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Imaging mimics of chronic recurrent multifocal osteomyelitis: avoiding pitfalls in a diagnosis of exclusion
Takashi Shawn Sato1, Pankaj Watal2, Polly J Ferguson3
1Division of Pediatric Radiology, Department of Radiology, Stead Family Children's Hospital, University of Iowa, 200 Hawkins Drive, 3889 JPP, Iowa City, IA, 52242, USA. shawn-sato@uiowa.edu.
Abstract:
Chronic recurrent multifocal osteomyelitis (CRMO) is a pediatric autoinflammatory disorder that is characterized by multiple sterile inflammatory bone lesions with a relapsing and remitting course. CRMO belongs to the autoinflammatory family of rheumatologic disorders based on absence of significant titers of autoantibodies and autoreactive T-lymphocytes. In absence of pathognomonic clinical, radiographic or pathological features, diagnosis can be challenging. CRMO shares imaging features with other diseases. It is important for radiologists to be able to differentiate other diseases from CRMO because prognosis varies from completely benign to frankly malignant. In this article we first present the clinical and imaging features of CRMO to help readers gain an understanding of the disease process, then discuss our imaging approach to CRMO and review other disease processes that sometimes share similar imaging findings to CRMO and review differentiating features to help avoid misdiagnoses.
Insights
Chronic recurrent multifocal osteomyelitis (CRMO) is a pediatric autoinflammatory bone disorder. Accurate diagnosis is crucial as CRMO imaging features can mimic other conditions, impacting patient prognosis.
Area of Science:
- Pediatric Rheumatology
- Autoinflammatory Disorders
- Pediatric Radiology
Background:
- Chronic recurrent multifocal osteomyelitis (CRMO) is a rare pediatric autoinflammatory bone disease.
- Characterized by recurrent, sterile inflammatory bone lesions with a relapsing-remitting course.
- Diagnosis is challenging due to the absence of specific autoantibodies and pathognomonic features.
Purpose of the Study:
- To present the clinical and imaging features of CRMO.
- To discuss an effective imaging approach for CRMO diagnosis.
- To review differential diagnoses that share similar imaging findings with CRMO.
Main Methods:
- Review of clinical presentation and imaging characteristics of CRMO.
- Description of a systematic imaging strategy for evaluating suspected CRMO.
- Comparative analysis of imaging findings in CRMO versus other bone pathologies.
Main Results:
- CRMO presents with multiple sterile inflammatory bone lesions.
- Imaging findings can overlap with infectious osteomyelitis, bone tumors, and other inflammatory conditions.
- Differentiating features are essential for accurate diagnosis and appropriate management.
Conclusions:
- Radiologists must be aware of CRMO's diverse presentations.
- A structured imaging approach aids in differentiating CRMO from mimics.
- Accurate differentiation is critical as prognoses vary significantly, ranging from benign to malignant.
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