Some aspects of the application of magnetic resonance imaging for differential diagnostics of acute hematogenous osteomyelitis in children

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Abstract

BACKGROUND: Acute hematogenous osteomyelitis is a purulent septic disease found in children at any age. This pathology still occupies a leading place in the structure of urgent pathologies in children which is characterized by difficult diagnostics, severe course and long-term complications leading to orthopedic problems and disability. Outcomes after its treatment directly depend on the effectiveness of early diagnostics. X-ray and CT examination at the first week of the disease are not effective in terms of accuracy and informativeness. Ultrasound is recognized as an effective method for diagnosing metaepiphyseal processes which are specific for young children. Osteoscintigraphy can be used, but in fact, it is rarely found in emergency departments; and besides, there is a probability that this technique in children can give false negative results. Osteotonometry and exploratory osteoperforation are invasive therapeutic and diagnostic procedures and should be used in case of strict indications. Magnetic resonance imaging (MRI) is an informative and non-invasive method that can be applied at the early intramedullary stages of the disease. MRI for differential diagnostics allows to avoid needless osteoperforation.

AIM: To conduct a retrospective analysis on MRI effectiveness for differential diagnostics in children with acute hematogenous osteomyelitis.

METHODS: The authors present their own experience in examining and treating children who were admitted to the City Emergency Clinical Hospital No 7 in Volgograd with acute pain in extremities and suspected arthritis or osteomyelitis in 2018-2021.

RESULTS: Patients were comparable in age, complaints, anamnesis and laboratory findings. In two clinical observations, retrospective analysis was done. In other two patients, MRI has proven its effectiveness when, in the first case, surgical aggression was avoided, and the patient was successfully cured with conservative techniques in a short time. In the second case, MRI helped to verify the diagnosis and to objectively justify indications for surgery.

CONCLUSION: MRI in children with suspected acute hematogenic osteomyelitis is justified and informative even at early stages of the disease. In some cases, it allows to avoid such invasive methods as exploratory osteoperforation.

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About the authors

Aleksey G. Sinitsyn

Volgograd State Medical University, Volgograd

Author for correspondence.
Email: all-sur04@mail.ru
ORCID iD: 0000-0002-8308-8364
SPIN-code: 3223-7231

MD

Russian Federation, 1 Pavshikh Bortsov square, 400066 Volgograd

Andrey I. Perepelkin

Volgograd State Medical University, Volgograd

Email: similipol@mail.ru
ORCID iD: 0000-0001-5964-3033
SPIN-code: 5545-8353

MD, Dr. Sci. (Medicine), Professor

Russian Federation, 1 Pavshikh Bortsov square, 400066 Volgograd

Gleb A. Kopan

Volgograd State Medical University, Volgograd

Email: gleb.kopan@yandex.ru
ORCID iD: 0000-0002-6627-1028
SPIN-code: 1465-6360

MD

Russian Federation, 1 Pavshikh Bortsov square, 400066 Volgograd

Nikita V. Novikov

Volgograd State Medical University, Volgograd

Email: nvnovikov.volsmu@mail.ru
ORCID iD: 0000-0002-6344-0236

MD

Russian Federation, 1 Pavshikh Bortsov square, 400066 Volgograd

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Supplementary files

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2. Fig. 1. Ultrasound of the left leg on day 8 of the disease: in the projection of the lower third of fibula external surface, liquid is seen — 40–42 mm high, 21 mm wide, up to 6–7 mm thick, with fine suspension, floating — paraossal phlegmon.

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3. Fig. 2. MRI of the fibula (front plane, T2-weighted imaging); patient — girl 8 y.o. with acute hematogenous osteomyelitis on day 2 of the disease; zone of reduced intensity of T2 signal from the bone marrow of the distal third of the metaphysis.

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4. Fig. 3. MRI of the radial bone (T2-weighted imaging with suppression of MR signal from adipose tissue) on day 5 of the disease; patient is a 13-year-old boy, a — axial plane, b — coronary plane): 1 — pronounced inflammatory reaction of the periosteum and its detachment, 2 — hypointensive metaphysis destruction zone along the medial surface of the radial bone.

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5. Fig. 4. MRI of the acute hematogenic osteomyelitis of the right iliac bone (front plane, T2-weighted imaging) in a 10-y.o. child on day 5 of the disease. Local edema of subchondral surface of the right iliac bone (arrow).

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6. Fig. 5. Osteoperforation of the right radial bone: creamy pus appeared under pressure.

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Copyright (c) 2024 Sinitsyn A.G., Perepelkin A.I., Kopan G.A., Novikov N.V.

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