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MRI features of spinal chronic recurrent multifocal osteomyelitis/chronic non-bacterial osteomyelitis in children
Andressa Guariento1, Parth Sharma1, Savvas Andronikou2,3
1Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Background:
Spinal lesions in pediatric chronic recurrent multifocal osteomyelitis/chronic non-bacterial osteomyelitis (CRMO/CNO) can cause permanent sequelae; thus, early recognition of these is vital for management.
Objective:
To characterize the MR imaging features and patterns of pediatric spinal CRMO/CNO.
Materials And Methods:
This cross-section study received IRB approval. The first available MRI with documented spine involvement in children with CRMO/CNO was reviewed by a pediatric radiologist. Descriptive statistics were used to describe the characteristics of vertebral lesions, disc involvement, and soft tissue abnormality.
Results:
Forty-two patients were included (F:M, 30:12); median age was 10 years (range 4-17). At diagnosis, 34/42 (81%) had spine involvement. Kyphosis in 9/42 (21%) and scoliosis in 4/42 (9.5%) patients were present at the time of spinal disease recognition. Vertebral involvement was multifocal in 25/42 (59.5%). Disc involvement was found in 11/42 (26%) patients, commonly in the thoracic spine and often with adjacent vertebrae height loss. Posterior element abnormalities were present in 18/42 patients (43%) and soft tissue involvement in 7/42 (17%). One hundred nineteen vertebrae were affected, commonly the thoracic vertebrae (69/119; 58%). Vertebral body edema was focal in 77/119 (65%) and frequently superior (42/77; 54%). Sclerosis and endplate abnormality were present in 15/119 (13%) and 31/119 (26%) vertebrae, respectively. Height loss was present in 41/119 (34%).
Conclusion:
Chronic non-bacterial osteomyelitis of spine is usually thoracic. Vertebral body edema is often focal at the superior vertebral body. Kyphosis and scoliosis occur in a quarter and vertebral height loss in a third of children at spinal disease recognition.
Insights
Early recognition of spinal lesions in pediatric chronic recurrent multifocal osteomyelitis (CRMO/CNO) is vital. MRI findings show multifocal vertebral involvement, often in the thoracic spine, with edema and height loss being common in children.
Area of Science:
- Pediatric Radiology
- Musculoskeletal Imaging
- Inflammatory Bone Disease
Background:
- Spinal lesions in pediatric chronic recurrent multifocal osteomyelitis/chronic non-bacterial osteomyelitis (CRMO/CNO) can lead to permanent damage.
- Early detection and management of spinal CRMO/CNO are crucial for preventing long-term sequelae.
Purpose of the Study:
- To characterize the magnetic resonance (MR) imaging features of pediatric spinal CRMO/CNO.
- To identify patterns of MR imaging findings in children with spinal CRMO/CNO.
Main Methods:
- Cross-sectional study with IRB approval.
- Retrospective review of MR imaging in pediatric patients with CRMO/CNO and documented spine involvement.
- Descriptive statistical analysis of vertebral lesions, disc involvement, and soft tissue abnormalities.
Main Results:
- Eighty-one percent of patients presented with spine involvement at diagnosis; 21% had kyphosis and 9.5% had scoliosis.
- Multifocal vertebral involvement (59.5%) was common, predominantly in the thoracic spine (58%).
- Focal edema (65%), often superior (54%), vertebral height loss (34%), and endplate abnormalities (26%) were frequently observed.
Conclusions:
- Pediatric spinal CRMO/CNO most commonly affects the thoracic spine.
- Vertebral body edema is typically focal and located superiorly.
- Kyphosis, scoliosis, and vertebral height loss are significant findings at the time of diagnosis.
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