Role of MRI in detecting early physeal changes due to acute osteoarticular infection around the knee joint: a pilot study

Abstract

Physeal changes of any aetiology in children are usually diagnosed once the deformity is clinically evident. Between January 2006 and June 2007, 15 children who suffered from acute osteoarticular infection around the knee joint were studied. They were called up for follow-up six months after the onset of infection. All patients were evaluated by clinical and roentgenographic examination before undergoing magnetic resonance imaging (MRI) study of both knees "with the unaffected knee serving as control". Abnormal findings in the physis, metaphysis and/ or epiphysis on MRI were observed in five children. This group of five children was compared with the other ten children for clinical presentation and course of disease. We believe that MRI is a useful tool in the evaluation of growth plate insult in the early period following acute osteoarticular infection, and we can diagnose and prevent the catastrophic complications of the same.Résumé La modification de la physe chez l'enfant, quelle que soit l'étiologie en cause est habituellement diagnostiquée après que la déformation devienne évidente. Entre janvier 2006 et juin 2007, 15 enfants présentant une infection ostéo articulaire aiguë autour du genou ont été étudiés et ont été suivis pendant six mois après le début de l'infection. Les patients ont été évalués de façon clinique et radiographique ainsi qu'avec une étude IRM au niveau des deux genoux, le genou sain servant de contrôle. Des modifications anormales de la physe ou de la métaphyse sur l'IRM ont été observées chez 5 enfants. Ce groupe de 5 enfants est comparé avec l'autre groupe de 10 enfants. Nous espérons que l'IRM sera un examen utile quant à l'évaluation de la lésion précoce de la plaque de croissance avec possibilité d'un diagnostic précoce après une infection ostéo articulaire de façon à prévenir une complication catastrophique.

Hematogenous Osteomyelitis in Infants and Children: Imaging of a Changing Disease

“…MR imaging can depict the bony bridge as early as 6 months after the infection. Fortunately, many children with physeal involvement show resolution of the physeal insult with adequate antibiotic therapy (64,65). A recently observed phenomenon is the development of pathologic fractures.…”

Is the emergency MRI protocol for acute pediatric osteoarticular infection a luxury or an absolute priority?

“…Multiple institutional guidelines have demonstrated that its earlier use remarkably improves the identification of OAIs surgical candidates, thus reducing the rate of sequelae and reoperations ( 1 , 5 , 6 , 12 – 16 , 20 – 24 ). Despite its benefits, the awareness of the resource intensity required by MRI has led to the development of multidisciplinary teams, to expedite the discussion around OAIs management among all the implicated stakeholders, such as pediatricians, orthopedic surgeons, anesthesiologists and radiologists ( 15 , 16 , 18 , 20 , 24 – 26 ).…”

Magnetic Resonance Imaging in Foals With Infectious Arthritis

“…Magnetic resonance (MR) imaging is superior to other modalities for detecting early osteomyelitis in people . MR imaging has the advantage of excellent soft‐tissue contrast resolution to visualize the presence of osteomyelitis and its complications, which include soft‐tissue and bone abscesses, physeal involvement, and infectious arthritis .…”

“…MR imaging has the advantage of excellent soft‐tissue contrast resolution to visualize the presence of osteomyelitis and its complications, which include soft‐tissue and bone abscesses, physeal involvement, and infectious arthritis . In children, it is used for early detection of osteomyelitis due to infectious arthritis and hematogenous routes of joint infection . Radiography still serves as the initial screening modality in children for osteomyelitis.…”