Computed and magnetic resonance imaging in the diagnosis of myositis ossificans in children

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

BACKGROUND. Post-traumatic myositis ossificans (MO) is a complication of observation characterized by bone formation in soft tissues. The lesion, proceeding in stages, according to clinical and visual manifestations, manifests itself at each stage. The diagnosis is established based on anamnesis, features and research methods, which can be informative depending on the stage of the disease.

AIM: To present the possibility of computed and magnetic resonance imaging in the diagnosis of MO in children.

METHODS: In this study we analyzed data from 68 children who had signs of MO according to radiological diagnostic methods. The average age of patients was 12.3±4.9, from 2 months to 17 years. There were 42 boys (61.76%), girls — 25 (38.24%). The cause of OM in the studied patients was damage to the musculoskeletal system (fractures, bruises of soft tissues) and/or impaired blood circulation in the muscles as a result of prolonged forced immobility during their stay in the intensive care unit, as well as in connection with the consequences of trauma (vegetative state, lower paraplegia).

RESULTS: At the early stage of MO, classical radiographs in all 49 children were negative, at 4–6 weeks after injury, half of them had weak radiopaque changes in the surrounding space. CT showed initial soft tissue edema or volumetric changes, both with and without calcification at 4–6 weeks. In case of fuzzy zonal changes on CT and differential diagnosis MRI was performed in 34 children, which made it possible to solve problems with the diagnosis of MO. MO affected zones were identified in several anatomical areas: in 48 children out of 68, dysfunction of the muscles of the limbs was revealed, followed by the muscles of the pelvis (29 children) and upper limbs (14 children).

CONCLUSION: Traumatic MO is capable of affecting any extraskeletal muscles. Our study showed that MO is more common in the anterior region of the thigh, which includes the quadriceps muscle group. For correct and timely MO diagnosis it needs to use several detection methods. CT is currently the best method for MO diagnosing. If the symptoms are not obvious on CT and there is a need for additional differential diagnosis, MRI should be performed.

Full Text

Restricted Access

About the authors

Tolibdzhon A. Akhadov

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma — Dr. Roshal’s Clinic

Email: AkhadovTA@zdrav.mos.ru
ORCID iD: 0000-0002-3235-8854

Dr. Sci. (Medicine), Professor

Россия, Moscow

Valery A. Mitish

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma — Dr. Roshal’s Clinic; Vishnevsky Institute of Surgery; Patrice Lumumba Peoples’ Friendship University of Russia

Email: MitishVA@zdrav.mos.ru
ORCID iD: 0000-0001-6411-0709
SPIN-code: 4529-4044

Cand. Sci. (Medicine)

Россия, Moscow; Moscow; Moscow

Olga V. Bozhko

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma — Dr. Roshal’s Clinic

Email: Bozhko2OV@zdrav.mos.ru
ORCID iD: 0000-0002-4709-9461
SPIN-code: 5713-3427

Cand. Sci. (Medicine)

Россия, Moscow

Maxim V. Ublinsky

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma — Dr. Roshal’s Clinic

Author for correspondence.
Email: maxublinsk@mail.ru
ORCID iD: 0000-0002-4627-9874
SPIN-code: 8332-2024

Cand. Sci. (Biology)

Россия, Moscow

Ilya A. Melnikov

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma — Dr. Roshal’s Clinic

Email: MelnikovIA3@zdrav.mos.ru
ORCID iD: 0000-0002-2910-3711
SPIN-code: 2512-2351

Cand. Sci. (Medicine)

Россия, Moscow

Dmitry M. Dmitrenko

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma — Dr. Roshal’s Clinic

Email: DmitrenkoDM@zdrav.mos.ru
ORCID iD: 0000-0003-1260-4509
SPIN-code: 9535-4852
Россия, Moscow

Darya N. Khusainova

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma — Dr. Roshal’s Clinic

Email: KhusainovaDN@zdrav.mos.ru
ORCID iD: 0000-0002-1698-0547
SPIN-code: 2184-4338
Россия, Moscow

Ruben T. Nalbandyan

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma — Dr. Roshal’s Clinic

Email: NalbandyanRT@zdrav.mos.ru
ORCID iD: 0000-0002-0332-9720
SPIN-code: 8674-0578

Cand. Sci. (Medicine)

Россия, Moscow

Olga V. Karaseva

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma — Dr. Roshal’s Clinic; National Medical Research Center for Children’s Health

Email: KarasevaOV@zdrav.mos.ru
ORCID iD: 0000-0001-9418-4418
SPIN-code: 7894-8369

Dr. Sci. (Medicine)

Россия, Moscow; Moscow

References

  1. Olsen KM, Chew FS. Tumoral calcinosis: pearls, polemics, and alternative possibilities. Radiographics. 2006;26:871–885. doi: 10.1148/rg.263055099
  2. Chen HC, Yang JY, Chuang SS, et al. Heterotopic ossification in burns: our experience and literature reviews. Burns. 2009;35(6):857–862. doi: 10.1016/j.burns.2008.03.002
  3. Devilbiss Z, Hess M, Ho GWK. Myositis ossificans in sport: a review. Curr Sports med rep. 2018;17:290–295. doi: 10.1249/JSR.0000000000000515
  4. Thomas EA, Cassar-Pullicino VN, McCall IW. The role of ultrasound in the early diagnosis and management of heterotopic bone formation. Clin Radiol. 1991;43(3):190–196. doi: 10.1016/s0009-9260(05)80478-7
  5. Walczak BE, Johnson CN, Howe BM. Myositis ossificans. J Am Acad Orthop Surg. 2015;23:612. doi: 10.5435/JAAOS-D-14-00269
  6. Sferopoulos NK, Kotakidou R, Petropoulos AS. Myositis ossificans in children: a review. Eur J Orthop Surg Traumatol. 2017;27:1–12. doi: 10.1007/s00590-017-1932-x
  7. Yamaga K, Kobayashi E, Kubota D, et al. Pediatric myositis ossificans mimicking osteosarcoma. Pediatr Int. 2015; 57(5): 996–999. doi: 10.1111/ped.12672
  8. Savvidou O, Papakonstantinou O, Lakiotaki E, et al. Post-traumatic myositis ossificans: a benign lesion that simulates malignant bone and soft tissue tumours. EFORT Open Rev. 2021;6(7):572–583. doi: 10.1302/2058-5241.6.210002
  9. Wang H, Nie P, Li Y, et al. MRI Findings of early myositis ossificans without calcification or ossification. Biomed Res Int. 2018:4186324. doi: 10.1155/2018/4186324
  10. Kumar Y, Wadhwa V, Phillips L, et al. MR imaging of skeletal muscle signal alterations: Systematic approach to evaluation. Eur J Radiol. 2016;85(5):922–935. doi: 10.1016/j.ejrad.2016.02.007
  11. Flores DV, Mej´ıa G´omez C, Estrada-Castrill´on M, et al. MR Imaging of Muscle Trauma: Anatomy, Biomechanics, Pathophysiology, and Imaging Appearance. RadioGraphics. 2018;38(1):124–148. doi: 10.1148/rg.2018170072
  12. Ngai A. Post-traumatic myositis ossificans. In: Roger B, Guermazi A, Skaf A, editors. Muscle Injuries in Sport Athletes. Sports and Traumatology. Springer. New York (NY), 2017.
  13. Abate M, Salini V, Rimondi E, et al. Post traumatic myositis ossificans: sonographic findings. J Clin Ultrasound. 2011;39(3):135–140. doi: 10.1002/jcu.20792
  14. Lau J, Hartin CWJr, Ozgediz DE. Myositis ossificans requires multiple diagnostic modalities. J Pediatr Surg. 2012;47(9):1763–1766. doi: 10.1016/j.jpedsurg.2012.05.009
  15. Kransdorf MJ, Meis JM, Jelinek JS. Myositis ossificans: MR appearance with radiologic-pathologic correlation. AJR Am J Roentgenol. 1991;157(6):1243–1248. doi: 10.2214/ajr.157.6.1950874
  16. Saad A, Azzopardi C, Patel A, et al. Myositis ossificans revisited — The largest reported case series. J Clin Orthop Trauma. 2021;17:123–127. doi: 10.1016/j.jcot.2021.03.005
  17. Parikh J, Hyare H, Saifuddin A. The imaging features of post-traumatic myositis ossificans, with emphasis on MRI. Clin Radiol. 2002;57(12):1058–1066. doi: 10.1053/crad.2002.1120
  18. Luczyńska E, Kasperkiewicz H, Domalik A, et al. Myositis ossificans mimicking sarcoma, the importance of diagnostic imaging — case report. Pol J Radiol. 2014;79:228–232. doi: 10.12659/PJR.890209

