Intramedullary and extramedullary fat globules on magnetic resonance imaging as a diagnostic sign for osteomyelitis

Davies, A. M.; Hughes, D. E.; Grimer, R. J.

doi:10.1007/s00330-005-2771-4

Cited by 50 publications

(38 citation statements)

References 22 publications

(30 reference statements)

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“…However, this is not pathognomonic for osteomyelitis, as fat globules can also be seen in sarcomas after treatment, in infarcts, and in Gaucher disease [ 23 ]. An extraosseous fat-fl uid level may be pathognomonic for osteomyelitis [ 24 ].…”

Section: Mrimentioning

confidence: 96%

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Musculoskeletal Infection

Stein-Wexler

2014

Pediatric Orthopedic Imaging

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Manifestation of musculoskeletal infection in children depends on the developmental anatomy of bones and in particular its changing vascular supply. Thus, it is essential to understand this process thoroughly. Osteomyelitis, septic arthritis, and cellulitis are relatively common. There are three accepted stages of osteomyelitisacute, subacute, and chronic. Each has a unique presentation and imaging appearance, but they can be confused with other entities. Radiology, ultrasound, nuclear imaging, CT, and MRI each play a critical role depending on the clinical scenario and the suspected pathogen. Much of this discussion focuses on common bacterial infections (including methicillin-resistant Staphylococcus aureus ), but meningococcemia, tuberculosis, fungal infections, and syphilis are also discussed. In addition, the chapter presents manifestations of osteomyelitis in unique locations, such as the epiphysis, the pelvis, and the spine, and in unique patient populations, such as those with sickle-cell disease. Although chronic recurrent multifocal osteomyelitis is auto-infl ammatory rather than infectious, we include it here as well.

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Section: Mrimentioning

confidence: 96%

“…Marrow edema is present, with a sharp, well-defi ned margin between normal and abnormal marrow (in acute osteomyelitis, the zone of transition is ill-defi ned) [ 7 ]. Fat signal-if present-is due to the restoration of normal marrow [ 23 ]. Primary differential considerations are osteosarcoma and Ewing sarcoma.…”

Section: Differential Diagnosismentioning

confidence: 99%

Musculoskeletal Infection

Stein-Wexler

2014

Pediatric Orthopedic Imaging

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“…It is likely that increased intramedullary pressure leads to necrosis of the adipose tissue and release of free fatty globules. Although not pathognomonic, fatty globules on MR imaging support the diagnosis of osteomyelitis over other marrow disorders such as neoplasia [20].…”

Section: Diagnostic Modalitiesmentioning

confidence: 99%

Infection: musculoskeletal

Jaramillo

2011

Pediatr Radiol

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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“…Literatürde bu konuda farklı araştırma sonuçları olmakla birlikte etnik köken ve yumuşak doku kitlesinin (beyaz ırk ve eşlik eden yumuşak doku kitlesi Ewing sarkomu lehinedir) ayrımda en önemli kriterler olduğu belirtilmektedir [6]. Kemik içinde veya komşuluğunda yağ lobül-lerinin görülmesi de osteomiyeliti destekleyen en önemli bulgulardan biridir [7]. Ancak bu bulgunun travma ve kemik enfarktı gibi durumlarda da görülebileceği akılda tutulmalıdır [8].…”

Section: Osteomiyelitunclassified

Ekstremitenin Travmatik Olmayan Acilleri

Özdemi̇r¹,

Kerimoğlu²

2016

Trd Sem

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Intramedullary and extramedullary fat globules on magnetic resonance imaging as a diagnostic sign for osteomyelitis

Cited by 50 publications

References 22 publications

Musculoskeletal Infection

Musculoskeletal Infection

Infection: musculoskeletal

Ekstremitenin Travmatik Olmayan Acilleri

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