Gray-scale and color Doppler ultrasonographic evaluation of reactivated post-traumatic/postoperative chronic osteomyelitis

Balanika, Alexia; Papakonstantinou, Olympia; Kontopoulou, Christine; Baltas, Christos; Athanassia, Sofia; Kanelakopoulou, K.; Brountzos, Elias; Γουλιάμος, Αθανάσιος; Kelekis, Nikolaos

doi:10.1007/s00256-008-0616-3

Cited by 10 publications

(15 citation statements)

References 33 publications

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“…Previous literature has demonstrated US to be a promising tool in monitoring the disease activity of acute OM, RA, and GA . However, the differential diagnosis can be challenging.…”

Section: Discussionmentioning

confidence: 99%

“…Besides bone cortex defects, US features at the erosive site were evaluated, including juxtacortical fluid, fistulous tract extending to the bone surface, and periosteal vascularity . Whether the periosteal tissue eroding bone contained small hyperechoic spots suggestive of tophaceous material was also determined.…”

Section: Methodsmentioning

confidence: 99%

“…US has shown its accuracy in the evaluation of OM in immature bones of children . Concerning adult patients with post‐traumatic or postoperative chronic OM, the imaging characteristics of diagnostic US, including fistulous tracts, juxtacortical fluid collections, periosteal thickening and periosteal vascularity, were reported useful for the detection of reactivated bone infection, among which periosteal vascularity is the most predictive sign . In RA, US has been demonstrated to be specific for synovitis as well as erosions, and able to detect subclinical disease .…”

Section: Introductionmentioning

confidence: 99%

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Can ultrasound differentiate acute erosive arthritis associated with osteomyelitis, rheumatoid arthritis, or gouty arthritis?

Hsiao

Hsu

et al. 2019

Int J of Rheum Dis

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Aim The study intended to determine the specific ultrasonographic features of acute arthritis with periarticular bone erosions caused by acute osteomyelitis (OM), rheumatoid arthritis (RA) and gouty arthritis (GA). Method We included 33 patients (seven with acute OM, 18 with RA flares, and eight with GA attacks) having acute monoarthritis or oligoarthritis, and receiving ultrasound (US) examinations in the acute stage. The US images were rated by three rheumatologists blinded to the diagnosis. The median scores of their evaluation of the subcutaneous tissue, periosteum, and synovium were compared. Interrater reliability was calculated using Cronbach's alpha. Results The highest mean grade of subcutaneous edema appeared in patients with acute OM, and grade 2 edema was more frequent than patients with RA and GA (P = .003 and P = .026, respectively; α = .869). The prevalence of subcutaneous power Doppler signal was also higher in patients with acute OM than in those with RA and GA (P < .001 and P = .041, respectively; α = .756). Periosteal vascularity presented more frequently in acute OM (P = .003 compared with RA; P = .041 compared with GA), but the interrater reliability was poor (α = .518). The tophaceous material in GA was distinctive from OM and RA (P = .010 and P < .001, respectively; α = .774). Conclusion The most discriminative US features in this study were the subcutaneous tissue changes in addition to the periosteal findings. US could contribute to the differential diagnosis of acute erosive arthritis.

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“…Previous literature has demonstrated US to be a promising tool in monitoring the disease activity of acute OM, RA, and GA . However, the differential diagnosis can be challenging.…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Can ultrasound differentiate acute erosive arthritis associated with osteomyelitis, rheumatoid arthritis, or gouty arthritis?

Hsiao

Hsu

et al. 2019

Int J of Rheum Dis

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“…The use of US is debated. Fistulous tracts, periosteal thickening, cortical discontinuity, juxtacortical fluid, and soft-tissue abscess have been described as sonographic signs of reactivated osteomyelitis in the setting of prior trauma or surgery [37]. Unfortunately, the study design did not assess the presence of these findings in a control group.…”

Section: Variant 4: Soft-tissue or Juxta-articular Swellingmentioning

confidence: 99%

“…Although a well-described complication of chronic osteomyelitis, sinuses also can be secondary to abscess formation from a retained foreign body. Persistent bone infection results in continuous infection of the overlying soft tissue, with consequent formation of a sinus tract to allow pus drainage through the skin [37]. Initial imaging typically includes radiographs of the affected bone or joint [5].…”

Section: Variant 4: Soft-tissue or Juxta-articular Swellingmentioning

confidence: 99%

ACR Appropriateness Criteria ® Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infection (Excluding Spine and Diabetic Foot)

Beaman

Herrmann

Kransdorf

et al. 2017

Journal of the American College of Radiology

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Infection of the musculoskeletal system is a common clinical problem. Differentiating soft tissue from osseous infection often determines the appropriate clinical therapeutic course. Radiographs are the recommend initial imaging examination, and although often not diagnostic in acute osteomyelitis, can provide anatomic evaluation and alternative diagnoses influencing subsequent imaging selection and interpretation. MRI with contrast is the examination of choice for the evaluation of suspected osteomyelitis, and MRI, CT, and ultrasound can all be useful in the diagnosis of soft tissue infection. CT or a labeled leukocyte scan and sulfur colloid marrow scan combination are alternative options if MRI is contraindicated or extensive artifact from metal is present. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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Ultrasound and bone: a pictorial review

Bianchi¹

2020

J Ultrasound

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Gray-scale and color Doppler ultrasonographic evaluation of reactivated post-traumatic/postoperative chronic osteomyelitis

Abstract: A constellation of gray-scale and CDUS findings can be highly indicative of reactivated bone infection in patients with long-standing chronic post-traumatic/post-operative osteomyelitis.

Cited by 10 publications

References 33 publications

Can ultrasound differentiate acute erosive arthritis associated with osteomyelitis, rheumatoid arthritis, or gouty arthritis?

Can ultrasound differentiate acute erosive arthritis associated with osteomyelitis, rheumatoid arthritis, or gouty arthritis?

ACR Appropriateness Criteria ® Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infection (Excluding Spine and Diabetic Foot)

Ultrasound and bone: a pictorial review

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