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Bone marrow edema in children: chronic nonbacterial osteomyelitis and its mimickers
Chiara Giraudo1, Giulia Fichera2, Anna Michielin2
1Department of Cardiac, Thoracic, Vascular Sciences and Public Health-DCTV, University of Padova, Via Giustiniani 2, Padova 35100, Italy.
Abstract:
Bone marrow is a highly cellular tissue undergoing significant developmental and physiologic changes with age. Indeed, with maturation from pediatric to the adult age there is a progressive, centrifugal conversion from red to yellow bone marrow. Histological characteristics of bone marrow are reflected in MR image signal. MR is therefore extremely sensitive in detecting pathological changes which are mostly characterized by increased free water causing high signal intensity on T2. Among the numerous diseases causing bone marrow edema in children chronic nonbacterial osteomyelitis (CNO) certainly has to be mentioned. This idiopathic inflammatory disorder is characterized by nonspecific migrating symptoms like skeletal pain with phases of exacerbations and relapses with alternating acute and chronic MR signs and it is often a diagnosis of exclusion. Hence, with bone marrow edema, various features at imaging should be considered to differentiate malignancies such as osseous lymphoma, osteosarcoma, and Ewing's sarcoma as well as benign lesions like osteomyelitis, post-traumatic, or post-treatment bone marrow edema. The aim of this review is to recall the main characteristics of CNO and provide an overview of its main mimickers highlighting similarities and differences.
Insights
Chronic nonbacterial osteomyelitis (CNO) in children presents with bone marrow edema on MRI. Differentiating CNO from other bone marrow pathologies, including malignancies and benign lesions, is crucial for accurate diagnosis.
Area of Science:
- Pediatric Radiology
- Musculoskeletal Imaging
- Inflammatory Disorders
Background:
- Bone marrow composition changes with age, impacting MR signal.
- Bone marrow edema on MRI, characterized by increased T2 signal intensity, indicates pathological changes.
- Chronic nonbacterial osteomyelitis (CNO) is an idiopathic inflammatory disorder in children presenting with bone marrow edema.
Purpose of the Study:
- To review the key imaging characteristics of CNO in children.
- To highlight the main differential diagnoses for CNO, focusing on distinguishing features.
- To aid in differentiating CNO from malignancies and other benign bone marrow lesions.
Main Methods:
- Review of existing literature on CNO and its mimics.
- Analysis of MR imaging features associated with CNO.
- Comparison of imaging findings across various bone marrow pathologies.
Main Results:
- CNO exhibits variable MR signs reflecting acute and chronic inflammation.
- Malignancies (lymphoma, osteosarcoma, Ewing's sarcoma) and benign lesions share some imaging similarities with CNO.
- Distinct imaging features exist to differentiate CNO from its mimics.
Conclusions:
- Accurate differentiation of CNO from other bone marrow pathologies is essential.
- Understanding the spectrum of MR imaging findings in CNO and its mimics improves diagnostic accuracy.
- This review provides a framework for distinguishing CNO in the context of bone marrow edema.
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