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Osteomyelitis in children: gadolinium-enhanced MR imaging
B C Dangman1, F A Hoffer, F F Rand
1Department of Radiology, Children's Hospital, Boston, MA 02115-5747.
Abstract:
Fifteen pediatric patients with biopsy- or culture-proved nonspinal osteomyelitis were studied with magnetic resonance (MR) imaging. Osteomyelitis was acute in seven patients, subacute in three, and chronic in five. Four patients had subperiosteal abscesses, one had a large associated soft-tissue abscess, and one had an intraosseous (Brodie) abscess. Areas of active inflammation had decreased marrow signal intensity on T1-weighted images, increased signal intensity on T2-weighted images, and enhancement on T1-weighted images obtained after gadopentetate dimeglumine administration (n = 10). Abscesses were rim enhancing (n = 3) or not (n = 2) with gadolinium-enhanced MR imaging. Nonenhancing areas presumably represented necrotic material. Gadolinium-enhanced MR imaging assisted in definition of the presence and extent of nonvascularized fluid collections within the bone and/or adjacent soft tissues and the extent of bone involvement in patients with chronic osteomyelitis. It also helped guide surgical debridement of intraosseous disease (n = 7) and open or percutaneous drainage of subperiosteal or soft-tissue fluid collections (n = 5).
Insights
Magnetic resonance (MR) imaging effectively diagnoses pediatric osteomyelitis by revealing inflammation and abscesses. Gadolinium-enhanced MR imaging aids in surgical planning for bone and soft tissue infections.
Area of Science:
- Pediatric Radiology
- Musculoskeletal Imaging
- Infectious Disease Imaging
Background:
- Osteomyelitis is a serious bone infection in children.
- Accurate diagnosis and staging are crucial for effective treatment.
- Magnetic resonance (MR) imaging offers detailed visualization of bone and soft tissues.
Purpose of the Study:
- To evaluate the utility of MR imaging in diagnosing and characterizing pediatric nonspinal osteomyelitis.
- To assess the role of gadolinium-enhanced MR imaging in identifying active inflammation and fluid collections.
- To determine how MR imaging findings correlate with treatment planning.
Main Methods:
- Retrospective study of 15 pediatric patients with confirmed nonspinal osteomyelitis.
- All patients underwent magnetic resonance (MR) imaging.
- Gadolinium-enhanced T1-weighted images were analyzed in 10 patients.
Main Results:
- MR imaging demonstrated characteristic signal changes in active inflammation (decreased T1, increased T2, enhancement).
- Abscesses (subperiosteal, soft-tissue, intraosseous) were identified, with variable enhancement patterns.
- Gadolinium enhancement helped define nonvascularized fluid collections and extent of chronic bone involvement.
Conclusions:
- MR imaging is a valuable tool for diagnosing pediatric osteomyelitis.
- Gadolinium-enhanced MR imaging improves the assessment of infection extent and guides surgical and drainage procedures.
- This imaging modality assists in differentiating active infection from necrotic tissue and planning interventions.