Clinical Indications for Repeat MRI in Children With Acute Hematogenous Osteomyelitis

Courtney, P. Maxwell; Flynn, John M.; Jaramillo, Diego; Horn, B. David; Calabro, Kristen; Spiegel, David A.

doi:10.1097/bpo.0b013e3181fcbae5

Cited by 32 publications

(17 citation statements)

References 9 publications

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“…Moreover, fat-suppressed contrast-enhanced MRI does not add to the sensitivity or specificity of the diagnosis, albeit it may bring a little more information in the search for an abscess [44]. Repeated MRI is indicated only if the recovery is not as expected, although even then the information thus obtained changes the treatment for only 10% of patients [45]. In vertebral osteomyelitis, repeated MRI might be useful because the endplate subchondral changes are sometimes unspecific and benign [46].…”

Section: Diagnosismentioning

confidence: 99%

Antibiotic treatment for acute haematogenous osteomyelitis of childhood: Moving towards shorter courses and oral administration

Pääkkönen¹,

Peltola²

2011

International Journal of Antimicrobial Agents

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Section: Diagnosismentioning

confidence: 99%

Antibiotic treatment for acute haematogenous osteomyelitis of childhood: Moving towards shorter courses and oral administration

Pääkkönen¹,

Peltola²

2011

International Journal of Antimicrobial Agents

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“…In a recent series, subperiosteal abscesses only occurred in children with a CRP greater than 3.6 mg/dL. Children with MRSA infection and a CRP greater than 6 mg/dL have a 40% chance of having deep venous thrombosis [11,12].…”

Section: Clinical Considerationsmentioning

confidence: 97%

“…Once the diagnosis of osteomyelitis is established, serial MR imaging studies appear to be of limited value in terms of affecting management [11]. On patients who do not respond to therapy or who have a persistently elevated CRP level, a repeat MRI may help by showing the development of an abscess.…”

Section: Role Of Imaging In Guiding Therapymentioning

confidence: 99%

Infection: musculoskeletal

Jaramillo

2011

Pediatr Radiol

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103

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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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“…Die limitierenden Faktoren der MRT-Untersuchung sind die geringe Verfügbarkeit sowie die begleitende Anästhesie, die bei Kleinkindern zur Ruhigstellung benötigt wird [26]. Dies veranschaulicht eine australische Studie aus dem Jahr 2016, welche retrospektiv 299 Kinder mit AHO untersuchte, von denen nur insgesamt 4 % eine MRT zur Abklärung erhielten [27].…”

Section: äTiologieunclassified