Computed and magnetic resonance imaging for osteomyelitis in children



如何引用文章

全文:

开放存取 开放存取
受限制的访问 ##reader.subscriptionAccessGranted##
受限制的访问 订阅或者付费存取

详细

Introduction. The frequency of osteomyelitis in pediatric population is approximately 1:5000, and the mortality rate is from 0.2% to 17.0%. In children, acute bone infection is most often of hematogenous origin. Transition from the classical radiography and radionuclide examination to computed tomography (CT) and magnetic resonance imaging (MRI) has been completed.

Purpose. To demonstrate potentials of CT and MRI in the diagnostics of osteomyelitis in children.

Material and methods. 238 children with osteomyelitis, aged 1-17 years (average 9.1 ± 4.9 years), were examined for the last ten years. There were 126 boys (53%) and 112 girls (47%). Depending on the disease nosology, patients were divided as follows: hematogenous osteomyelitis (n = 112 children, 47%), BCG-osteomyelitis (n = 20, 8.4%), post-traumatic osteomyelitis (n = 67, 28.2%). 138 children (58%) were treated surgically. CT scanning was performed in 174 patients using Brilliance 16 scanners. MRI was performed using Philips AchievadStream 3.0 T scanner to obtain multi-planar STIR, T1-, T2- and PD weighted images (SE and GE). In addition, new MRI methods were used: diffusion-weighted images (DWI), Dixon, dynamic MRI with contrast enhancement (DCE).

Results. CT examination, which was performed in 174 patients at the same terms as radiography, confirmed density decrease ( though not large). Periosteal changes were better visualized at CT examination in 107 out of 174 patients (61.5%) including those who had changes at the classical radiography. MRI was performed in 51 patients ( including those with intravenous contrast enchancement) on Day 2-3 since the disease onset. This examination was effective in all cases (sensitivity 100%). T2WI and STIR with fat suppression (FS) clearly revealed edema of the bone marrow and surrounding muscles as well as small changes.

Conclusion. MRI is the most informative diagnostic technique in acute osteomyelitis at its early period because main signs of the initial stage of this disease - edema of bone marrow, periosteum and soft tissues - are detected during the first days. In addition, MRI reveals details of bone and soft tissues damages, including abscess and sequester formation, especially in spinal and pelvic lesions. MRI sensitivity in osteomyelitis reaches up to 100%. Sequences with the fat suppression (FS) can better detect bone marrow edema and inflammation than radiography. MRI is a preferable technique in diagnostics of infectious lesions of the spine, pelvis, and limbs.

