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Ten-year review of Danish children with chronic non-bacterial osteitis
Agnes Ziobrowska-Bech1, Bente Fiirgaard, Carsten Heuck
1Pediatric Rheumatology Clinic, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark. agneszio@hotmail.com.
Insights
Chronic non-infectious osteomyelitis (CNO) in children presents similarly whether monofocal or multifocal. Whole-body MRI is crucial for diagnosing CNO, revealing silent lesions and aiding in comprehensive assessment.
Area of Science:
- Pediatric rheumatology
- Pediatric orthopedics
- Diagnostic imaging
Background:
- Chronic non-infectious osteomyelitis (CNO) is an inflammatory bone condition in children.
- Distinguishing between monofocal and multifocal CNO is important for management.
- The role of advanced imaging in CNO diagnosis requires further elucidation.
Purpose of the Study:
- To compare clinical and radiological characteristics of pediatric CNO with monofocal versus multifocal bone lesions.
- To evaluate the diagnostic utility and advantages of whole-body MRI in CNO.
Main Methods:
- Retrospective analysis of 31 children diagnosed with CNO between 2001 and 2011.
- Clinical and radiological data were collected, with lesion distribution defining monofocal or multifocal disease.
- Imaging modalities included X-ray, CT, MRI, and whole-body MRI.
Main Results:
- Most children (71%) presented with multifocal CNO; six multifocal cases were initially diagnosed as monofocal.
- Whole-body MRI detected significantly more lesions than conventional imaging, including 'silent' lesions.
- Extra-osseous involvement was common (64.5%); psoriasis and pustulosis palmoplantaris were associated with multifocal CNO.
Conclusions:
- Pediatric CNO exhibits comparable clinical and radiological features regardless of lesion distribution (monofocal vs. multifocal).
- Whole-body MRI is an effective screening tool for diagnosing CNO, identifying the full extent of disease.
- Early and accurate diagnosis using whole-body MRI can guide appropriate treatment strategies.
Objectives:
To compare clinical characteristics of children with chronic non-infectious osteomyelitis (CNO) with either mono- or multifocal bone lesions, and to report potential advantages of using whole-body MRI.
Methods:
A retrospective evaluation of 31 children (19 girls, 12 boys) diagnosed with CNO between 2001 and 2011. CNO was diagnosed as mono-, or multifocal inflammatory bone lesions (osteomyelitis, osteitis, osteosclerosis), duration of complaints more than 6 weeks and exclusion of infection and malignancy. Clinical and radiological data were registered. The definition of mono- or multifocality was based on the description of imaging results.
Results:
Mean age at disease onset was 10.3 ± 2.6 years. Mean duration of active disease was 44.4 ± 25.6 months. Twenty-two (71.0%) had two or more bone lesions and 9 (29.0%) had one lesion. Of those with multifocal lesions six were initially detected as monofocal. The most frequent location of the bone lesions was in the metaphysis of the lower extremities. MRI/CT discovered most lesions compared to x-ray and scintigraphy. MRI was performed in 93.5% of which 25.8 % had a whole-body-MRI. Whole-body MRI revealed disclosure of several silent lesions. Extra-osseous involvement occurred in 64.5%. In the multifocal group 22.7 % had psoriasis and 13.6 % had pustulosis palmoplantaris but neither was seen in the monofocal group. All were treated with NSAIDs; 54.8% corticosteroids, 29.1 % methotrexate, 9.7 % pamidronate and 3.2 % infliximab.
Conclusions:
Monofocal CNO had comparable clinical and radiological characteristics to multifocal disease. We conclude that whole-body MRI is a relevant screening instrument for the diagnosis of CNO.
