Imaging of Chronic Recurrent Multifocal Osteomyelitis

Abstract

Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory disorder of children and young adults that is characterized by nonbacterial osteomyelitis. Patients typically present with multifocal bone pain secondary to sterile osseous inflammation, and the disease has a relapsing and remitting course. The cause of CRMO remains unclear, although the results of several studies have suggested a genetic component. The typical imaging findings of CRMO include lytic and sclerotic lesions in the metaphyses of long bones and the medial clavicles. Other common sites of disease are the vertebral bodies, pelvis, ribs, and mandible. CRMO is often bilateral and multifocal at presentation. Owing to the lack of a diagnostic test, CRMO remains a diagnosis of exclusion. Although generally a self-limiting disease, CRMO can have a prolonged course and result in significant morbidity. Radiologists can be the first to suggest this diagnosis given its characteristic radiographic appearance and distribution of disease. Radiologists should be familiar with the typical imaging findings of CRMO to prevent unnecessary multiple biopsies and long-term antibiotic treatment in children with CRMO.

Influence of Chronic Recurrent Multifocal Osteomyelitis (CRMO) On Densitometry Measurements Obtained by Dual X-Ray Absorptiometry

“…On a per-lesion basis, 129 CRMO-related skeletal lesions were detected on MRI and/or bone scan and only 25 (19.4%) of these lesions were detected on DXA. Most of the lesions were identified in the distal femoral metadiaphysis [9,10], while other lesions were identified in the proximal tibia [6], lumbar vertebral bodies [3], clavicle [4], and mid/hind foot bones [2].…”

“…Each child was scanned twice; once with a total-body scan requiring 3-5 minutes, and then with a dedicated lumbar spine scan (to include L1-L4) similarly requiring 30 seconds to 1 minute [6]. Results were determined as BMD (g/cm 2 ) and BMC (g) values and age and sex matched Z-score. The height-for-age Z-score-adjusted BMD/BMC Z-scores was not calculated as none of these patients had a short status or a delayed bone age [7].…”

“…CRMO typically affects the metaphysis of long bones and spine in children and young adolescents [1]. Radiographically, early CRMO lesions show osteolysis, whereas later stages of the disease may present as hyperostosis and sclerosis [2]. Treatment options include non-steroidal anti-inflammatory agents (NSAIDs), corticosteroids, methotrexate, bisphosphonates as well as anti-TNF therapies [1].…”

Chronic recurrent multifocal osteomyelitis with an atypical presentation in an adult man

“…CRMO has actually been described in adults as old as 55 years old, although mostly in women [26]. Although considered to be a rare disorder, CRMO is likely underdiagnosed as it has no specific clinical, laboratory, imaging, or pathological findings.…”

“…As such, the diagnosis requires a high index of suspicion and a team effort from the clinician, orthopedic surgeon, radiologist, and pathologist. It is important for skeletal radiologists to become familiar with the varied imaging findings of CRMO, as imaging plays a vital role in the workup of this condition and they will be often the first to suggest the diagnosis [26]. …”