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Benefits of diffusion-weighted imaging in pediatric acute osteoarticular infections
Céline Habre1, Paul Botti2, Méryle Laurent2
1Pediatric Radiology Unit, Radiology Division, Diagnostic Department, Children's Hospital, University Hospitals of Geneva, CH-1211, Geneva 14, Switzerland. celine.habre@hcuge.ch.
Background:
Contrast-enhanced magnetic resonance imaging (MRI) is recommended for the diagnosis of acute osteoarticular infections in children. Diffusion-weighted imaging (DWI) may be an alternative to the injection of gadolinium.
Objective:
To evaluate unenhanced MRI with DWI in comparison to contrast-enhanced MRI for the diagnostic work-up of acute osteoarticular infections in children.
Materials And Methods:
This retrospective study included 36 children (age range: 7 months-12 years) with extra-spinal osteoarticular infections and MRI performed within 24 h of admission. MRI protocol included short tau inversion recovery (STIR), water-only T2 Dixon, T1, DWI, and gadolinium-enhanced T1 sequences. Two readers reviewed three sets of images: 1) unenhanced sequences, 2) unenhanced sequences with DWI and 3) unenhanced followed by contrast-enhanced sequences (reference standard). Sensitivity and specificity of sets 1 and 2 were compared to set 3 and assessed to identify osteoarticular infections: osteomyelitis (long bones, metaphyseal equivalents), septic arthritis and abscess (soft tissues, bone).
Results:
All 14 cases of osteomyelitis in the metaphyses and diaphyses of long bones and all 27 cases of septic arthritis were identified by unenhanced sequences, but 4/16 abscesses were missed. For the diagnosis of abscess, DWI increased sensitivity to 100%. Among the 18 osteomyelitis in metaphyseal equivalents, 4 femoral head chondroepiphyses were identified by contrast-enhanced sequences only.
Conclusion:
MRI for suspected pediatric acute osteoarticular infections is the best diagnostic modality to guide patient management. An unenhanced protocol with DWI may be an alternative to a contrast-based protocol, even in the presence of an abscess. However, gadolinium remains necessary to assess for chondroepiphyseal involvement of the femoral head.
Insights
Unenhanced MRI with diffusion-weighted imaging (DWI) can effectively diagnose pediatric osteoarticular infections, including abscesses. However, contrast-enhanced MRI remains crucial for detecting certain femoral head chondroepiphyseal issues.
Area of Science:
- Pediatric Radiology
- Musculoskeletal Imaging
- Infectious Diseases
Background:
- Contrast-enhanced MRI is standard for diagnosing pediatric osteoarticular infections.
- Diffusion-weighted imaging (DWI) offers a potential alternative to gadolinium contrast agents.
Purpose of the Study:
- To compare unenhanced MRI with DWI against contrast-enhanced MRI for diagnosing acute osteoarticular infections in children.
- To evaluate the diagnostic performance of MRI protocols in identifying osteomyelitis, septic arthritis, and abscesses.
Main Methods:
- Retrospective analysis of 36 children with osteoarticular infections.
- MRI protocols included STIR, T2 Dixon, T1, DWI, and contrast-enhanced T1 sequences.
- Comparison of image sets: unenhanced, unenhanced with DWI, and contrast-enhanced (reference).
Main Results:
- Unenhanced MRI with DWI achieved 100% sensitivity for diagnosing abscesses, improving detection over unenhanced sequences alone.
- All cases of osteomyelitis and septic arthritis were identified by unenhanced sequences.
- Contrast-enhanced MRI was necessary to identify 4 cases of femoral head chondroepiphyseal osteomyelitis.
Conclusions:
- Unenhanced MRI with DWI is a viable alternative to contrast-enhanced MRI for pediatric osteoarticular infections, including abscesses.
- Gadolinium contrast remains essential for evaluating chondroepiphyseal involvement of the femoral head.
- MRI is the optimal imaging modality for managing suspected pediatric osteoarticular infections.
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