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[Febrile osseous pain in children with sickle cell disease: MRI findings]
Purpose:
The aim of this study was to report the MRI findings that can suggest a vaso-occlusive crisis in cases of febrile osseous pain in children suffering from sickle cell disease.
Materials And Methods:
MRI (T1 and T2 weighted sequences and T1 weighted sequence with fat saturation before and after gadolinium injection) was performed in 10 children with sickle cell disease, presenting with febrile osseous pain. The diagnosis of vaso-occlusive crisis was made after fast improvement due to symptomatic treatment and negative bacteriological result.
Results:
MRI was abnormal in all cases. A multifocal localisation was found in 2 cases. Bone marrow abnormalities were constant. In 10 cases, high T1 and T2 signal and metaphyso-diaphysial lesions were noted. Heterogeneous medullar enhancement with "ink stain" feature was constant. Early periosteal abnormalities were noted in 8 cases with inflammatory or stratified features. Cortical thinning was found in 1 case. Soft tissue abnormalities were observed in 5 cases with inflammatory features in 4.
Conclusion:
Multifocal synchronous localisation, medullar abnormalities resulting from hemoglobin degradation, heterogeneous enhancement, early periosteal abnormalities and associated soft tissues swelling are MRI findings suggesting acute vaso-occlusive disease.
Insights
Magnetic Resonance Imaging (MRI) can identify vaso-occlusive crises in children with sickle cell disease experiencing bone pain. Key MRI findings include multifocal lesions, medullary abnormalities, and periosteal changes.
Area of Science:
- Radiology
- Pediatrics
- Hematology
Context:
- Sickle cell disease (SCD) is a genetic blood disorder.
- Vaso-occlusive crisis (VOC) is a common and painful complication of SCD.
- Febrile osseous pain in SCD patients can be challenging to diagnose.
Purpose:
- To identify specific MRI findings suggestive of vaso-occlusive crisis (VOC) in children with sickle cell disease (SCD) presenting with febrile osseous pain.
- To differentiate VOC from other causes of bone pain in SCD.
Summary:
- MRI revealed abnormalities in all 10 children with SCD and febrile osseous pain.
- Consistent findings included multifocal lesions, high T1 and T2 signal, metaphyso-diaphysial lesions, heterogeneous medullary enhancement with an "ink stain" appearance, and early periosteal abnormalities.
- Soft tissue abnormalities were also noted in some cases.
Impact:
- MRI findings can aid in the early and accurate diagnosis of vaso-occlusive crises in pediatric SCD patients.
- This can lead to timely and appropriate treatment, potentially reducing complications.
- Highlights the utility of advanced imaging in managing SCD complications.
