Early diagnosis and response assessment in chronic recurrent multifocal osteomyelitis: changes in lesion volume and signal intensity assessed by whole-body MRI

Objective: To assess the effectiveness of whole-body MRI (WB-MRI) in early diagnosis of chronic recurrent multifocal osteomyelitis (CRMO) and the prediction of clinical response through quantitative MRI features. Methods: 20 children (mean age, 10.3 years; range, 5–14 years) with CRMO underwent WB-MRI and were assessed with a clinical score (Jansson) at baseline (median time after first encounter, 8 months) and follow-up (median time after baseline, 11.5 months). Baseline WB-MRI scans were classified as early (within 6 months after first encounter) and late. Clinical responders and non-responders were compared regarding number and localization of bone lesions, lesion volume and T2 signal intensity (SI) ratio (lesion to muscle). Results: Diagnosis of CRMO was made promptly in the early WB-MRI group (n = 10; median, 3 months) compared to the late WB-MRI group (n = 10; 18 months; p = 0.006). Bone lesions were mainly located in the lower extremities (n = 119/223; 53%). No significant difference was detected regarding the number of bone lesions and lesion volume in the subgroups of clinical responders (n = 10) and non-responders (n = 10). Responders showed a higher volume reduction of bone lesions at follow-up compared to non-responders (p = 0.03). Baseline and follow-up SI ratios were lower in responders (5.6 and 5.8 vs 6.1 and 7.2; p = 0.047 and p = 0.005). Conclusion: The use of WB-MRI within 6 months of disease suspicion may serve as a benchmark to support early diagnosis of CRMO. T2 SI ratios and the reduction of lesions’ volume correlate with clinical outcome. Advances in knowledge: WB-MRI at an early stage of suspected CRMO plays a key role for early diagnosis. This is the first study showing that quantitative MRI features are suitable for response assessment and can be used as prognostic markers for the prediction of clinical response.

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Whole-Body MRI in Rheumatology: Major Advances and Future Perspectives

Diagnostics ◽

10.3390/diagnostics11101770 ◽

2021 ◽

Vol 11 (10) ◽

pp. 1770

Author(s):

Luca Deplano ◽

Matteo Piga ◽

Michele Porcu ◽

Alessandro Stecco ◽

Jasjit S. Suri ◽

...

Keyword(s):

Pediatric Population ◽

Standard Technique ◽

Chronic Recurrent Multifocal Osteomyelitis ◽

Whole Body ◽

Whole Body Mri ◽

Treatment Response Evaluation ◽

Multifocal Osteomyelitis ◽

Body Magnetic Resonance Imaging ◽

Juvenile Spondyloarthritis

Whole-body magnetic resonance imaging is constantly gaining more importance in rheumatology, particularly for what concerns the diagnosis, follow-up, and treatment response evaluation. Initially applied principally for the study of ankylosing spondylitis, in the last years, its use has been extended to several other rheumatic diseases. Particularly in the pediatric population, WB-MRI is rapidly becoming the gold-standard technique for the diagnosis and follow-up of both chronic recurrent multifocal osteomyelitis and juvenile spondyloarthritis. In this review, we analyze the benefits and limits of this technique as well as possible future applications.

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Whole-body MRI in the diagnosis of paediatric CNO/CRMO

Rheumatology ◽

10.1093/rheumatology/keaa303 ◽

2020 ◽

Vol 59 (10) ◽

pp. 2671-2680 ◽

Cited By ~ 1

Author(s):

Savvas Andronikou ◽

Jeannette K Kraft ◽

Amaka C Offiah ◽

Jeremy Jones ◽

Hassan Douis ◽

...

