Magnetic Resonance Imaging Detection of Early Experimental Periostitis

Spaeth, H J; Chandnani, Vijay P.; Beltran, Javier; Lucas, Joel G.; Ortiz, Irene; King, Masao; Bennett, William F.; Bova, JG; Mueller, Charles F.; Shaffer, Phillip

doi:10.1097/00004424-199104000-00003

Cited by 18 publications

(1 citation statement)

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“…[ 6 ] Computed tomography can detect ossified periosteum at an earlier stage, while early nonossified periosteum is only visualized by US and magnetic resonance imaging (MRI). [ 7 8 ] As opposed to MRI, performing US in ambulatory and point-of-care settings is much more convenient and practical.…”

Section: Introductionmentioning

confidence: 99%

Periosteal Manifestations of Osteomyelitis and Arthritis on Ultrasound: A Systematic Review

Waitayangkoon,

Weilg-Espejo,

Kissin

2023

Journal of Medical Ultrasound

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Ultrasound (US) can visualize the periosteal changes in the early stage compared to radiography. In this review, we studied periosteal manifestations on US and assessed their diagnostic utility for osteomyelitis (OM) and arthritis. We included articles that studied ultrasonographic findings of periosteal changes in OM and arthropathies with aims to systematically review periosteal manifestations of each condition and summarize diagnostic values of each finding. A total of 13 articles were included in the systematic review. Of these, 10 articles are on OM, 3 articles are on psoriatic arthritis (PsA), 1 article is on rheumatoid arthritis (RA), and 1 article is on gouty arthritis (GA). In OM, subperiosteal fluid/subperiosteal collection (SF/SC) was detected in 32%–76% within 72 h after presentation. Periosteal reaction (PR) was seen after day 4 and the sensitivity on US ranges from 33% to 100%. In PsA, PR was seen near 16%–59% in active PsA joints. Periosteal changes are rarely detected in RA joints. Small hyperechoic spots were seen in 87.5% of GA. SF/SC may be seen on US as the earliest sign followed by PR for OM. PR is more specific in PsA than RA. Further investigations on periosteal abnormalities on US are warranted to confirm our findings.

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Section: Introductionmentioning

confidence: 99%

Periosteal Manifestations of Osteomyelitis and Arthritis on Ultrasound: A Systematic Review

Waitayangkoon,

Weilg-Espejo,

Kissin

2023

Journal of Medical Ultrasound

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Chronic recurrent multifocal osteomyelitis (CRMO) with symmetric involvement of both femora: X‐ray, bone scintigram, and MR imaging findings in one case

Buck

Treumann

Winiker

et al. 2007

Magnetic Resonance Imaging

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The case of a 17-month-old boy with symmetric involvement of both femora in chronic recurrent multifocal osteomyelitis (CRMO) is presented. Imaging showed an extraordinary involvement of both femoral diaphyses and distal metaphyses with extensive lamellar-like periosteal reactions. Diagnosis was based upon laboratory tests, bone scintigraphy, and MRI findings and was proved by open bone biopsy. SYMMETRIC INVOLVEMENT of extremity bones in chronic recurrent multifocal osteomyelitis (CRMO) is rare and is documented in the literature in several case reports (1-3). The first case was published by Giedion et al (1) in 1972. Both femoral metaphyses were involved in a nine-year-old girl. In 1974, Gustavson and Wilbrand (3) published another case of symmetric chronic osteomyelitis of the distal femora in a seven-year-old girl. Two further cases of bilateral symmetric CRMO of the femoral metaphyses, in a four-year-old girl and in an eight-year-old boy, were published by Brown and Wilkinson in 1988 (13). Whereas periosteal changes were mild in these cases, Schenk et al (4) reported progressive hyperostosis with osteolytic areas in another case of CRMO with unilateral femoral involvement. We describe the imaging findings of a symmetric involvement of both femora in CRMO with extensive periosteal changes and osteolyses. CASE REPORTA 17-month-old boy was admitted to hospital after a four week episode of weakness, inappetence, and weight loss. Eventually, he refused to walk. Ultrasonography of the hip and knee joints was normal. Laboratory tests showed a white blood cell count of 16,800/ mm 3 , a C-reactive protein of 99 mg/liter, and an erythrocyte sedimentation rate (ESR) of 75 mm, indicating an inflammatory process. Elevated serum alkaline phosphatase of 435 U/liter pointed to a process at the skeletal system. Bone scintigraphy with 99m Technetium-labeled methylene diphosphonate showed multiple abnormal foci of increased calcium turnover. The main finding was a symmetrically increased radiotracer uptake in the diaphyses of both femora (Fig. 1a). In addition, several ribs showed a mildly increased activity (Fig. 1b). Radiographs were obtained and extensive concentric solid periosteal new bone formation at both femoral diaphyses with a few small osteolytic zones were discovered (Fig. 2a). The third to sixth rib on the right side were deformed and sclerotic (Fig. 2b). Based on these findings, multifocal chronic osteomyelitis was presumed.As differential diagnoses, neoplastic diseases such as histiocytosis X or leukemia, and metastatic disease from Ewing sarcoma or neuroblastoma were considered. Ultrasonography of the abdomen and bone marrow biopsy gave no further evidence of malignant disease.For further assessment of the femoral lesions, MRI was performed on a 1.5-Tesla scanner (Magnetom Symphony; Siemens, Erlangen, Germany).Transverse T2-weighted (TR ϭ 3800 msec, TE ϭ 90 msec), T1-weighted (TR ϭ 560 msec, TE ϭ 12 msec), and T1-weighted images after intravenous (i.v.) injection of 0.1 mmol/kg of gadodiamide (Omniscan; Nycome...

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Periosteum: Characteristic imaging findings with emphasis on radiologic-pathologic comparisons

et al. 2014

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The periosteum covers most bone structures. It has an outer fibrous layer and an inner cambial layer that exhibits osteogenic activity. The periosteum is a dynamic structure that plays a major role in bone modeling and remodeling under normal conditions. In several disorders such as infections, benign and malignant tumors, and systemic diseases, the osteogenic potential of the periosteum is stimulated and new bone is produced. The newly formed bone added onto the surface of the cortex adopts various configurations depending on the modalities and pace of bone production. Our aim here is to describe the anatomy, histology, and physiology of the periosteum and to review the various patterns of periosteal reaction with emphasis on relations between radiological and histopathological findings. A careful evaluation of the periosteal reaction and appearance of the underlying cortex, in combination with the MRI, clinical, and laboratory data, provides valuable information on lesion duration and aggressiveness, thereby assisting in the etiological diagnosis and optimizing patient management. A solid reaction strongly suggests a benign and slow-growing process that gives the bone enough time to wall off the lesion. Single lamellar reactions occur in acute and usually benign diseases. Multilamellar reactions are associated with intermediate aggressiveness and a growth rate close to the limit of the walling-off capabilities of the bone. Spiculated, interrupted, and complex combined reactions carry the worst prognosis, as they occur in the most aggressive and fast-growing diseases: the periosteum attempts to create new bone but is overwhelmed and may be breached.

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Magnetic Resonance Imaging Detection of Early Experimental Periostitis

Cited by 18 publications

References 0 publications

Periosteal Manifestations of Osteomyelitis and Arthritis on Ultrasound: A Systematic Review

Periosteal Manifestations of Osteomyelitis and Arthritis on Ultrasound: A Systematic Review

Chronic recurrent multifocal osteomyelitis (CRMO) with symmetric involvement of both femora: X‐ray, bone scintigram, and MR imaging findings in one case

Periosteum: Characteristic imaging findings with emphasis on radiologic-pathologic comparisons

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