Role of MRI in the diagnosis and treatment of osteomyelitis in pediatric patients

Abstract

Osteomyelitis is a significant cause of morbidity in children throughout the world. Multiple imaging modalities can be used to evaluate for suspected osteomyelitis, however magnetic resonance imaging (MRI) has distinct advantages over other modalities given its ability to detect early changes related to osteomyelitis, evaluate the true extent of disease, depict extraosseous spread of infection, and help guide surgical management. MRI has assumed a greater role in the evaluation of osteomyelitis with the increase in musculoskeletal infections caused by methicillin-resistant Staphylococcus aureus which have unique imaging features that are well-demonstrated with MRI. This review focuses primarily on the use of MRI in the evaluation of osteomyelitis in children and will include a discussion of the clinically important and characteristic findings on MRI of acute bacterial osteomyelitis and related conditions.

Detecting Chronic Post-Traumatic Osteomyelitis of Mouse Tibia via an IL-13Rα2 Targeted Metallofullerene Magnetic Resonance Imaging Probe

“…Targeted MRI appears to be a favored choice as it not only provides excellent imaging contrast and resolution, but also allows detection of biological response at functional or even molecular level without employing ionizing radiation. 18 Recently, superparamagnetic iron oxide nano-particles (SPIONs) have been utilized as contrast agents for in vivo MRI detection of infiltrated macrophages to identify infection in patients with septic arthritis and osteomyelitis, given to the phagocytosis by macrophages after probe administration. 19,20 This is because the persistence of the pathogenic agents during the chronic stage of osteomyelitis leads to constant recruitment of macrophages to the site of infection, resulting in macrophages as the most abundant immune cells in the infection foci, unlike aseptic inflammation.…”

“…23 IL-13 mediates its effects via a complex receptor system that includes IL-4R α , IL-13R α 1, and IL-13R α 2. 13–18 IL-13R α 1 and IL-4R α form a heterodimeric complex that signals through the JAK-STAT pathway. In contrast, IL-13R α 2 has been postulated to be a decoy receptor, not responsible for the signal transduction.…”

The Beit CURE Classification of Childhood Chronic Haematogenous Osteomyelitis—a guide to treatment

“…Ultrasound, CT and MRI have been shown to be reliable modalities in both diagnosis and treatment planning [9]; however, in the resource-poor countries that this disease is most prevalent, these advanced diagnostics are often unavailable. Only one study of CCHOM in patients from resource-poor countries has used MRI, in which patients were expatriated to Germany for treatment [10].…”

Distal Forearm Fracture Open Reduction–Internal Fixation: Sonographic Detection of Hardware Malalignment and Associated Tendon Injuries Missed by Radiography

“…Postoperatively, despite multiplanar views, radiographs also can fail to show subtle abnormalities in hardware placement. Magnetic resonance imaging is often used in assessments for infection, particularly osteomyelitis, but artifacts around tendons due to hardware remain a substantial limitation . Computed tomography has the advantage of showing more subtle changes in hardware misalignment or prominence but has the drawbacks of radiation exposure and beam‐hardening metallic hardware artifacts …”

“…Magnetic resonance imaging is often used in assessments for infection, particularly osteomyelitis, but artifacts around tendons due to hardware remain a substantial limitation. 9 Computed tomography has the advantage of showing more subtle changes in hardware misalignment or prominence but has the drawbacks of radiation exposure and beam-hardening metallic hardware artifacts. 1,2 The diagnostic accuracy of sonography for tendon abnormalities is comparable with that of MRI.…”