Keyword(s):

Chronic Recurrent Multifocal Osteomyelitis ◽

Bisphosphonate Therapy ◽

Whole Body ◽

Inflammatory Disorder ◽

Whole Body Mri ◽

Spine Imaging ◽

Multifocal Osteomyelitis ◽

Hands And Feet ◽

Short Tau Inversion Recovery

Abstract Chronic recurrent multifocal osteomyelitis (CRMO) is an auto-inflammatory disorder affecting the skeleton of children and adolescents. Whole-body MRI (WBMRI) is key in the diagnosis and follow-up of CRMO. Imaging protocols should include sagittal short Tau inversion recovery of the spine, imaging of the hands and feet, and T1 images for distinguishing normal bone marrow. CRMO lesions can be metaphyseal, epiphyseal and physeal—potentially causing growth disturbance and deformity. Spinal lesions are common, important and can cause vertebral collapse. Lesion patterns include multifocal tibial and pauci-focal patterns that follow a predictable presentation and course of disease. Common pitfalls of WBMRI include haematopoietic marrow signal, metaphyseal signal early on in bisphosphonate therapy and normal high T2 signal in the hands and feet. Pictorial reporting assists in recording lesions and follow-up over time. The purpose of this paper is to review the different WBMRI protocols, imaging findings, lesion patterns and common pitfalls in children with CRMO

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1369. The Spectrum of Chronic Osteomyelitis in Children

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1551 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S694-S695

Author(s):

Marritta Joseph ◽

Lauren Sommer ◽

Jesus G Vallejo ◽

Jonathon C McNeil

Keyword(s):

Clinical Features ◽

Hospital Admissions ◽

Chronic Osteomyelitis ◽

Functional Limitations ◽

Chronic Recurrent Multifocal Osteomyelitis ◽

Intravenous Therapy ◽

Days Of Therapy ◽

Common Etiology ◽

Multifocal Osteomyelitis

Abstract Background While the majority of pediatric osteomyelitis cases are acute in nature, a significant subset present with prolonged symptoms often associated with substantial morbidity. Little data exist to guide clinicians in the management of these infections. We sought to describe the epidemiology, clinical features and management of chronic osteomyelitis in children. Methods We reviewed hospital admissions with an ICD10 code for chronic osteomyelitis from 2011-2018 at Texas Children’s Hospital. Cases were included if symptoms lasted >28 days on presentation. Patients diagnosed with chronic recurrent multifocal osteomyelitis were excluded. Cases were classified as those 1) associated with a contiguous focus (CoF), 2) penetrating or open trauma, 3) orthopedic hardware (OH), 4) post-acute chronic osteomyelitis (PACO, those occurring after >28 days of therapy for acute osteomyelitis) and 5) primary hematogenous chronic osteomyelitis (PHCO, those with 28 days of symptoms without other clear risk factors). Results 114 cases met inclusion criteria. The median patient age is 11.8 years and 35.9% patients had underlying comorbidities. 83% of patients underwent a surgical procedure. Cases were diverse in terms of pathogenesis (Figure 1). A microbiologic etiology was identified in 72.8% of cases and was polymicrobial in 20.2% of cases; Staphylococcus aureus was the single most common etiology (Figure 2). CoF infection was more often associated with polymicrobial etiology with or without Pseudomonas (P< 0.001) and disease of the foot. PACO was caused by S. aureus in 95% of cases (p< 0.001, Figure 3). The overall median duration of total therapy was 210 days. 41% were discharged from hospital on OPAT with or without later transition to oral antibiotics. 26.3% of patients had persistent functional limitations at time of last follow-up of which 46% experienced repeat hospital admission/surgery. There was no association between duration of intravenous therapy and persistent functional limitations. Figure 1. Categories of Chronic Osteomyelitis Figure 2. Microbiology of Pediatric Chronic Osteomyelitis Figure 3. Clinical Features of Pediatric Chronic Osteomyelitis Conclusion Children with chronic osteomyelitis are diverse both in terms of pathogenesis and microbiology. Pathogenesis and clinical presentation can provide clues to microbiologic etiology. Prolonged intravenous therapy does not appear to improve functional outcomes in chronic osteomyelitis Disclosures Jonathon C. McNeil, MD, Allergan (Research Grant or Support, Allergan provided ceftaroline powder for use in studies described in this abstract)

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Comparison of results of whole-body magnetic resonance imaging scans and traditional imaging modalities in diagnostic management of chronic recurrent multifocal osteomyelitis

Archives of Medical Science - Civilization Diseases ◽

10.5114/amscd.2018.75591 ◽

2018 ◽

Vol 3 (1) ◽

pp. 41-46

Author(s):

Jerzy Sułko ◽

Artur Oberc

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Chronic Recurrent Multifocal Osteomyelitis ◽

