Utility of unenhanced fat-suppressed T1-weighted MRI in children with sickle cell disease — can it differentiate bone infarcts from acute osteomyelitis?

Delgado, Jorge; Bedoya, Maria A.; Green, Abby M.; Jaramillo, Diego; Ho-Fung, Víctor

doi:10.1007/s00247-015-3423-8

Cited by 18 publications

(11 citation statements)

References 22 publications

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“…Conversely, we found that the majority of patients with culture‐positive OM had MRI findings consistent with OM. Prior studies have shown that various imaging studies including bone scintigram, ultrasound, contrast enhanced, and unenhanced fat‐suppressed T1‐weighted MRI may not accurately and consistently distinguish between OM and VOC/bone infarction in children with SCD 21‐23 . In SCD, red marrow hyperplasia, perivascular fibrosis, and hemosiderosis lead to baseline marrow signal alterations on MRI further complicating detection of superimposed infarction and/or infection 7 .…”

Section: Discussionmentioning

confidence: 99%

Characteristics and outcomes of osteomyelitis in children with sickle cell disease: A 10‐year single‐center experience

Weisman

Nickel

Darbari

et al. 2020

Pediatric Blood & Cancer

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Background Patients with sickle cell disease (SCD) are at increased risk for osteomyelitis (OM). Diagnosis of OM in SCD is challenging as the clinical presentation is similar to a vasoocclusive crisis (VOC) with no diagnostic gold standard. We report characteristics and outcomes of OM in SCD patients treated at our center over 10‐year period. Design/Method We conducted a retrospective analysis of patients with SCD who were treated for OM at our center over a 10‐year period (2006‐2016). Cases were identified utilizing radiology data mining software. Radiology reports and medical charts of potential OM cases were reviewed. Results Twenty‐eight children with SCD were treated for OM at our institution. Patients treated for OM were largely similar to patients treated for a VOC. However, patients treated for OM had significantly higher C‐reactive protein (10 mg/dL vs 5.58 mg/dL, P = 0.03) and erythrocyte sedimentation rate (60 mm/h vs 47 mm/h, P = 0.02). Magnetic resonance imaging (MRI) findings were consistent with OM in 18 (64%) patients and indeterminate in the remaining. Based on clinical, laboratory, and radiological findings, the diagnosis of OM was considered confirmed in 3 patients, probable in 6 patients, and presumed in 19 patients. Nontyphoidal Salmonella was isolated from cultures in 9 (32%) patients, while no organism was identified in 19 (67%) patients. All patients were treated with antibiotics. Six patients (21%) required surgical interventions. Conclusions OM continues to pose diagnostic challenges. Most patients are treated for OM without definitive confirmation. Nontyphoidal Salmonella was the only organism identified in our cohort.

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Section: Discussionmentioning

confidence: 99%

Characteristics and outcomes of osteomyelitis in children with sickle cell disease: A 10‐year single‐center experience

Weisman

Nickel

Darbari

et al. 2020

Pediatric Blood & Cancer

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“…16 These children are also at increased risk for bone infection secondary to immunosuppression from poor splenic function and chronically poor bone vascularization. 38 Bone infarction is the most common cause of hospitalization in the affected patients, 39 and it can represent an uncommon cause of acute limp when the lower extremity is affected.…”

Section: Diaphyseal Bone Infarcts Secondary To Hemoglobinopathymentioning

confidence: 99%

“…16 MRI is the most reliable technique for evaluating bone abnormalities in sickle-cell disease. 38 Jain et al 40 proposed that noncontrast T1-weighted MRI appearances accurately distinguish between osteomyelitis and sickle-cell disease, but a subsequent study refuted this statement. 38 Conventional radiographs are often normal or show subtle, nonspecific soft tissue edema during early stages of the disease.…”

Section: Diaphyseal Bone Infarcts Secondary To Hemoglobinopathymentioning

confidence: 99%

“…38 Jain et al 40 proposed that noncontrast T1-weighted MRI appearances accurately distinguish between osteomyelitis and sickle-cell disease, but a subsequent study refuted this statement. 38 Conventional radiographs are often normal or show subtle, nonspecific soft tissue edema during early stages of the disease. Ultrasound has been used to evaluate associated soft tissue and subperiosteal fluid collections; however, these findings can overlap with osteomyelitis.…”

Section: Diaphyseal Bone Infarcts Secondary To Hemoglobinopathymentioning

confidence: 99%

“…Ultrasound has been used to evaluate associated soft tissue and subperiosteal fluid collections; however, these findings can overlap with osteomyelitis. 38…”

Section: Diaphyseal Bone Infarcts Secondary To Hemoglobinopathymentioning

confidence: 99%

See 2 more Smart Citations

The Acutely Limping Preschool and School-Age Child: An Imaging Perspective

Chaturvedi

Cain

Rupasov

2018

Semin Musculoskelet Radiol

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Acute limp in a child presents a diagnostic conundrum and can result from a variety of causes. The underlying etiology is often referable to the hip, but the spine, abdomen, pelvis, or knee can be alternatively implicated. An adequate clinical history and satisfactory physical examination are often difficult in younger children. Consequently, there is disproportionate reliance on imaging to arrive at the correct diagnosis. The potential for rapid clinical deterioration and long-term sequelae is a risk with some of the conditions presenting with acute hip (septic hip, osteomyelitis). This review article describes the imaging appearance of common etiologies for acute limp in the ambulatory preschool (1-5 years) and school-age child (5-12 years). The ultimate goal is to familiarize the interpreting radiologist with the imaging appearance of specific clinical entities that lead to acute limp while providing a readily accessible resource on how to image the patient most appropriately and judiciously.

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Infection Mimics: Differential Diagnoses of Musculoskeletal Infections

Shih¹,

Thacker²

2022

Pediatric Musculoskeletal Infections

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Utility of unenhanced fat-suppressed T1-weighted MRI in children with sickle cell disease — can it differentiate bone infarcts from acute osteomyelitis?

Abstract: The bone marrow signal intensity on unenhanced T1-W fat-saturated MR images is not a reliable criterion to differentiate bone infarcts from osteomyelitis in children.

Cited by 18 publications

References 22 publications

Characteristics and outcomes of osteomyelitis in children with sickle cell disease: A 10‐year single‐center experience

Characteristics and outcomes of osteomyelitis in children with sickle cell disease: A 10‐year single‐center experience

The Acutely Limping Preschool and School-Age Child: An Imaging Perspective

Infection Mimics: Differential Diagnoses of Musculoskeletal Infections

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