Clinical indications for repeat MRI in children with acute hematogenous osteomyelitis
Paul Maxwell Courtney1, John M Flynn, Diego Jaramillo
1Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
Background:
At our center and at others, some children with acute hematogenous osteomyelitis (AHO) are evaluated with multiple magnetic resonance imagings (MRIs) during their treatment. Do these serial MRI studies have a role in the management of AHO? We examine several clinical indications for ordering a repeat MRI and whether the imaging study resulted in a change in management.
Methods:
A total of 59 children (60 cases) with AHO were imaged with more than 1 MRI. We retrospectively reviewed the MRI studies and hospital records to investigate whether the results of the MRIs prompted a change in clinical management (surgical exploration or drainage, biopsy, change in the course of antibiotics). We investigated several clinical indicators including C-reactive protein (CRP) levels, time since index study, anatomic location of infection, and blood cultures. Differences in the proportion of patients with specified clinical characteristics, whose repeat MRI resulted in a change in management, were assessed by the use of χ² analysis.
Results:
The median age of our patient population was 8.4 years; a total of 104 repeat MRI studies were undertaken on 59 children. Eleven (10.6%) of these studies prompted a change in patient treatment. Statistically significant indications for repeat MRI in changing clinical management included failure to improve clinically in 10 studies (21%, P<0.001), persistently elevated or increasing CRP levels in 11 MRI studies (52%, P<0.001), and the repeat study occurring within 14 days of the diagnostic MRI in 8 studies (29%, P=0.003).
Conclusions:
The results of our study showed that additional MRI studies provide information that affected patient management in only a limited number of cases. Although repeat MRI does not have a role in routine surveillance in children with AHO undergoing treatment, it can be a useful adjunct to clinical evaluation in patients who do not respond to therapy or who have a persistently elevated CRP level.
Level Of Evidence:
Level IV, Therapeutic Study.
Insights
Serial magnetic resonance imaging (MRI) studies in children with acute hematogenous osteomyelitis (AHO) rarely change management. Repeat MRI is most useful for patients not improving or with persistently high C-reactive protein (CRP) levels.
Area of Science:
- Pediatric Orthopedics
- Pediatric Infectious Diseases
- Diagnostic Imaging
Background:
- Acute hematogenous osteomyelitis (AHO) management in children sometimes involves serial magnetic resonance imaging (MRI) studies.
- The clinical utility and impact of these repeat MRI examinations on treatment decisions remain unclear.
- This study investigates the role of serial MRI in managing pediatric AHO.
Purpose of the Study:
- To determine if serial MRI studies alter the clinical management of children with AHO.
- To identify specific clinical indications that correlate with repeat MRI findings prompting a change in treatment.
- To evaluate the overall effectiveness of repeat MRI in guiding AHO therapy.
Main Methods:
- Retrospective review of 60 cases of AHO in 59 children who underwent more than one MRI.
- Analysis of MRI results and hospital records to assess changes in management (e.g., surgery, antibiotics).
- Investigation of clinical indicators such as C-reactive protein (CRP) levels, time to repeat MRI, and blood cultures, using chi-squared analysis.
Main Results:
- Only 10.6% of 104 repeat MRI studies led to a change in patient management.
- Statistically significant indicators for management change included clinical non-improvement (21%), persistently elevated CRP (52%), and repeat MRI within 14 days (29%).
- The median age of patients was 8.4 years.
Conclusions:
- Serial MRI studies provide valuable information in a limited number of pediatric AHO cases.
- Repeat MRI is not recommended for routine surveillance during AHO treatment.
- MRI is a useful adjunct for evaluating patients with AHO who show poor clinical response or have persistent CRP elevation.
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