Imaging Modalities ◽

Whole Body ◽

Resonance Imaging ◽

Comparison Of Results ◽

Diagnostic Management ◽

Multifocal Osteomyelitis ◽

Body Magnetic Resonance Imaging

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Chronic recurrent multifocal osteomyelitis: follow up Longitudinal case series study for five years with radiographic and scintigraphic imaging perspective and health outcome analysis with EQ5D-5L

Pediatric Rheumatology ◽

10.1186/1546-0096-13-s1-p188 ◽

2015 ◽

Vol 13 (Suppl 1) ◽

pp. P188

Author(s):

N Roy ◽

S Sathyanandan ◽

K Lalitha ◽

M Mathew

Keyword(s):

Health Outcome ◽

Case Series ◽

Chronic Recurrent Multifocal Osteomyelitis ◽

Outcome Analysis ◽

Scintigraphic Imaging ◽

Case Series Study ◽

Multifocal Osteomyelitis ◽

Series Study ◽

Imaging Perspective

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Whole-Body Diffusion-Weighted Imaging in Chronic Recurrent Multifocal Osteomyelitis in Children

PLoS ONE ◽

10.1371/journal.pone.0147523 ◽

2016 ◽

Vol 11 (1) ◽

pp. e0147523 ◽

Cited By ~ 18

Author(s):

Nadine Leclair ◽

Gregor Thörmer ◽

Ina Sorge ◽

Lutz Ritter ◽

Volker Schuster ◽

...

Keyword(s):

Diffusion Weighted Imaging ◽

Chronic Recurrent Multifocal Osteomyelitis ◽

Whole Body ◽

Diffusion Weighted ◽

Multifocal Osteomyelitis

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The benefit of whole-body low-dose unenhanced multidetector computer tomography (WBLD-MDCT) for follow up and therapy response monitoring in patients with multiple myeloma: Correlation with hematologic parameters

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.7607 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 7607-7607

Author(s):

M. S. Horger ◽

C. Driessen ◽

C. Brodoefel ◽

C. Faul ◽

P. Pereira ◽

...

Keyword(s):

Multiple Myeloma ◽

Computer Tomography ◽

Low Dose ◽

Laboratory Data ◽

Whole Body ◽

Acquisition Time ◽

Bone Lesions ◽

Appendicular Skeleton ◽

Multidetector Computer Tomography

7607 Background: To assessthe value of whole-body low-dose multidetector computer tomography (WBLD-MDCT) as diagnostic and survey modality in multiple myeloma (MM), and as a one-stop alternative (Horger et al. EJR 2005;54:289–297) to established imaging techniques (e.g. x-ray and MRI). Methods: Between 7/2001 and 2/2005, WBLD-MDCT scans were obtained in 90 consecutive patients with histologically proven stage II-III MM, all patients having 2 or more scans (mean = 3,8; range = 2–6). CT-scans were performed using a standardized low-dose protocol and the number, size and density of focal or diffuse medullary (in the appendicular skeleton and pelvis) and extra-medullary lesions as well as osteolysis were analysed for each examination and at follow up. Results were correlated with current standard MM laboratory data and at follow up in order to assess correct temporal recognition of significant myeloma changes by both methods. Results: Detection and follow up of medullary and extra-medullary MM lesions and osteolysis by WBLD-MDCT resulted in a sensitivity of 92%, a specificity of 93%, a NPV of 95%, a PPV of 85% and a likelihood ratio for patients with CT-abnormalities to present changes in the course of their disease of 12. Results of radiologic and hematologic analysis showed high agreement at follow up (median, 3 mo). However, agreement of both techniques at the time of investigation was only moderate (κ = 0.629), with CT being correct in 60% of mismatching cases. Thus, CT enabled earlier detection of MM changes. WBLD-MDCT assessed correctly the course of disease in all 4 patients with nonsecretory MM. Evaluation of stability was optimal in all patients. Conclusions: WBLD-MD represents a reliable, widespread, quick (75s acquisition time), and cost-effective imaging technique in MM, allowing detection of bone marrow involvement, extra-medullary tumors and lytic bone lesions in different clinical settings (staging, follow up, therapy monitoring, evaluation of stability). WBLD-MDCT repeatedly allowed detection of changes in the course of the disease prior to laboratory data, especially in extramedullary MM relapse and nonsecretory MM. No significant financial relationships to disclose.

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