Abstract
Background
Children with sickle cell disease (SCD) are at risk of bone infarcts and acute osteomyelitis. The clinical differentiation between a bone infarct and acute osteomyelitis is a diagnostic challenge. Unenhanced T1-W fat-saturated MR images have been proposed as a potential tool to differentiate bone infarcts from osteomyelitis.
Objective
To evaluate the reliability of unenhanced T1-W fat-saturated MRI for differentiation between bone infarcts and acute osteomyelitis in children with SCD.
Materials and methods
We retrospectively reviewed the records of 31 children (20 boys, 11 girls; mean age 10.6 years, range 1.1–17.9 years) with SCD and acute bone pain who underwent MR imaging including unenhanced T1-W fat-saturated images from 2005 to 2010. Complete clinical charts were reviewed by a pediatric hematologist with training in infectious diseases to determine a clinical standard to define the presence or absence of osteomyelitis. A pediatric radiologist reviewed all MR imaging and was blinded to clinical information. Based on the signal intensity in T1-W fat-saturated images, the children were further classified as positive for osteomyelitis (low bone marrow signal intensity) or positive for bone infarct (high bone marrow signal intensity).
Results
Based on the clinical standard, 5 children were classified as positive for osteomyelitis and 26 children as positive for bone infarct (negative for osteomyelitis). The bone marrow signal intensity on T1-W fat-saturated imaging was not significant for the differentiation between bone infarct and osteomyelitis (P = 0.56). None of the additional evaluated imaging parameters on unenhanced MRI proved reliable in differentiating these diagnoses.
Conclusion
The bone marrow signal intensity on unenhanced T1-W fat-saturated MR images is not a reliable criterion to differentiate bone infarcts from osteomyelitis in children.
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References
Wright J, Ahmedzai SH (2010) The management of painful crisis in sickle cell disease. Curr Opin Support Palliat Care 4:97–106
Stuart MJ, Nagel RL (2004) Sickle-cell disease. Lancet 364:1343–1360
Schnog JB, Duits AJ, Muskiet FA et al (2004) Sickle cell disease; a general overview. Neth J Med 62:364–374
Wong AL, Sakamoto KM, Johnson EE (2001) Differentiating osteomyelitis from bone infarction in sickle cell disease. Pediatr Emerg Care 17:60–63, quiz 64
Keeley K, Buchanan GR (1982) Acute infarction of long bones in children with sickle cell anemia. J Pediatr 101:170–175
Inusa BP, Oyewo A, Brokke F et al (2013) Dilemma in differentiating between acute osteomyelitis and bone infarction in children with sickle cell disease: the role of ultrasound. PLoS ONE 8:e65001
Almeida A, Roberts I (2005) Bone involvement in sickle cell disease. Br J Haematol 129:482–490
Skaggs DL, Kim SK, Greene NW et al (2001) Differentiation between bone infarction and acute osteomyelitis in children with sickle-cell disease with use of sequential radionuclide bone-marrow and bone scans. J Bone Joint Surg Am 83:1810–1813
Umans H, Haramati N, Flusser G (2000) The diagnostic role of gadolinium enhanced MRI in distinguishing between acute medullary bone infarct and osteomyelitis. Magn Reson Imaging 18:255–262
Bonnerot V, Sebag G, de Montalembert M et al (1994) Gadolinium-DOTA enhanced MRI of painful osseous crises in children with sickle cell anemia. Pediatr Radiol 24:92–95
Stark JE, Glasier CM, Blasier RD et al (1991) Osteomyelitis in children with sickle cell disease: early diagnosis with contrast-enhanced CT. Radiology 179:731–733
William RR, Hussein SS, Jeans WD et al (2000) A prospective study of soft-tissue ultrasonography in sickle cell disease patients with suspected osteomyelitis. Clin Radiol 55:307–310
Sadat-Ali M, al-Umran K, al-Habdan I et al (1998) Ultrasonography: can it differentiate between vasoocclusive crisis and acute osteomyelitis in sickle cell disease? J Pediatr Orthop 18:552–554
Jain R, Sawhney S, Rizvi SG (2008) Acute bone crises in sickle cell disease: the T1 fat-saturated sequence in differentiation of acute bone infarcts from acute osteomyelitis. Clin Radiol 63:59–70
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174
Gill FM, Sleeper LA, Weiner SJ et al (1995) Clinical events in the first decade in a cohort of infants with sickle cell disease. Cooperative study of sickle cell disease. Blood 86:776–783
Embury SH (2004) The not-so-simple process of sickle cell vasoocclusion. Microcirculation 11:101–113
Wun T (2001) The role of inflammation and leukocytes in the pathogenesis of sickle cell disease: haemoglobinopathy. Hematology 5:403–412
Chambers JB, Forsythe DA, Bertrand SL et al (2000) Retrospective review of osteoarticular infections in a pediatric sickle cell age group. J Pediatr Orthop 20:682–685
Jaramillo D (2011) Infection: musculoskeletal. Pediatr Radiol 41:S127–S134
Frush DP, Heyneman LE, Ware RE et al (1999) MR features of soft-tissue abnormalities due to acute marrow infarction in five children with sickle cell disease. AJR Am J Roentgenol 173:989–993
Dillman JR, Ellis JH, Cohan RH et al (2011) Safety of gadolinium-based contrast material in sickle cell disease. J Magn Reson Imaging 34:917–920
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Delgado, J., Bedoya, M.A., Green, A.M. et al. Utility of unenhanced fat-suppressed T1-weighted MRI in children with sickle cell disease — can it differentiate bone infarcts from acute osteomyelitis?. Pediatr Radiol 45, 1981–1987 (2015). https://doi.org/10.1007/s00247-015-3423-8
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DOI: https://doi.org/10.1007/s00247-015-3423-8