{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T23:16:36Z","timestamp":1790982996996,"version":"4.1.0"},"reference-count":13,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Osteonecrosis (avascular necrosis, AVN) is a disabling complication of corticosteroid exposure and is well recognized in adolescents treated for hematologic malignancies, including acute lymphoblastic leukemia (ALL). We report a 17\u2010year\u2010old female with ALL and later acute myelogenous leukemia (AML) after hematopoietic stem cell transplantation (HSCT), who received documented post\u2010HSCT prednisolone therapy and presented with progressive bilateral knee pain. MRI demonstrated multifocal osteonecrosis involving both distal femoral condyles and proximal tibiae, with classic serpiginous infarct morphology and a double\u2010line sign. A [99mTc]\u2010MDP three\u2010phase bone scan with hybrid SPECT\/CT demonstrated discordant activity: intense uptake and marked sclerosis in the femoral condyles but minimal uptake in the tibial lesions. This pattern may reflect heterogeneous lesion activity or different reparative stages rather than a validated predictor of collapse. The case highlights the potential value of bone scintigraphy\/SPECT\/CT as an adjunct to MRI for lesion activity mapping and surveillance planning in selected high\u2010risk pediatric oncology patients while emphasizing that its prognostic role requires longitudinal validation.<\/jats:p>","DOI":"10.1002\/ccr3.73212","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:55:58Z","timestamp":1787028958000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Bilateral Knee Osteonecrosis in an Adolescent With Leukemia on Prolonged Corticosteroids: Discordant Femoral\u2013Tibial Findings on Bone Scan\n                    <scp>SPECT<\/scp>\n                    \u2013\n                    <scp>CT<\/scp>"],"prefix":"10.1002","volume":"14","author":[{"given":"Fatemeh","family":"Haghighi","sequence":"first","affiliation":[{"name":"Department of Nuclear Medicine Children Medical Center Hospital, Tehran University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatemeh Tahghighi","family":"Sharabian","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Children Medical Center Hospital, Tehran University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatemeh","family":"Jooshaei","sequence":"additional","affiliation":[{"name":"Research Center for Nuclear Medicine Shariati Hospital, Tehran University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farzaneh Ghaffari","family":"Yousefzadeh","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine Children Medical Center Hospital, Tehran University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3076-156X","authenticated-orcid":false,"given":"Marzieh","family":"Ebrahimi","sequence":"additional","affiliation":[{"name":"Department of Medical Physics School of Medicine, Iran University of Medical Sciences (IUMS)  Tehran Iran"},{"name":"Department of Nuclear Medicine Rasoul Akram Hospital, School of Medicine, Iran University of Medical Sciences (IUMS)  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7009-5127","authenticated-orcid":false,"given":"Zeinab","family":"Paymani","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine Children Medical Center Hospital, Tehran University of Medical Sciences  Tehran Iran"},{"name":"Research Center for Nuclear Medicine Shariati Hospital, Tehran University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2000.18.18.3262"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.37.3217"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41408-018-0150-z"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2013.095562"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.04.1598"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.60.1.14"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/RLU.0000000000004312"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.04.1597"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/sarh.2002.33724b"},{"issue":"5","key":"e_1_2_11_11_1","first-page":"1117","article-title":"Nontraumatic Osteonecrosis of the Femoral Head: Ten Years Later","volume":"88","author":"Mont M. A.","year":"2006","journal-title":"Journal of Bone and Joint Surgery. American Volume"},{"issue":"1","key":"e_1_2_11_12_1","first-page":"6","article-title":"Osteonecrosis of the Knee: Review","volume":"3","author":"Karim A. 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