[Chronic nonbacterial osteomyelitis : Imaging and differential diagnoses].

Area of Science:

• Pediatric Rheumatology
• Pediatric Orthopedics
• Medical Imaging

Background:

• Chronic nonbacterial osteomyelitis (CNO) is a rare autoinflammatory bone disorder primarily affecting children and adolescents, with a higher incidence in females.
• CNO presents with multifocal bone lesions, often in the metaphyses of long bones, characterized by recurrence and variable appearance.
• Patients typically have a prolonged disease history with nonspecific clinical and laboratory findings, complicating diagnosis.

Purpose of the Study:

• To highlight the diagnostic challenges and imaging characteristics of chronic nonbacterial osteomyelitis in pediatric patients.
• To emphasize the importance of considering CNO in the differential diagnosis of pediatric bone inflammatory processes.
• To underscore the role of whole-body magnetic resonance imaging (MRI) in the diagnosis and management of CNO.

Main Methods:

• Review of clinical presentations, imaging findings, and diagnostic considerations for CNO.
• Emphasis on the utility of whole-body MRI as the imaging modality of choice for CNO diagnosis and follow-up.
• Discussion of differential diagnoses, including infectious, benign, and malignant bone conditions.

Main Results:

• CNO lesions exhibit predilection for metaphyseal regions of long bones and can present multifocally and recurrently.
• Magnetic resonance imaging (MRI), especially whole-body scans, is crucial for early diagnosis and monitoring of CNO.
• Distinguishing CNO from other bone diseases requires a high index of suspicion and comprehensive diagnostic evaluation.

Conclusions:

• Chronic nonbacterial osteomyelitis is an important consideration in pediatric patients with unexplained bone inflammation.
• Whole-body MRI significantly aids in the diagnosis and management of CNO, improving patient outcomes.
• Accurate diagnosis of CNO is essential to differentiate it from other bone pathologies and initiate appropriate treatment.