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[Osteomyelitis during the growth period. Diagnostic imaging]
1Abteilung Pädiatrische Radiologie, Radiologische Klinik, Klinikum der Ruprecht-Karls-Universität Heidelberg.
Insights
Rapid diagnosis of childhood osteomyelitis is crucial. Imaging, including radiography, sonography, MRI, and bone scans, aids early antibiotic therapy to prevent long-term complications.
Area of Science:
- Pediatric Radiology
- Musculoskeletal Imaging
- Infectious Disease Imaging
Context:
- Acute osteomyelitis in children requires prompt diagnosis and treatment to avoid sequelae.
- Diagnostic imaging is essential for timely intervention in pediatric osteomyelitis.
Purpose:
- To outline an imaging-based diagnostic workup for acute osteomyelitis in children.
- To detail the roles of various imaging modalities in diagnosing pediatric osteomyelitis.
Summary:
- Initial imaging for suspected pediatric osteomyelitis involves radiography, followed by sonography to detect abscesses or joint effusions.
- MRI or 99mTc-MDP bone scan are subsequent steps for unclear diagnoses, chosen based on localization and lesion site.
- MRI offers superior anatomical detail, especially for spinal osteomyelitis, while bone scans are useful for whole-body assessment and multifocal cases.
Impact:
- Establishes a clear imaging algorithm for pediatric osteomyelitis, guiding clinicians towards appropriate diagnostic choices.
- Highlights the strengths and weaknesses of different imaging techniques, optimizing diagnostic accuracy and patient management.
- Emphasizes the importance of early and accurate diagnosis through imaging to prevent long-term complications in children.
Abstract:
In acute osteomyelitis of childhood a rapid diagnosis and initiation of antibiotic therapy is necessary in order to prevent late sequelae. Thus, diagnostic imaging plays a crucial role. If acute osteomyelitis is suspected in a child, imaging starts with conventional radiography in order to exclude other differential diagnoses. This is followed by sonography for the purpose of diagnosing a subperiosteal abscess or joint fluid from which the causative organism could be isolated. If the diagnosis is unclear, the next step should be either MRI or 99mTc-MDP bone scan, depending on the possibility of clinical localization and the site of the suspected lesion. MRI is superior to bone scan in depicting the exact anatomy, which is extremely important in spinal osteomyelitis and preoperatively. The bone scan can show the whole skeleton in one examination and should be favored if there is no definite localization or in suspected multifocal osteomyelitis. Rarely scintigraphy with labeled white blood cells is indicated. The 67Ga scan, however, should not be used in children because of the high level of radiation exposure. The different imaging modalities are described in detail and an imaging diagnostic workup is outlined.
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