Diagnosis of Osteomyelitis in Children: Utility of Fat-Suppressed Contrast-Enhanced MRI

Averill, Lauren W.; Hernández, Andrea; Gonzalez, Leonardo; Pena, Andres; Jaramillo, Diego

doi:10.2214/ajr.07.3400

Cited by 92 publications

(49 citation statements)

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“…Gadolinium enhancement does not increase the sensitivity or specificity for diagnosis of osteomyelitis. If the water-sensitive images are normal, gadolinium enhancement is of no value [21,22]. One exception is an abscess involving the epiphyseal cartilage alone, in which unenhanced images can be negative [23].…”

Section: Diagnostic Modalitiesmentioning

confidence: 99%

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Infection: musculoskeletal

Jaramillo

2011

Pediatr Radiol

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The imaging approach to osteomyelitis has evolved in the past two decades. Advances in MRI allow for whole body imaging, decreasing the need for scintigraphy when symptoms are not localized or the disease may be multifocal. There is an increasing clinical need for depiction of abscesses in the soft tissues and subperiosteal space, particularly because methicillin-resistant Staphylococcus aureus infections constitute more than one-third of all the infections. The increasing emphasis on radiation dose reduction has also led away from scintigraphy and computed tomography. MR imaging has become the advanced imaging modality of choice in osteomyelitis. There is an increasing understanding of the appropriate role for gadolinium enhancement, which is not indicated when the pre-gadolinium images are normal. Other related infections, including pyomyositis, are best imaged with MRI.Keywords Infection . Musculoskeletal . Children . MRI EpidemiologyAcute hematogenous osteomyelitis is the most common form of musculoskeletal infection [1]. Its incidence is difficult to determine, but it has been reported to be 1 per 5,000 [2]. There is conflicting data regarding the change of the disease over time. A study in 1998 found that the incidence in Norway ranged between 70 and 160 per million and that the incidence had remained stable between 1965 and 1994 [3]. An American study, however, found that in the last 20 years the incidence of osteomyelitis had increased 2.8-fold, whereas that of septic arthritis was stable. Methicillin-resistant Staphylococcus aureus (MRSA) was the causative organism in 30% of the children [4]. More than half of the cases occur before 5 years of age, and it appears to be more frequent in boys. Approximately 70% of infections involve the lower extremities and onethird affect the knee [2]. PathophysiologyHematogenous osteomyelitis results from the seeding of bacteria, usually Staphylococcus aureus (S. aureus) in the metaphysis of a long bone (Fig. 1) or in the metaphyseal equivalents of the axial skeleton (Fig. 2). S. aureus bacteria, which are present in the skin or mucosal membranes, enter the bloodstream and lodge in the bone, usually at sites where blood flow is abundant and slow. The metaphyses are richly vascularized and the valveless sinusoidal loops of the metaphyseal venules have sluggish flow and discontinuous endothelium which facilitates bacterial invasion. During childhood, the metaphyses that grow the fastest, such as those around the knee, are the most richly vascularized in order to produce new bone at a rapid rate. These rapidly growing metaphyses also tend to be affected more frequently by infection. S. aureus has the capacity to attach to the bony matrix and produce proteolytic enzymes that destroy the surrounding tissues, allowing the spread of the infection. From the bone, the infection extends through the porous metaphyseal cortex into the subperiosteal space. The periosteum in children is loosely attached to the bone and separates easily from it, creating a space that allows ...

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Section: Diagnostic Modalitiesmentioning

confidence: 99%

“…One exception is an abscess involving the epiphyseal cartilage alone, in which unenhanced images can be negative [23]. If the watersensitive images are abnormal, however, gadolinium enhancement is of value in increasing confidence in the diagnosis of an abscess [21] and allowing the planning of the abscess aspiration and drainage.…”

Section: Diagnostic Modalitiesmentioning

confidence: 99%

Infection: musculoskeletal

Jaramillo

2011

Pediatr Radiol

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“…Plain film radiography (PFR) and MRI images were interpreted separately by two expert radiologists without awareness of the results of scintigraphy and laboratory tests. On unenhanced images, the MRI criteria for the presence of osteomyelitis were diminished signal intensity on the T1-weighted sequences and increased signal intensity on T2-weighted sequences within the bone marrow [17]. After contrast administration, focal abnormal bone marrow enhancement on fat-suppressed T1-weighted images was considered as osteomyelitis [17].…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

“…On unenhanced images, the MRI criteria for the presence of osteomyelitis were diminished signal intensity on the T1-weighted sequences and increased signal intensity on T2-weighted sequences within the bone marrow [17]. After contrast administration, focal abnormal bone marrow enhancement on fat-suppressed T1-weighted images was considered as osteomyelitis [17]. When visible radiographically on PFR, focal bone rarefaction, diminished bone density, periostitis, bone erosion, or destruction were considered as osteomyelitis.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Diagnostic value of 99mTc-ubiquicidin scintigraphy for osteomyelitis and comparisons with 99mTc-methylene diphosphonate scintigraphy and magnetic resonance imaging

