Early diagnosis and response assessment in chronic recurrent multifocal osteomyelitis: changes in lesion volume and signal intensity assessed by whole-body MRI

Abstract

Objective: To assess the effectiveness of whole-body MRI (WB-MRI) in early diagnosis of chronic recurrent multifocal osteomyelitis (CRMO) and the prediction of clinical response through quantitative MRI features. Methods: 20 children (mean age, 10.3 years; range, 5–14 years) with CRMO underwent WB-MRI and were assessed with a clinical score (Jansson) at baseline (median time after first encounter, 8 months) and follow-up (median time after baseline, 11.5 months). Baseline WB-MRI scans were classified as early (within 6 months after first encounter) and late. Clinical responders and non-responders were compared regarding number and localization of bone lesions, lesion volume and T2 signal intensity (SI) ratio (lesion to muscle). Results: Diagnosis of CRMO was made promptly in the early WB-MRI group (n = 10; median, 3 months) compared to the late WB-MRI group (n = 10; 18 months; p = 0.006). Bone lesions were mainly located in the lower extremities (n = 119/223; 53%). No significant difference was detected regarding the number of bone lesions and lesion volume in the subgroups of clinical responders (n = 10) and non-responders (n = 10). Responders showed a higher volume reduction of bone lesions at follow-up compared to non-responders (p = 0.03). Baseline and follow-up SI ratios were lower in responders (5.6 and 5.8 vs 6.1 and 7.2; p = 0.047 and p = 0.005). Conclusion: The use of WB-MRI within 6 months of disease suspicion may serve as a benchmark to support early diagnosis of CRMO. T2 SI ratios and the reduction of lesions’ volume correlate with clinical outcome. Advances in knowledge: WB-MRI at an early stage of suspected CRMO plays a key role for early diagnosis. This is the first study showing that quantitative MRI features are suitable for response assessment and can be used as prognostic markers for the prediction of clinical response.

A Successful Bisphosphonates Monotherapy in Spinal Form of Paediatric Chronic Recurrent Multifocal Osteomyelitis (CRMO)—Case Report

“…As in cases of other syndromes associated with sterile osteomyelitis (Majeed, DIRA and PAPA syndromes), which were proven to be caused by single gene mutations [ 21 ], further analyses could lead to establishing reliable diagnostic tools for genetic assessment and evaluation of CRMO diagnosis [ 22 ]. The imaging technique, which in previous studies has been indicated as that offering the earliest and the best differentiating potential, consists of whole-body MRI scanning [ 10 , 23 ]. In the presented case, it was also MRI which led to an early discovery of multifocal lesions, and in consequence aroused the suspicion of CRMO.…”

“…The lesions are located most frequently in lower extremities (ca. 20–50% of lesions), especially in the pelvis [ 9 , 10 ]. Spinal lesions are found less frequently, amounting to ca.…”

“…Spinal lesions are found less frequently, amounting to ca. 13–17% of lesions [ 9 , 10 ]. It is the latter localisation which is associated with compressive fractures and malformations, leading to the developmental problems [ 11 ].…”

Advances in Bone Marrow Imaging: Strengths and Limitations from a Clinical Perspective

“…MRI acquisition protocols vary, but experts agree it should include T1-weighted, STIR, and DWI sequences, with recent trends toward using T2-weighted Dixon images to replace T1-weighted and STIR. 8,9, 41,81 Non-oncologic applications of whole-body MRI include the investigation of fever of unknown origin (FUO) in children, 82,83 the diagnosis and assessment of disease activity and treatment response in chronic recurrent multifocal osteomyelitis, [84][85][86][87][88][89] and synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO). 90 Whole-body MRI has also been used to detect clinically occult inflammatory lesions and to provide a simultaneous evaluation of the axial and appendicular skeleton in inflammatory arthritis.…”

Whole-Body MRI at Initial Presentation of Chronic Recurrent Multifocal Osteomyelitis, Juvenile Idiopathic Arthritis, Their Overlapping Syndrome, and Non-Specific Arthropathy

“…CRMO, also referred to by the alternative name chronic nonbacterial osteomyelitis (CNO), is a non-bacterial autoinflammatory osteitis of unclear etiology characterized by recurrent episodes of bone pain and a restricted range of movement for more than 6 months [1,7,10,[12][13][14]. More common in females, it has an incidence of 0.4/100,000 [1,12].…”