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Metaphyseal lucent bands, often referred to as "leukemic lines", are transverse radiolucent zones seen in the metaphysis of long bones.

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They are one of the earliest and most specific skeletal radiographic findings in pediatric acute leukemia, especially Acute lymphoblastic leukemia (ALL) .

Pathophysiology

These bands represent areas of impaired mineralization or metaphyseal infiltration by leukemic cells.
They arise due to:
- Hypercellular marrow replacing normal trabeculae
- Disruption of endochondral ossification
- Accumulation of abnormal leukemic cells in the metaphyseal region

Associated Clinical & Lab Features

Bone pain or refusal to walk
Hepatosplenomegaly or lymphadenopathy
CBC: anemia, thrombocytopenia, or leukocytosis/leukopenia
Peripheral smear: presence of blasts
Confirmatory: Bone marrow biopsy

Radiology

Radiographic features:

Parameter	Description
Location	Adjacent to the growth plate in rapidly growing bones (e.g., distal femur, proximal tibia, proximal humerus)
Appearance	Transversely oriented, symmetrical, radiolucent (dark) bands within metaphysis
Number	Often multiple, parallel, bilateral
Margins	Well-defined with sharp interfaces; can be subtle
Distribution	Most often seen in children with ALL due to their active bone turnover and marrow involvement

![A 6-year-old girl with AML presenting with weakness, pallor and tenderness of lower extremities

Radiography reveals metaphyseal hypodensity on both femurs with sclerotic lesions (arrows). There are also lytic lesions in the left femoral neck (arrowhead).

Makhtoom Shahnazi, Khatami A, Bibishahin Shamsian, Bibimaryam Haerizadeh, Mastooreh Mehrafarin. Bony Lesions in Pediatric Acute Leukemia: Pictorial Essay. Iranian Journal of Radiology. 2012;9(1):50-56. doi:https://doi.org/10.5812/iranjradiol.6765 ‌](https://prod-files-secure.s3.us-west-2.amazonaws.com/2aa05644-4658-4c26-84d3-64c36b55fb6c/4a1c94b9-7d68-42f1-bf4e-58ac15544584/AML.png)

A 6-year-old girl with AML presenting with weakness, pallor and tenderness of lower extremities

Radiography reveals metaphyseal hypodensity on both femurs with sclerotic lesions (arrows). There are also lytic lesions in the left femoral neck (arrowhead).

![A 4-year-old girl with ALL presenting with pallor and wrist tenderness

Wrist X-ray reveals metaphyseal lucent band (arrow head) in radial and ulnar metaphyses. Note the lucent bony lesions of the first and third metacarpal bone on the right side (arrows).

A 4-year-old girl with ALL presenting with pallor and wrist tenderness

Wrist X-ray reveals metaphyseal lucent band (arrow head) in radial and ulnar metaphyses. Note the lucent bony lesions of the first and third metacarpal bone on the right side (arrows).

Differentials

Other metaphyseal changes: