Typical Patterns of Bone Involvement in Whole-Body MRI of Patients with Chronic Recurrent Multifocal Osteomyelitis (CRMO)

Abstract

Purpose: The diagnosis of CRMO often involves a long patient history. We evaluated the spectrum of bone involvement in whole-body magnetic resonance imaging (WB-MRI) and assessed its potential contribution to a more rapid diagnosis.

Materials and Methods: WB-MRI (1.5 T, coronal STIR sequences) in 53 children and adolescents (mean age 11 years, 4.8 – 15.1) with histologically (n = 37) or clinically (n = 16) confirmed CRMO were retrospectively reviewed by two experienced pediatric radiologists.

Results: WB-MRI revealed multifocal lesions in all but one patients. Only 26 of them had presented with multifocal complaints. We detected 1 – 27 geographic lesions/patient (mean 9.7). 510 of 513 lesions were significantly hyperintense compared to normal bone marrow. The pelvis, lower extremities, shoulders and spine were most frequently involved. 40 patients (75 %) had bilateral symmetrical involvement of bones. Most of the lesions were located in tubular bones, in 87 % adjacent to one or both sides of a growth plate. 32 % of lesions showed periosteal involvement. Of 456 affected bones, 33 (7.2 %) were deformed, 6 (18 %) were vertebra plana.

Conclusion: In the absence of more specific diagnostic criteria, WB-MRI can, in synopsis with clinical findings, substantially contribute to a rapid diagnosis of CRMO. It discovers the typical pattern of multifocal and bilateral bone involvement more often than has been reported for targeted MRI. It readily reveals the characteristic proximity of lesions to growth plates, the sacroiliac joint and triradiate cartilage and helps to uncover asymptomatic spinal complications.

Zusammenfassung

Ziel: Die Diagnose einer CRMO wird häufig erst nach einer längeren Anamnese gestellt. Wir werteten Ganzkörper-MRT (GK-MRT) hinsichtlich typischer Muster des Knochenbefalls aus und beurteilten deren potentiellen Beitrag zu einer schnelleren Diagnosestellung.

Material und Methoden: GK-MRT (1,5 T, coronare STIR-Sequenzen) bei 53 Kindern und Adoleszenten (mittleres Alter 11 Jahre, 4,8 – 15,1) mit histologisch (n = 37) oder klinisch (n = 16) gesicherter CRMO wurden retrospektiv von 2 erfahrenen pädiatrischen Radiologen beurteilt.

Ergebnisse: GK-MRI zeigte multifokale Läsionen von einer Ausnahme abgesehen bei allen Patienten. Nur 26 hatten multifokale Beschwerden angegeben. Wir entdeckten 1 – 27 geografische Läsionen pro Patient (Mittelwert 9,7). 510 der 513 Läsionen waren deutlich hyperintens im Vergleich zu normalem Knochenmark. Becken, untere Extremitäten, Schultern und Wirbelsäule waren am häufigsten betroffen. 40 Patienten (75 %) hatten beidseitige symmetrische Knochenbeteiligung. Die meisten aller Läsionen traten in Röhrenknochen auf, in 87 % angrenzend an eine Epiphysenfuge. 32 % der Läsionen hatten eine periostale Begleitreaktion. 33 der 456 betroffenen Knochen (7,2 %) waren deformiert, 6 (18 %) waren vertebra plana.

Schlussfolgerung: Da spezifischere Diagnose-Kriterien fehlen, kann die GK-MRT in Zusammenschau mit klinischen Befunden einen wichtigen Beitrag zu einer zügigen Diagnosestellung der CRMO leisten. Sie entdeckt typische Muster des multifokalen und bilateralen Knochenbefalls häufiger als für regionale MRT-Untersuchungen berichtet. Sie zeigt die charakteristische Nähe der Läsionen zu den Epiphysenfugen, zu den Iliosakralgelenken sowie zur Y-Fuge und erlaubt die Entdeckung asymptomatischer spinaler Komplikationen.

Key words

bones - MR imaging - non-bacterial chronic osteomyelitis - children - adolescents

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