Assadi

Vahdat²,

Nabipour³

et al. 2011

Nuclear Medicine Communications

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Objective The discrimination of bacterial infections from sterile inflammatory processes is of great importance in the management of inflammation. Currently available techniques cannot decisively address this issue. In this respect, antimicrobial peptide 99m Tc-ubiquicidin (UBI) 29-41 scans have been showing interesting results. The aim of this study was to determine the accuracy of 99m Tc-UBI scan in the detection of osteomyelitis and to compare it with 99m Tc-methylene diphosphonate scan and magnetic resonance imaging (MRI).Methods Twenty patients (mean age = 48.90 years) with suspected osteomyelitis were included in this study. After evaluation of each patient through history taking, physical examination, appropriate laboratory tests, and other processes including bone probing, wound culture, and plain film radiography, MRIs, 99m Tc-UBI scans, and 99m Tc-methylene diphosphonate scans were performed. For quantitative analysis, the mean count of abnormal-tonormal (A/N) region was calculated for images acquired at 15, 30, 45, 60, 120, and 240 min to obtain the most favorable time for imaging. Results In total, osteomyelitis was detected in the 99mTc-UBI scans of 17 patients, indicating 100% accuracy, compared with an accuracy of 90% for osteomyelitis detected in three-phase bone scans. The maximum mean A/N was observed at 15 min after intravenous injection (median: 1.91; interquartile range: 1.54-2.94). MRI was performed in 12 cases only with 75% accuracy. In addition, the A/N ratios for the 99m Tc-UBI scans were not significantly different between patients with or without Staphylococcus aureus growth on wound cultures.Conclusion For fast imaging with high accuracy, 99m Tc-UBI 29-41 is a suitable choice for the detection of osteomyelitis.

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“…Гадо-линий накапливается в гиповаскулярных участках кости, что позволяет дифференцировать остеоми-елит от флегмоны мягких тканей или абсцесса. Исследования с контрастными препаратами дают возможность с большей уверенностью предпола-гать наличие эпифизарного остеомиелита, если на МР-томограмме имеются признаки периостально-го отека или отека мягких тканей [31].…”

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Methods of diagnosis of acute epiphyseal osteomyelitis in children

Labuzov

Сергеевич²,

Salopenkova

et al. 2017

Pediatr Traum Orthop Reconstr Surg

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1 ФГБОУ ВО «Смоленский государственный медицинский университет» Минздрава России, Смоленск; 2 ОГБУЗ «Смоленская областная клиническая больница», Смоленск; 3 ФГБУ «НИДОИ им. Г.И. Турнера» Минздрава России, Санкт-Петербург В статье представлен анализ различных методов диагностики эпифизарного остеомиелита -рентгенография, ультразвуковая диагностика, компьютерная томография, магнитно-резонансная томография, радиоизотопная остеосцинтиграфия. Приводятся недостатки и преимущества, а также оцениваются возможности каждого из методов с позиций ранней диагностики остеомиелита у детей. По данным литературы, наиболее эффективными и надежными методами ранней диагностики эпифизарно-го остеомиелита в педиатрической практике являются магнитно-резонансный и ультразвуковой, у представ-ленных методов отсутствует лучевая нагрузка, в то же время при использовании ультразвукового метода не требуется полная неподвижность пациента, его можно применять с момента новорожденности и в любом количественном режиме, а общедоступность и относительная низкая стоимость ультразвуковой аппаратуры позволяет иметь ее в любых медицинских учреждениях.Ключевые слова: острый эпифизарный остеомиелит, ребенок, рентгенография, ультразвуковая диагностика, компьютерная томография, магнитно-резонансная томография, радиоизотопная остеосцинтиграфия. Summary. The article presents the analysis of different method for diagnosis of epiphyseal osteomyelitis, including radiography, ultrasonography, computed tomography, magnetic resonance tomography, and radioisotope bone scans. We address the advantages, disadvantages, and possibilities of each method from the standpoint of early diagnosis of osteomyelitis in children. Based upon the literature, the most effective and reliable methods for early diagnosis of epiphyseal osteomyelitis in pediatric patients are magnetic resonance and ultrasound. The present diagnostic methods involve no radiation exposure. Using an ultrasonic diagnostic method does not require complete immobility of the patient, can be used from the moment of birth, has widespread availability, and has a relative low cost to allow its use in any medical institution. METHODS OF DIAGNOSIS OF ACUTE EPIPHYSEAL OSTEOMYELITIS IN CHILDREN

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Diagnosis of Osteomyelitis in Children: Utility of Fat-Suppressed Contrast-Enhanced MRI

Cited by 92 publications

References 19 publications

Infection: musculoskeletal

Infection: musculoskeletal

Diagnostic value of 99mTc-ubiquicidin scintigraphy for osteomyelitis and comparisons with 99mTc-methylene diphosphonate scintigraphy and magnetic resonance imaging

Methods of diagnosis of acute epiphyseal osteomyelitis in children

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