Acute hematogenous pelvic osteomyelitis: appropriate timing for magnetic resonance imaging.
MRI
acute hematogenous osteomyelitis
bone marrow edema
metaphyseal equivalent
pelvis
sacroiliitis
Journal
Pediatrics international : official journal of the Japan Pediatric Society
ISSN: 1442-200X
Titre abrégé: Pediatr Int
Pays: Australia
ID NLM: 100886002
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
received:
18
05
2019
revised:
05
06
2020
accepted:
11
06
2020
pubmed:
21
6
2020
medline:
12
8
2021
entrez:
21
6
2020
Statut:
ppublish
Résumé
The precise time of appearance of bone marrow edema in acute hematogenous pelvic osteomyelitis (AHPO) is unknown. The purpose of the present research is to clarify the time of appearance of bone marrow edema on magnetic resonance imaging (MRI) in AHPO. Our hypothesis was that onset is slower than in long-bone osteomyelitis. We selected 12 patients (mean, 11.8 years) with MRI findings and clinical diagnosis of AHPO. The signal ratios of bone marrow (BM) and gluteus maximus muscle (M, BM/M ratio) in fat-suppressed T2- and T1-weighted images (T2WI, T1WI) were calculated to evaluate changes in bone-marrow signals. The correlation between BM/M ratios and days from onset was evaluated statistically and compared with lower extremity osteomyelitis. Bone marrow/M ratio of T2WI increased over time after the onset of the primary symptom in all patients and showed a statistically positive correlation (r = 0.36). In seven patients in whom an MRI scan was conducted twice, all showed higher values for the second MRI, and changes were more pronounced over time. The mean BM/M ratio of T2WI was 4.1 when 7 days or less had elapsed from the primary symptom, and 6.4 when more than 7 days had elapsed. The BM/M ratios in the sacroiliac joint group were lower than in the non-sacroiliac joint group. Unlike long-bone osteomyelitis, it took 1 week before findings for AHPO became fully evident. A definitive diagnosis can be made in patients with suspected sacroiliitis by performing a further MRI scan at 7 days or later.
Sections du résumé
BACKGROUND
BACKGROUND
The precise time of appearance of bone marrow edema in acute hematogenous pelvic osteomyelitis (AHPO) is unknown. The purpose of the present research is to clarify the time of appearance of bone marrow edema on magnetic resonance imaging (MRI) in AHPO. Our hypothesis was that onset is slower than in long-bone osteomyelitis.
METHODS
METHODS
We selected 12 patients (mean, 11.8 years) with MRI findings and clinical diagnosis of AHPO. The signal ratios of bone marrow (BM) and gluteus maximus muscle (M, BM/M ratio) in fat-suppressed T2- and T1-weighted images (T2WI, T1WI) were calculated to evaluate changes in bone-marrow signals. The correlation between BM/M ratios and days from onset was evaluated statistically and compared with lower extremity osteomyelitis.
RESULTS
RESULTS
Bone marrow/M ratio of T2WI increased over time after the onset of the primary symptom in all patients and showed a statistically positive correlation (r = 0.36). In seven patients in whom an MRI scan was conducted twice, all showed higher values for the second MRI, and changes were more pronounced over time. The mean BM/M ratio of T2WI was 4.1 when 7 days or less had elapsed from the primary symptom, and 6.4 when more than 7 days had elapsed. The BM/M ratios in the sacroiliac joint group were lower than in the non-sacroiliac joint group.
CONCLUSIONS
CONCLUSIONS
Unlike long-bone osteomyelitis, it took 1 week before findings for AHPO became fully evident. A definitive diagnosis can be made in patients with suspected sacroiliitis by performing a further MRI scan at 7 days or later.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
72-80Subventions
Organisme : National Center for Child Health and Development
Informations de copyright
© 2020 Japan Pediatric Society.
Références
Connolly SA, Connolly LP, Drubach LA, Zurakowski D, Jaramillo D. MRI for detection of abscess in acute osteomyelitis of the pelvis in children. Am. J. Roentgenol. 2007; 189: 867-72.
Laor T, Jaramillo D, Oestreich AE. Skeletal system. In: Kirks DR (ed). Practical Pediatric Imaging: Diagnostic Radiology of Infants and Children, 3rd edn. Lippincott-Raven, Philadelphia, PA, 1998; 32.
Jaramillo D, Treves ST, Kasser JR, Harper M, Sundel R, Laor T. Osteomyelitis and septic arthritis in children: appropriate use of imaging to guide treatment. Am. J. Roentgenol. 1995; 165: 399-40.
Stürzenbecher A, Braun J, Paris S, Biedermann T, Hamm B, Bollow M. MR imaging of septic sacroiliitis. Skeletal Radiol. 2000; 29: 439-46.
Lee YJ, Sadigh S, Mankad K, Kapse N, Rajeswaran G. The imaging of osteomyelitis. Quant. Imaging Med. Surg. 2016; 6: 184-98.
Jaramillo D. Infection: musculoskeletal. Pediatr. Radiol. 2011; 41(Suppl 1): S127-34.
Haliloglu M, Kleiman MB, Siddiqui AR, Cohen MD. Osteomyelitis and pyogenic infection of the sacroiliac joint. MRI findings and review. Pediatr. Radiol. 1994; 24: 333-5.
Nixon GW. Hematogenous osteomyelitis of metaphyseal-equivalent locations. Am. J. Roentgenol. 1978; 130: 123-9.
Miyazaki O, Miyasaka M, Okamoto R, Tsutsumi Y, Nosaka S. Osteomyelitis of a sacral neurocentral synchondrosis: A case report of another metaphyseal equivalent. Skeletal Radiol. 2019; 48: 1125-9. https://doi.org/10.1007/s00256-018-3122-2.
Cinar M, Sanal HT, Yilmaz S et al. Radiological follow up of the evolution of inflammatory process in sacroiliac joint with Magnetic Resonance Imaging: A case with pyogenic sacroiliitis. Case Rep. Rheumatol. 2012; 2012: 1-4.
Wada A, Takamura K, Fujii T, Yanagida H, Surijamorn P. Septic sacroiliitis in children. J. Pediatr. Orthop. 2008; 28: 488-92.
Pugmire BS, Shailam R, Gee MS. Role of MRI in the diagnosis and treatment of osteomyelitis in pediatric patients. World J. Radiol. 2014; 6: 530-7.