Skip to main content

Advertisement

SpringerLink
Log in

Update on MRI findings of osteomyelitis of long bones in the adult population

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the usefulness of new and established MRI signs of osteomyelitis in long bones in adults.

Methods

All patient records over a 9-year period with clinical or MRI suspicion for osteomyelitis were retrospectively reviewed, using strict criteria for proof of infection. Two musculoskeletal radiologists independently reviewed the MRIs of proven osteomyelitis.

Results

Out of 45 MRIs of confirmed osteomyelitis, 2 MRIs (4%) did not show confluent low-signal intensity on T1-weighted images, but all showed confluent high-signal intensity on T2-weighted images. Central hypoenhancing regions of marrow without abscess formation were found in 15–18/35 (43–51%) cases where gadolinium was given. We often found multiple foci of marrow replacement in the same bone. The areas of marrow involvement often had an irregular contour. Penumbra sign, marrow fat globules, and sequestra were uncommon.

Conclusion

Multiple foci of bone marrow signal abnormalities, an irregular contour of marrow abnormality, and central marrow hypoenhancement without abscess are common signs of osteomyelitis of long bones in adults. Confluent low T1-signal intensity is not always present.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

OM:

Osteomyelitis

HOM:

Hematogenous osteomyelitis

COM:

Osteomyelitis due to contiguous spread

ESR:

Erythrocyte sedimentation rate

CRP:

C-reactive protein

MRI:

Magnetic resonance imaging

References

  1. Tehranzadeh J, Wong E, Wang F, Sadighpour M. Imaging of osteomyelitis in the mature skeleton. Radiol Clin North Am. 2001;39(2):223–50.

    Article  CAS  Google Scholar 

  2. Beaman FD vHP, Kransdorf MJ, Adler RS, Amini B, Appel M, et al. . ACR Appropriateness Criteria® Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infection (Excluding Spine and Diabetic Foot). J Am Coll Radiol [Internet]. https://doi.org/10.1016/j.jacr.2017.02.008: Elsevier Inc; 2017:S326–337.

  3. Pineda C, Vargas A, Rodriguez AV. Imaging of osteomyelitis: current concepts. Infect Dis Clin North Am. 2006;20(4):789–825.

    Article  Google Scholar 

  4. Lee YJ, Sadigh S, Mankad K, Kapse N, Rajeswaran G. The imaging of osteomyelitis. Quant Imaging Med Surg. 2016;6(2):184–98.

    Article  Google Scholar 

  5. Beltran J, Noto AM, McGhee RB, Freedy RM, McCalla MS. Infections of the musculoskeletal system: high-field-strength MR imaging. Radiology. 1987;164(2):449–54.

    Article  CAS  Google Scholar 

  6. Levine SE, Neagle CE, Esterhai JL, Wright DG, Dalinka MK. Magnetic resonance imaging for the diagnosis of osteomyelitis in the diabetic patient with a foot ulcer. Foot Ankle Int. 1994;15(3):151–6.

    Article  CAS  Google Scholar 

  7. Johnson PW, Collins MS, Wenger DE. Diagnostic utility of T1-weighted MRI characteristics in evaluation of osteomyelitis of the foot. AJR Am J Roentgenol. 2009;192(1):96–100.

    Article  Google Scholar 

  8. Collins MS, Schaar MM, Wenger DE, Mandrekar JN. T1-weighted MRI characteristics of pedal osteomyelitis. AJR Am J Roentgenol. 2005;185(2):386–93.

    Article  Google Scholar 

  9. Jowett AJ, Middleton SW, Quaye MC, Chesterfield H, Lasrado I, Witham FM. Intracortical haematogenous osteomyelitis. Ann R Coll Surg Engl. 2014;96(2):e13-16.

    Article  CAS  Google Scholar 

  10. Prodinger PM, Pilge H, Banke IJ, Burklein D, Gradinger R, Miethke T, et al. Acute osteomyelitis of the humerus mimicking malignancy: Streptococcus pneumoniae as exceptional pathogen in an immunocompetent adult. BMC Infect Dis. 2013;13:266.

    Article  Google Scholar 

  11. Zalavras CG, Rigopoulos N, Lee J, Learch T, Patzakis MJ. Magnetic resonance imaging findings in hematogenous osteomyelitis of the hip in adults. Clin Orthop Relat Res. 2009;467(7):1688–92.

    Article  Google Scholar 

  12. Howe BM, Wenger DE, Mandrekar J, Collins MS. T1-weighted MRI imaging features of pathologically proven non-pedal osteomyelitis. Acad Radiol. 2013;20(1):108–14.

    Article  Google Scholar 

  13. Jaramillo D, Dormans JP, Delgado J, Laor T, St Geme JW, 3rd. Hematogenous osteomyelitis in infants and children: imaging of a changing disease. Radiology. 2017; 283(3):629-643.

  14. Whyte NS, Bielski RJ. Acute hematogenous osteomyelitis in children. Pediatr Ann. 2016;45(6):e204-208.

    Article  Google Scholar 

  15. Trueta J. The three types of acute haematogenous osteomyelitis. J Bone Joint Surg. 1959;41B(4):671–9.

    Article  Google Scholar 

  16. Kiaer T. Bone perfusion and oxygenation Animal experiments and clinical observations. Acta Orthop Scand Suppl. 1994;257:1–41.

    CAS  PubMed  Google Scholar 

  17. Kavanagh N, Ryan EJ, Widaa A, Sexton G, Fennell J, O’Rourke S, et al. Staphylococcal osteomyelitis: disease progression, treatment challenges, and future directions. Clin Microbiol Rev. 2018;31(2):e00084-17.

  18. Cook GE, Markel DC, Ren W, Webb LX, McKee MD, Schemitsch EH. Infection in Orthopaedics. J Orthop Trauma. 2015;29(Suppl 12):S19-23.

    Article  Google Scholar 

  19. Carek PJ, Dickerson LM, Sack JL. Diagnosis and management of osteomyelitis. Am Fam Physician. 2001;63(12):2413–20.

    CAS  PubMed  Google Scholar 

  20. Markanday A. Acute phase reactants in infections: evidence-based review and a guide for clinicians. Open Forum Infect Dis. 2015;2(3):ofv098.

    Article  Google Scholar 

  21. Lavery LA, Ahn J, Ryan EC, Bhavan K, Oz OK, La Fontaine J, et al. What are the optimal cutoff values for ESR and CRP to diagnose osteomyelitis in patients with diabetes-related foot infections? Clin Orthop Relat Res. 2019;477(7):1594–602.

    Article  Google Scholar 

  22. Wu JS, Gorbachova T, Morrison WB, Haims AH. Imaging-guided bone biopsy for osteomyelitis: are there factors associated with positive or negative cultures? AJR Am J Roentgenol. 2007;188(6):1529–34.

    Article  Google Scholar 

  23. Wong A, Grando H, Fliszar E, Pathria M, Chang EY, Resnick D. Intramedullary fat globules related to bone trauma: a new MR imaging finding. Skeletal Radiol. 2014;43(12):1713–9.

    Article  Google Scholar 

  24. Grey AC, Davies AM, Mangham DC, Grimer RJ, Ritchie DA. The “penumbra sign” on T1-weighted MR imaging in subacute osteomyelitis: frequency, cause and significance. Clin Radiol. 1998;53(8):587–92.

    Article  CAS  Google Scholar 

  25. Gwet KL. Computing inter-rater reliability and its variance in the presence of high agreement. Br J Math Stat Psychol. 2008;61(Pt 1):29–48.

    Article  Google Scholar 

  26. Calhoun JH, Manring MM. Adult osteomyelitis. Infect Dis Clin North Am. 2005;19(4):765–86.

    Article  Google Scholar 

  27. Lazzarini L, Mader JT, Calhoun JH. Osteomyelitis in long bones. J Bone Joint Surg Am. 2004;86(10):2305–18.

    Article  Google Scholar 

  28. Hatzenbuehler J, Pulling TJ. Diagnosis and management of osteomyelitis. Am Fam Physician. 2011;84(9):1027–33.

    PubMed  Google Scholar 

  29. Rosenberg A, Khurana J. Osteomyelitis and osteonecrosis. Diagn Histopathol. 2016;22(10):355–68.

    Article  Google Scholar 

  30. Tomlinson RE, Silva MJ. Skeletal Blood Flow in Bone Repair and Maintenance. Bone Res. 2013;1(4):311–22.

    Article  CAS  Google Scholar 

  31. Colman MW, Hornicek FJ, Schwab JH. Spinal cord blood supply and its surgical implications. J Am Acad Orthop Surg. 2015;23(10):581–91.

    Article  Google Scholar 

  32. Palestro CJ, Love C, Miller TT. Infection and musculoskeletal conditions: Imaging of musculoskeletal infections. Best Pract Res Clin Rheumatol. 2006;20(6):1197–218.

    Article  Google Scholar 

  33. Mader JT, Mohan D, Calhoun J. A practical guide to the diagnosis and management of bone and joint infections. Drugs. 1997;54(2):253–64.

    Article  CAS  Google Scholar 

  34. Calhoun JH, Manring MM, Shirtliff M. Osteomyelitis of the long bones. Semin Plast Surg. 2009;23(2):59–72.

    Article  Google Scholar 

  35. Garcia Del Pozo E, Collazos J, Carton JA, Camporro D, Asensi V. Bacterial osteomyelitis: microbiological, clinical, therapeutic, and evolutive characteristics of 344 episodes. Rev Esp Quimioter. 2018;31(3):217–25.

    CAS  PubMed  Google Scholar 

  36. Barakat E, Guischer N, Houssiau F, Lecouvet FE. The “birth of death”: MRI step-by-step reveals the early appearance of a bone marrow infarct. Acta Radiol Open. 2019;8(3):2058460119834691.

    PubMed  PubMed Central  Google Scholar 

  37. Murphey MD, Foreman KL, Klassen-Fischer MK, Fox MG, Chung EM, Kransdorf MJ. From the radiologic pathology archives imaging of osteonecrosis: radiologic-pathologic correlation. Radiographics. 2014;34(4):1003–28.

    Article  Google Scholar 

  38. Blacksin MF, Finzel KC, Benevenia J. Osteomyelitis originating in and around bone infarcts: giant sequestrum phenomena. AJR Am J Roentgenol. 2001;176(2):387–91.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors thank Lada Micheas, PhD, for her contribution to statistical analysis.

The authors declare no competing interests. Approval from the Institutional Review Board was obtained and in keeping with the policies for a retrospective review, informed consent was not required.

Author information

Authors and Affiliations

  1. University of Missouri at Columbia, 1 Hospital Dr, Columbia, MO, 65212, USA

    Julia Crim, Samantha Salmon, Christy Waranch, Jacob Elfrink & J. Derek Stensby

  2. University of Pennsylvania, Philadelphia, PA, USA

    Eleanor Layfield

Authors
  1. Julia Crim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Samantha Salmon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christy Waranch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jacob Elfrink
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eleanor Layfield
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Derek Stensby
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julia Crim.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Key points

1. A small number of cases of proven osteomyelitis lack confluent low signal intensity on T1-weighted images, while all show confluent high signal on T2-weighted images.

2. Osteomyelitis, especially when due to hematogenous spread, often shows a pattern of multiple separate areas of marrow abnormality.

3. Osteomyelitis often shows central contrast hypoenhancement without abscess formation and its irregular contour may mimic a bone infarct.

4. Previously described findings of marrow fat globules, subperiosteal abscess, penumbra sign and intraosseous abscess were uncommon in our patient population.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Crim, J., Salmon, S., Waranch, C. et al. Update on MRI findings of osteomyelitis of long bones in the adult population. Skeletal Radiol 51, 1787–1796 (2022). https://doi.org/10.1007/s00256-022-04020-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-022-04020-w

Keywords

Search

Navigation