Imaging of Osteomyelitis with Special Reference to Children

Abstract

Infection of bone in children represents a diagnostic and therapeutic challenge to the pediatrician, the surgeon, the radiologist, and the pathologist. The pattern of manifestation varies and is dependent on the site of involvement, the initiating event, the infecting organism, and the acute or chronic nature of the illness. Early diagnosis allows prompt treatment, which can prevent many of the dreaded complications of this disease. Plain radiographs remain the initial imaging modality used in the diagnosis and differential diagnosis of osteomyelitis. However, with the advent of newer imaging techniques such as scintigraphy, ultrasonography, computed tomography, and magnetic resonance imaging, a higher degree of accuracy in diagnosis and definition of the extent of the disease has been achieved. The time interval between the onset of symptoms and diagnosis has also been significantly reduced. Although magnetic resonance imaging has the additional advantage of multiplanar capability, greater anatomic detail, and excellent soft tissue resolution, it is a relatively expensive technique, which somewhat limits its use. Following a brief review of the classification and pathophysiology of osteomyelitis, we have tried to elucidate the utility of various imaging modalities in the diagnosis of osteomyelitis in children, outlining their relative strengths and weaknesses. Certain entities specific to children and a brief review of differential diagnosis are also presented.

Update on Acute Bone and Joint Infections in Paediatrics: A Narrative Review on the Most Recent Evidence-Based Recommendations and Appropriate Antinfective Therapy

“…MRI is superior to other imaging methods, particularly to identify early infections affecting the bone marrow before the involvement of the cortical bone, to detect pelvic OM and discitis that are usually undetected by X-rays, to evaluate the involvement of the growth plates, joint structures, and soft tissues (e.g., pyomyositis, muscular abscesses) and to exclude deep venous thrombosis associated with BJI [ 41 , 42 , 43 ]. Furthermore, MRI is usually required in presurgical planning and surgical follow-up when drainage is indicated.…”

Magnetic Resonance Imaging in Foals With Infectious Arthritis

“…Subjectively, the 3D RSSG water excitation sequence used in the current study provided the best contrast between subchondral bone and articular cartilage and hypointense synovial fluid and has potential as a pulse sequence to examine cartilage thickness with MR imaging. In humans, the highest accuracies of cartilage assessment are with T1W spoiled gradient echo imaging with fat suppression and T2W fast spin echo with fat suppression . We did not perform T2W fast spin echo fat suppression sequences in this study.…”

Concomitant septic arthritis and osteomyelitis of the hip in young children; a new pathophysiological hypothesis suggested by MRI enhancement pattern

“…In recent years, MRI has gained interest to establish the diagnosis of osteoarticular infection of the hip, especially for excluding concomitant SA with AHO [ 15 – 18 ].…”