Whole‐body MRI in pediatric undefined inflammatory conditions

Abstract

Background: Whole-body magnetic resonance imaging (WBMRI) is a multiregional imaging technique suitable for investigating the extent of multisystemic diseases without exposure to radiation, with a high sensitivity to bone alterations. The aim of our study was to evaluate the role of WBMRI in the workup of children with non-specific musculoskeletal features and non-indicative laboratory and instrumental data, who were suspected to have a rheumatologic disease. Methods: We retrospectively analyzed medical records, including laboratory tests and radiological data of 34 children who had been evaluated due to non-specific musculoskeletal manifestations, for which a WBMRI was prescribed. Results: We included 34 children, 19 females and 15 males, mean age 10 years (range 2-16 years), with the following clinical features: diffuse arthralgia (12 children), persistent fever (2 children), persistent fever and diffuse arthralgia (20 children). Serologic inflammatory markers were increased in 29/34 patients. Twenty-five children had already received X-ray and / or ultrasound before WBMRI, with a negative / uninformative result. WBMRI was performed 3-6 weeks (median, 3.5 weeks) after the initial presentation of symptoms. In 22/34 (65%) children, WBMRI revealed some abnormalities that supported the final diagnosis. Twelve out of 34 children (35%) were be affected by chronic recurrent multifocal osteomyelitis. Conclusions: WBMRI is helpful in pediatric rheumatology for the differential diagnosis of undefined inflammatory conditions. It appears to be a promising tool, especially in the detection of multifocal bone lesions. The diagnosis that mainly benefits from WBMRI in our series is chronic recurrent multifocal osteomyelitis. WBMRI can also help in excluding neoplastic diseases.

Utilization of Whole-Body Magnetic Resonance Imaging in Challenging Diagnoses in Pediatric Rheumatology

“…Pediatric patients may exhibit a relatively restricted capacity to articulate and localize symptoms within the musculoskeletal system, thereby rendering the examination of the musculoskeletal system challenging in clinical practice. 8 Hence, in pediatric patients with diffuse pain that cannot be localized, the importance of imaging studies becomes even more significant. Due to its easy accessibility and cost-effectiveness, conventional x-ray is commonly the initial imaging test in these patients, yet it may lack suitability for examining soft tissues and exhibit lower sensitivity to early bone changes compared to MRI.…”

“… 13 Whole-body magnetic resonance imaging has gained significance in pediatrics due to its ability to describe and characterize disorders at an early or pre-clinical stage without the use of ionizing radiation, especially within a 40-minute data collection period. 8 …”

“…6 , 7 It allows for the description and characterization of disorders at an early, and in some cases pre-clinical stage, without ionizing radiation, hence rising in significance and implementation in pediatrics within a 40-minute data collection period. 8 , 9 Musculoskeletal system involvement is observed in many diseases during the pediatric age, and multifocal musculoskeletal system symptoms are more commonly encountered in children compared to adults. Children may have a relatively limited ability to express and localize symptoms in the musculoskeletal system, making musculoskeletal system examination challenging in clinical practice.…”