Gadolinium-DOTA enhanced MRI of painful osseous crises in children with sickle cell anemia

Abstract

In order to evaluate the role of gadolinium-DOTA enhanced MRI in the management of painful osseous crises in children with sickle cell anemia (SCA), nine children with SCA underwent MRI, bone scans and ultrasonographic studies during 11 osseous crises. Imaging findings were compared with the final diagnosis: three acute osteomyelitis (AO) and 16 acute infarcts (AI). MRI could not differentiate AO from AI. The appearance of severe AI was very misleading and was similar to the usual appearance of AO, including soft tissue changes, periosteal reaction and patterns of enhancement. Gadolinium-DOTA enhanced MRI was useful for determining the anatomic site and extent of AO or AI and for distinguishing between necrotic material, fluid collection and vascularized inflammatory tissue. It can also help to guide the aspiration of intraosseous, subperiosteal and soft tissue fluid collections.

Sickle Cell Anemia

“…Thus, the differentiation of infection from marrow infarction at MR imaging may not be possible (42,50). Soft-tissue abnormalities such as edema and abnormal enhancement of periosteum, muscle, deep fascia, and subcutaneous fat were once thought to indicate osteomyelitis; unfortunately, the same softtissue abnormalities may also be seen with infarction (42,50). Studies of scintigraphic evaluation with various combinations of technetium-99m methylene diphosphonate, gallium-67, and Tc99m sulfur colloid have failed to produce definitive results.…”

“…Studies of scintigraphic evaluation with various combinations of technetium-99m methylene diphosphonate, gallium-67, and Tc99m sulfur colloid have failed to produce definitive results. In conclusion, imaging alone does not yet allow reliable and accurate differentiation of osteomyelitis from infarction (37,42,50).…”

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

“…Although the use of contrast agent in children with SCD is not associated with an increased risk of hemolysis or vaso-occlusive crisis [22], conflicting results for the differentiation of bone infarct from osteomyelitis using contrast-enhanced MRI have been found [9,10]. Additional research is required to determine the efficacy of contrastenhanced studies for this purpose.…”

“…The use of extra-osseous abnormalities in unenhanced MRI is not useful to differentiate bone infarct from osteomyelitis in children with SCD [10,21]. Although the use of contrast agent in children with SCD is not associated with an increased risk of hemolysis or vaso-occlusive crisis [22], conflicting results for the differentiation of bone infarct from osteomyelitis using contrast-enhanced MRI have been found [9,10].…”

“…Computed tomography (CT), ultrasonography (US) and enhanced MRI do not reliably distinguish these two entities [9][10][11][12][13]. To our knowledge, only a single article, with a population age 2-37 years, has suggested the use of unenhanced fat-suppressed T1-weighed images for the differentiation of bone infarct and osteomyelitis in children with SCD; Jain et al [14] reported areas of high bone marrow signal intensity in patients with bone infarct and areas of low bone marrow signal intensity in acute osteomyelitis.…”