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Whole-body MRI in the diagnosis of paediatric CNO/CRMO
Savvas Andronikou1,2, Jeannette K Kraft3, Amaka C Offiah4,5
1Department of Radiology, The Children's Hospital of Philadelphia.
Abstract:
Chronic recurrent multifocal osteomyelitis (CRMO) is an auto-inflammatory disorder affecting the skeleton of children and adolescents. Whole-body MRI (WBMRI) is key in the diagnosis and follow-up of CRMO. Imaging protocols should include sagittal short Tau inversion recovery of the spine, imaging of the hands and feet, and T1 images for distinguishing normal bone marrow. CRMO lesions can be metaphyseal, epiphyseal and physeal-potentially causing growth disturbance and deformity. Spinal lesions are common, important and can cause vertebral collapse. Lesion patterns include multifocal tibial and pauci-focal patterns that follow a predictable presentation and course of disease. Common pitfalls of WBMRI include haematopoietic marrow signal, metaphyseal signal early on in bisphosphonate therapy and normal high T2 signal in the hands and feet. Pictorial reporting assists in recording lesions and follow-up over time. The purpose of this paper is to review the different WBMRI protocols, imaging findings, lesion patterns and common pitfalls in children with CRMO.
Insights
Whole-body MRI (WBMRI) aids in diagnosing and monitoring chronic recurrent multifocal osteomyelitis (CRMO) in children. Understanding WBMRI protocols, findings, and pitfalls is crucial for accurate assessment and management of this skeletal disorder.
Area of Science:
- Pediatric rheumatology
- Medical imaging
- Auto-inflammatory disorders
Background:
- Chronic recurrent multifocal osteomyelitis (CRMO) is a pediatric auto-inflammatory skeletal condition.
- Whole-body MRI (WBMRI) is essential for CRMO diagnosis and management.
- CRMO affects children and adolescents, impacting bone growth and potentially causing deformities.
Purpose of the Study:
- To review WBMRI protocols for CRMO.
- To describe CRMO imaging findings and lesion patterns.
- To highlight common WBMRI pitfalls in pediatric CRMO.
Main Methods:
- Review of WBMRI protocols including sagittal STIR of the spine, hands, feet, and T1 images.
- Analysis of CRMO lesion characteristics: metaphyseal, epiphyseal, physeal involvement.
- Identification of common WBMRI pitfalls: hematopoietic marrow, bisphosphonate effects, normal high T2 signals.
Main Results:
- Specific WBMRI protocols are recommended for CRMO diagnosis and follow-up.
- CRMO lesions exhibit distinct patterns (multifocal tibial, pauci-focal) with predictable disease courses.
- Potential pitfalls in WBMRI interpretation include normal variants and treatment-related changes.
Conclusions:
- Standardized WBMRI protocols are vital for accurate CRMO assessment in children.
- Recognizing CRMO lesion patterns and WBMRI pitfalls improves diagnostic confidence.
- Effective WBMRI utilization supports optimal patient management and monitoring.
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