Optimal imaging strategy for community-acquired Staphylococcus aureus musculoskeletal infections in children

Browne, Lorna P.; Mason, Edward O.; Kaplan, Sheldon L.; Cassady, Christopher I.; Krishnamurthy, Rajesh; Guillerman, R. Paul

doi:10.1007/s00247-008-0888-8

Cited by 112 publications

(72 citation statements)

References 9 publications

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“…The sensitivity has decreased as infections that have marked soft tissue involvement have increased. Currently, the sensitivity may be as low as 53% [29]. FDG PET appears to be considerably more sensitive (95%) and specific (87%).…”

Section: Diagnostic Modalitiesmentioning

confidence: 99%

“…A recent series found that nearly 70% of community-acquired (CA) S. aureus infections [29] were associated with such extraosseous findings. An important contributor has been the rise of community-acquired MRSA, which now accounts for 30%-40% of osteomyelitis cases [32].…”

Section: Determination Of the Extent Of Diseasementioning

confidence: 99%

“…An important contributor has been the rise of community-acquired MRSA, which now accounts for 30%-40% of osteomyelitis cases [32]. In patients with CA MRSA, two series reported rates of surgery greater than 90% [29,32]. Another ominous trend has been the increasing involvement of the cartilaginous epiphyses in younger patients [23].…”

Section: Determination Of the Extent Of Diseasementioning

confidence: 99%

“…There is less of an advantage in using scintigraphy for those cases in which there may be disseminated disease or in which there are no focal symptoms. Second, growing concern about exposing children to radiation has led to increasing substitution of MRI and sonography for scintigraphy and CT. Third, MRSA has changed the presentation of the disease, with a significant percentage of patients having soft tissue findings and decreased vascularization, both of which are better depicted by MRI [29]. Finally, MRI has become more readily available, even on an emergency basis.…”

Section: Role Of Imaging In Guiding Therapymentioning

confidence: 99%

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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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Section: Diagnostic Modalitiesmentioning

confidence: 99%

Section: Determination Of the Extent Of Diseasementioning

confidence: 99%

Section: Determination Of the Extent Of Diseasementioning

confidence: 99%

Section: Role Of Imaging In Guiding Therapymentioning

confidence: 99%

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Infection: musculoskeletal

Jaramillo

2011

Pediatr Radiol

103

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“…МРТ позиционируется как предпочтитель-ный метод визуализации с высокой чувствитель-ностью (82-100 %) и специфичностью (75-99 %) в отличие от ограниченно применимых КТ и УЗИ [9,13,34]. В случае использования последователь-ности STIR МРТ имеет стопроцентную прогно-стическую ценность отрицательного результата, и диагноз остео миелита может быть исключен при отсутствии изменений на МР-томограммах [13].…”

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Methods of diagnosis of acute epiphyseal osteomyelitis in children

Labuzov

Сергеевич²,

Salopenkova

et al. 2017

Pediatr Traum Orthop Reconstr Surg

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1 ФГБОУ ВО «Смоленский государственный медицинский университет» Минздрава России, Смоленск; 2 ОГБУЗ «Смоленская областная клиническая больница», Смоленск; 3 ФГБУ «НИДОИ им. Г.И. Турнера» Минздрава России, Санкт-Петербург В статье представлен анализ различных методов диагностики эпифизарного остеомиелита -рентгенография, ультразвуковая диагностика, компьютерная томография, магнитно-резонансная томография, радиоизотопная остеосцинтиграфия. Приводятся недостатки и преимущества, а также оцениваются возможности каждого из методов с позиций ранней диагностики остеомиелита у детей. По данным литературы, наиболее эффективными и надежными методами ранней диагностики эпифизарно-го остеомиелита в педиатрической практике являются магнитно-резонансный и ультразвуковой, у представ-ленных методов отсутствует лучевая нагрузка, в то же время при использовании ультразвукового метода не требуется полная неподвижность пациента, его можно применять с момента новорожденности и в любом количественном режиме, а общедоступность и относительная низкая стоимость ультразвуковой аппаратуры позволяет иметь ее в любых медицинских учреждениях.Ключевые слова: острый эпифизарный остеомиелит, ребенок, рентгенография, ультразвуковая диагностика, компьютерная томография, магнитно-резонансная томография, радиоизотопная остеосцинтиграфия. Summary. The article presents the analysis of different method for diagnosis of epiphyseal osteomyelitis, including radiography, ultrasonography, computed tomography, magnetic resonance tomography, and radioisotope bone scans. We address the advantages, disadvantages, and possibilities of each method from the standpoint of early diagnosis of osteomyelitis in children. Based upon the literature, the most effective and reliable methods for early diagnosis of epiphyseal osteomyelitis in pediatric patients are magnetic resonance and ultrasound. The present diagnostic methods involve no radiation exposure. Using an ultrasonic diagnostic method does not require complete immobility of the patient, can be used from the moment of birth, has widespread availability, and has a relative low cost to allow its use in any medical institution. METHODS OF DIAGNOSIS OF ACUTE EPIPHYSEAL OSTEOMYELITIS IN CHILDREN

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