Role of MRI in the diagnosis and treatment of osteomyelitis in pediatric patients

Abstract

Osteomyelitis is a significant cause of morbidity in children throughout the world. Multiple imaging modalities can be used to evaluate for suspected osteomyelitis, however magnetic resonance imaging (MRI) has distinct advantages over other modalities given its ability to detect early changes related to osteomyelitis, evaluate the true extent of disease, depict extraosseous spread of infection, and help guide surgical management. MRI has assumed a greater role in the evaluation of osteomyelitis with the increase in musculoskeletal infections caused by methicillin-resistant Staphylococcus aureus which have unique imaging features that are well-demonstrated with MRI. This review focuses primarily on the use of MRI in the evaluation of osteomyelitis in children and will include a discussion of the clinically important and characteristic findings on MRI of acute bacterial osteomyelitis and related conditions.

Keywords: Magnetic resonance imaging; Osteomyelitis; Pediatrics; Infectious diseases

Core tip: Osteomyelitis is a significant cause of morbidity and mortality in children. Plain radiography and radionuclide bone scintigraphy, which have been the traditional imaging modalities for detecting osteomyelitis, both have significant limitations. Magnetic resonance imaging (MRI) is increasingly relied upon for detecting osteomyelitis in children, due to its superior soft tissue contrast for detecting early disease and extraosseous complication, as well as its lack of ionizing radiation exposure to patients. This article focuses on basic and advanced MRI techniques for evaluating osteomyelitis, as well as MRI imaging features of disease and their impact on clinical management.