作者简介

T. Akhadov

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

Email: fake@neicon.ru
ORCID iD: 0000-0002-3235-8854

Moscow, 119180, Russian Federation

俄罗斯联邦

V. Mitish

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

Email: fake@neicon.ru
ORCID iD: 0000-0001-6411-0709

Moscow, 119180, Russian Federation

俄罗斯联邦

I. Melnikov

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

Email: fake@neicon.ru
ORCID iD: 0000-0002-2910-3711

Moscow, 119180, Russian Federation

俄罗斯联邦

O. Bozhko

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

Email: fake@neicon.ru
ORCID iD: 0000-0002-4709-9461

Moscow, 119180, Russian Federation

俄罗斯联邦

R. Nalbandyan

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

Email: fake@neicon.ru
ORCID iD: 0000-0002-0332-9720

Moscow, 119180, Russian Federation

俄罗斯联邦

M. Ublinskiy

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

编辑信件的主要联系方式.
Email: maxublinsk@mail.ru
ORCID iD: 0000-0002-4627-9874

Maxim V. Ublinskiy, MD, Ph.D., radiologist, researcher

Moscow, 119180, Russian Federation

俄罗斯联邦

D. Dmitrenko

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

Email: fake@neicon.ru
ORCID iD: 0000-0003-1260-4509

Moscow, 119180, Russian Federation

俄罗斯联邦

A. Manzhurtsev

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

Email: fake@neicon.ru
ORCID iD: 0000-0001-5022-9952

Moscow, 119180, Russian Federation

俄罗斯联邦

M. Akhlebinina

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

Email: fake@neicon.ru
ORCID iD: 0000-0001-9862-3609

Moscow, 119180, Russian Federation

俄罗斯联邦

T. Kostikova

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

Email: fake@neicon.ru
ORCID iD: 0000-0002-9103-9191

Moscow, 119180, Russian Federation

俄罗斯联邦

参考

  1. Абаев Ю.К. Хронический рецидивирующий многоочаговый остеомиелит в детском возрасте. Вестник хирургии имени И.И. Грекова. 2010; 169(2): 118-20.
  2. Никитин Г.Д., Рак А.В., Линник С.А. Наш взгляд на остеомиелит и его лечение. Сб. Тр. Института хирургии им. А.В. Вишневского РАМН. 2001: 39-43
  3. Saavedra-Lozano J., Falup-Pecurariu O., Faust S.N., Girschick H., Hartwig N., Kaplan S., et al. Bone and joint infections. The Pediatric infectious disease journal. 2017; 36(8): 788-99.
  4. Амирасланов Ю.А., Светухин А.М., Борисов И.В., Ушаков А.А. Выбор хирургической тактики при лечении больных остеомиелитом длинных костей в зависимости от характера поражения. Хирургия. 2008; 9: 46-50.
  5. Jaramillo D., Dormans J.P., Delgado J., LaorT., St Geme J.W. Hematogenous osteomyelitis in infants and children: imaging of a changing disease. Radiology. 2017; 283(3): 629-43.
  6. Исаков Ю.Ф. Хирургические болезни детского возраста. Учебник. в 2 т. М.: ГЭОТАР-Медиа; 2004.
  7. Dartnell J., Ramachandran M., Katchburian M. Haematogenous acute and subacute paediatric osteomyelitis: a systematic review of the literature. The Journal of bone and joint surgery. British volume. 2012; 94(5): 584-95.
  8. Pineda C., Espinosa R., Pena A. Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging, and scintigraphy. In: Seminars in plastic surgery. Thieme Medical Publishers. 2009; 23(2): 80-9.
  9. Жарков П.Л. Рентгенодиагностика острого и хронического неспецифического воспаления костно-суставного аппарата. Лекция. Вестник Российского научного центра рентгенорадиологии Минздрава России. 2012; 3(12).
  10. Pääkkönen M., Peltola H. Bone and Joint Infections. Pediatric Clinics of North America. 2013,; 60(2): 425-36.
  11. Cherry J., Demmler-Harrison G.J., Kaplan S.L., Steinbach W.J., Hotez P.J. Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 7th Edition. Elsevier Health Sciences; 2013.
  12. Ковалинин В.В., Клещевникова К.Ю., Джанчатова Б.А. Лучевая диагностика остеомиелита. RJER (Российский электронный журнал лучевой диагностики). 2014; 4(3): 66-76.
  13. Arnold J.C., Bradley J.S. Osteoarticular infections in children. Infect. Dis. Clin. N. Am. 2015; 29: 557-74.
  14. Castellazzi L., Mantero M., Esposito S. Update on the Management of Pediatric Acute Osteomyelitis and Septic Arthritis.Int. J. Mol. Sci. 2016; 17: 855-64.
  15. Юрковский А.М., Воронецкий А.Н. Ранняя диагностика у детей: пределы диагностических возможностей. Новости хирургии. 2009; 17(4): 194-9.
  16. Sreenivas T., Nataraj A.R., Menon J.,Patro D.K. Acute multifocal haematogenous osteomyelitis in children.J.Child Orthop. 2011; 5(3): 231-5.
  17. Fayad L.M., Carrino J.A., Fishman E.K. Musculoskeletal infection: role of CT in the emergency department. Radiographics. 2007; 27: 1723-36.
  18. Дьячкова Г.В., Митина Ю.Л. Компьютерно-томографическая семиотика костной деструкции при хроническом остеомиелите, развившемся после гематогенного.Медицинская визуализация. 2008; 5: 104-10.
  19. Tanwar Y.S., Jaiswal A., Singh S., Arya R.K., Lal H. Acute pediatric septic arthritis: A systematic review of literature and current controversies. Pol. Orthop. Traumatol. 2014; 79: 23-9.
  20. Jevtic V. Vertebral infection. Eur Radiol. 2004; 14(Suppl 3): E43-E52.
  21. Flemming D., Murphey M., McCarthy K. Imaging of the foot and ankle: summary and update.Curr Opin Orthop. 2005; 16: 54-9.
  22. Marx J., Hockberger R., Walls R.Rosen’s Emergency Medicine: Concepts and Clinical Practice. New York, NY: Mosby; 2006.
  23. Faust S.N., Clark J., Pallett A., Clark N. Managing bone and joint infection in children. Arch Dis Child. 2012; 97: 545-53.
  24. Calvo C., Núñez E., Camacho M., Clemente D., Fernández-Cooke E., Alcobendas R., et al; Collaborative Group. Epidemiology and management of acute, uncomplicated septic arthritis and osteomyelitis: Spanish multicenter study. Pediatr Infect Dis J. 2016; 35: 1288-93.
  25. Manssor E., Abuderman A., Osman S., Alenezi S.B., Almehemeid S., Babikir E., et al. Radiation doses in chest, abdomen and pelvis CT procedures.Radiation protection dosimetry. 2015; 165(1–4): 194-8.
  26. McNeil J.C., Forbes A.R., Vallejo J.G., Flores A.R., Hultén K.G., Mason E.O., et al. Role of operative or interventional radiology-guided cultures for osteomyelitis.Pediatrics. 2016; 137(5): e20154616.
  27. Mazur J.M., Ross G., Cummings J., Hahn G.A. Jr, McCluskey W.P. Usefulness of magnetic resonance imaging for the diagnosis of acute musculoskeletal infections in children. J Pediatr Orthop. 1995; 15: 144-7.
  28. Walker M.L., Nicol R.O. An audit of magnetic resonance imaging in the paediatric orthopaedic setting. N Z Med J. 1998; 13: 430-2.
  29. Teixeira S.R., Elias Junior J., Nogueira-Barbosa M.H., Guimarães M.D., Marchiori E., Santos M.K. Whole-body magnetic resonance imaging in children: state of the art. Radiol Bras. 2015; 48(2): 111-20.

补充文件

附件文件
动作
1. JATS XML

版权所有 © ,

##common.cookie##