouse parietal bones. Endocrinology. 1991;129:2699–706. https://doi.org/10.1210/endo-129-5-2699.CrossRefPubMed

28.

Scaglietti O, Marchetti PG, Bartolozzi P. The effects of methylprednisolone acetate in the treatment of bone cysts. Results of three years follow-up. J Bone Joint Surg Br. 1979;61-B:200–4.CrossRef

29.

Chang CY, Kattapuram SV, Huang AJ, et al. Treatment of aneurysmal bone cysts by percutaneous CT-guided injection of calcitonin and steroid. Skeletal Radiol. 2017;46:35–40. https://doi.org/10.1007/s00256-016-2503-7.CrossRefPubMed

30.

Thompson J, Buechner HA, Fishman R. Eosinophilic granuloma of the lung. Ann Intern Med. 1958;48:1134–45. https://doi.org/10.7326/0003-4819-48-5-1134.CrossRefPubMed

31.

Levy EI, Scarrow A, Hamilton RC, et al. Medical management of eosinophilic granuloma of the cervical spine. Pediatr Neurosurg. 1999;31:159–62. https://doi.org/10.1159/000028853.CrossRefPubMed

32.

Watzke IM, Millesi W, Kermer C, Gisslinger H. Multifocal eosinophilic granuloma of the jaw: long-term follow-up of a novel intraosseous corticoid treatment for recalcitrant lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90:317–22. https://doi.org/10.1067/moe.2000.107535.CrossRefPubMed

33.

Sasaki H, Nagano S, Shimada H, et al. Clinical course of the bony lesion of single-system single-site Langerhans cell histiocytosis - Is appropriate follow-up sufficient treatment? J Orthop Sci. 2018;23:168–73. https://doi.org/10.1016/j.jos.2017.08.018.CrossRefPubMed

34.

Plasschaert F, Craig C, Bell R, et al. Eosinophilic granuloma. A different behaviour in children than in adults. J Bone Joint Surg Br. 2002;84:870–2. https://doi.org/10.1302/0301-620x.84b6.12585.CrossRefPubMed

35.

den Herder BA. Changing views on eosinophilic granuloma of bone. Radiol Clin Biol. 1973;42:218–21.

36.

Corby RR, Stacy GS, Peabody TD, Dixon LB. Radiofrequency ablation of solitary eosinophilic granuloma of bone. AJR Am J Roentgenol. 2008;190:1492–4. https://doi.org/10.2214/AJR.07.3415.CrossRefPubMed

37.

Becce F, Theumann N, Rochette A, et al. Osteoid osteoma and osteoid osteoma-mimicking lesions: biopsy findings, distinctive MDCT features and treatment by radiofrequency ablation. Eur Radiol. 2010;20:2439–46. https://doi.org/10.1007/s00330-010-1811-x.CrossRefPubMed

38.

Papavasiliou K, Bintoudi A, Vlahodimos A, et al. Localized chronic form of langerhans cell histiocytosis in the femur of a 16-year-old male successfully treated with radiofrequency ablation. Case Rep. Oncol Med. 2020;2020:4052034. https://doi.org/10.1155/2020/4052034.CrossRef

Titel: Percutaneous CT-guided corticosteroid injection for the treatment of osseous Langerhans cell histocytosis: a three institution retrospective analysis
verfasst von: Connie Y. Chang
Julio Brandao Guimares
Gabby Joseph
Marcelo de Toledo Petrilli
Santiago Lozano-Calderon
Miriam A. Bredella
Thomas M. Link
Publikationsdatum: 04.10.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Skeletal Radiology / Ausgabe 5/2022
Print ISSN: 0364-2348
Elektronische ISSN: 1432-2161
DOI: https://doi.org/10.1007/s00256-021-03917-2

Distant migration of gluteal augmentation fat presenting as a soft tissue knee mass

Case Report

Traumatic vertebra and endplate fractures promote adjacent disc degeneration: evidence from a clinical MR follow-up study

Scientific Article

Update on imaging in chronic kidney disease-mineral and bone disorder: promising role of functional imaging

Review Article

Meniscus position and size in knees with versus without structural knee osteoarthritis progression: data from the osteoarthritis initiative

Open Access
Scientific Article

The use of cone-beam computed tomography (CBCT) in radiocarpal fractures: a diagnostic test accuracy meta-analysis

Open Access
Review Article

Update on imaging of the discoid meniscus

Review Article

Neu im Fachgebiet Radiologie

Hölzerner Fremdkörper in der Orbita? Zuerst eine CT!

09.03.2025
Erkrankungen der Orbita
Nachrichten

Besteht der Verdacht, dass ein Fremdkörper aus Holz in den Orbitalraum eingedrungen ist, spielt die Bildgebung eine entscheidende diagnostische Rolle. Was von CT und MRT zu erwarten ist, hat ein chinesisches Radiologenteam untersucht.

Diagnostik von Rippenfrakturen: KI schlägt Radiologen

07.03.2025
Rippenfraktur
Nachrichten

Mensch gegen Maschine: Beim Erkennen von Rippenfrakturen in Röntgen- und CT-Aufnahmen entschied sich dieses Duell zugunsten der künstlichen Intelligenz (KI). Die Algorithmen zeigten eine höhere Sensitivität als ihre menschlichen Kollegen.

Ärztinnen überholen Ärzte bei Praxisgründungen

Praxis und Beruf
Nachrichten

Bei Praxisgründungen haben inzwischen die Frauen deutlich die Nase vorn: Seit zehn Jahren wagen laut apoBank mehr Ärztinnen als Ärzte den Schritt in die Selbstständigkeit. In puncto Finanzierung sind sie aber vorsichtiger als die männlichen Kollegen.

Ambulante Behandlung darf länger dauern als stationäre

Recht für Ärzte
Nachrichten

Ambulante Behandlungen haben Vorrang vor stationären - auch wenn diese läner dauern. Das hat das Bundessozialgericht klargestellt. Konkret ging es um Liposuktionen der Ober- und Unterschenkel.

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Percutaneous CT-guided corticosteroid injection for the treatment of osseous Langerhans cell histocytosis: a three institution retrospective analysis