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Myositis ossificans of the left pectoralis major muscle (in the area of its clavicular part). History of sports injury, 7 weeks. Ultrasound examination (а) shows a heteroechoic formation (between two crosses), indicated by an arrow with fine-grained hyperechoic inclusions. CT scan: (b) — axial section, (c) and (d) — sagittal and coronal multiplanar reconstruction of the periclavicular region. Arrows indicate calcifications.

Download (656KB)
Indexing metadata
3. Fig. 2. Ossifying myositis of quadriceps muscle (intermediate vastus) of the right thigh. History of multiple recurrent sports injuries. Radiography 5 weeks after the last injury. On radiographs in the direct (а) and oblique projections (b) of the right thigh, in the soft tissues, at the level of the middle and lower thirds of the femoral shaft, along the anterior surface (projected in the intermediate vastus muscle of the thigh), a conglomerate of ossifications is visualized.

Download (533KB)
Indexing metadata
4. Fig. 3. Patient, 15 years 9 months. Road traffic accident. 6 weeks after polytrauma, late stage of MO. X-ray of the right hip: a — lateral projection, b — direct projection. In the area of the femoral diaphysis, at the lateral surfaces of the bone, a well-defined cortical structure is visualized.

Download (593KB)
Indexing metadata
5. Fig. 4. The same patient (see Fig. 3), 14 weeks after polytrauma, late stage of MO. Periscapular region of the chest. CT scan of the chest: a, b — axial plane c, d — three-dimensional reconstruction. In the structure of the subscapularis muscle on the left, near the inner surface of the neck of the left scapula, there is uneven ossification.

Download (849KB)
Indexing metadata
6. Fig. 5. Patient, 10 years old. Road traffic accident. 24 weeks after polytrauma, late stage of MO. CT scan: a, b — axial plane, c — coronal plane, d — three-dimensional reconstruction. In the soft tissues of both thighs, there is circular extended peripheral calcification, including the “string symptom” type; on the left, there are air inclusions in places.

Download (1MB)
Indexing metadata
7. Fig. 6. MRI of the right thigh 3 weeks after injury. Axial and coronal T1-weighted images before (a, c) and after (b, d) contrast administration show relative homogeneous enhancement within the intramuscular lesion.

Download (586KB)
Indexing metadata
8. Fig. 7. 5 weeks after blunt sports injury. Myositis ossificans of the deltoid muscle. Anteroposterior radiograph of the shoulder (a), reconstructed CT in the coronal plane visualizes developing mature peripheral calcification (b, arrow), MRI of the shoulder joint area, coronal T2WI with fat signal suppression shows marked edema (oval) around the lesion with heterogeneous MR signal (c).

Download (659KB)
Indexing metadata
9. Fig. 8. Patient, 11 years 11 months. Road traffic accident. CT 15 weeks after polytrauma, late stage of MO. CT scan: a — axial plane, b, c — sagittal plane, d — coronal plane, е — three-dimensional reconstruction. CT shows semicircular extended heterogeneous peripheral calcification in the soft tissues of both thighs (in the anterior and posterior groups of the femoral muscles), extending to the gluteal muscles on both sides.

Download (1MB)
Indexing metadata
10. Fig. 9. Patient, 16 years old, 8 weeks after blunt trauma, late stage of MO. MRI before and after contrast: a, b, c — coronal plane, d — axial plane. In the series of MR tomograms, in the structure of the intermediate vastus muscle of the thigh there are delimited fluid inclusions (probably the consequences of previous hemorrhages), along the periphery of the fluid inclusions there is a diffuse uniform accumulation of contrast agent.

Download (753KB)
Indexing metadata

Copyright (c) 2025 Akhadov T.A., Mitish V.A., Bozhko O.V., Ublinsky M.V., Melnikov I.A., Dmitrenko D.M., Khusainova D.N., Nalbandyan R.T., Karaseva O.V.

License URL: https://eco-vector.com/for_authors.php#07

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies