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MRI in the Diagnosis and Treatment Response Assessment of Chronic Nonbacterial Osteomyelitis in Children and Adolescents

  • Pediatric Rheumatology (S Ozen, Section Editor)
  • Published:
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Abstract

Purpose of Review

To explain the central role of magnetic resonance imaging (MRI) in the diagnosis and follow-up of chronic nonbacterial osteomyelitis (CNO) in children and adolescents, centering on practical technical aspects and salient diagnostic features.

Recent Findings

In the absence of conclusive clinical features and widely accepted laboratory tests, including validated disease biomarkers, MRI (whether targeted or covering the entire body) currently plays an indispensable role in the diagnosis and therapy response assessment of CNO. Whole-body MRI, which is the reference imaging standard for CNO, can be limited to a short tau inversion recovery (STIR) coronal image set covering the entire body and a STIR sagittal set covering the spine, an approximately 30-min examination with no need for intravenous contrast or diffusion-weighted imaging. The hallmark of CNO is periphyseal (metaphyseal and/or epi-/apophyseal) osteitis, identified as bright foci on STIR, with or without inflammation of the adjacent periosteum and surrounding soft tissue. Response to bisphosphonate treatment for CNO has some unique MRI findings that should not be mistaken for residual or relapsing disease.

Summary

Diagnostic features and treatment response characteristics of MRI in pediatric CNO are discussed, also describing the techniques used, pitfalls encountered, and differential diagnostic possibilities considered during daily practice.

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Abbreviations

CNO:

Chronic nonbacterial osteomyelitis

CRMO:

Chronic recurrent multifocal osteomyelitis

CRPS:

Complex regional pain syndrome

CT:

Computed tomography

FOPE:

Focal periphyseal edema

JIA:

Juvenile idiopathic arthritis

LCH:

Langerhans cell histiocytosis

MRI:

Magnetic resonance imaging

STIR:

Short tau inversion recovery

T1W:

T1-weighted

T2W:

T2-weighted

WB-MRI:

Whole-body magnetic resonance imaging

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  1. Division of Musculoskeletal Radiology, Department of Radiology, Hacettepe University School of Medicine, 06230, Ankara, Turkey

    Üstün Aydıngöz & Adalet Elçin Yıldız

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Institutional Review Board (IRB) approval (GO 20/958/2020/17–44) was obtained in the ongoing study mentioned in this paper and being performed by the authors. Informed consent was waived by the IRB due to the retrospective nature of the study. This article does not contain any studies with animal subjects performed by any of the authors.

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Ongoing study with Institutional Review Board approval (GO 20/958/2020/17–44):

Aydıngöz Ü, Yıldız AE, Ayaz E, Batu ED, Bilginer Y, Ergen FB, Özen S. Preferential involvement of the periphyseal bone marrow at and around the pelvis in chronic nonbacterial osteomyelitis.

Dr. Yıldız is also a subspecialty-trained and board-certified pediatric radiologist.

This article is part of the Topical Collection on Pediatric Rheumatology

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Aydıngöz, Ü., Yıldız, A. MRI in the Diagnosis and Treatment Response Assessment of Chronic Nonbacterial Osteomyelitis in Children and Adolescents. Curr Rheumatol Rep 24, 27–39 (2022). https://doi.org/10.1007/s11926-022-01053-x

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