Acute hematogenous osteomyelitis of children: assessment of skeletal scintigraphy-based diagnosis in the era of MRI.
Abstract
UNLABELLED: The emergence of MRI has challenged the long-standing primacy of skeletal scintigraphy in pediatric cases of suspected acute hematogenous osteomyelitis (AHO) with nondiagnostic radiographs. This study evaluated a strategy in which skeletal scintigraphy is the primary and MRI a supplemental test.
METHODS: We reviewed the records of 213 children (age range, 8 mo-18 y; mean age, 67 mo) with musculoskeletal symptoms and nondiagnostic radiographs who were referred for skeletal scintigraphy because of the possibility of AHO. MRI was performed when diagnostic uncertainty persisted after skeletal scintigraphy or when abscess was suspected.
RESULTS: Diagnosis was made using skeletal scintigraphy without referral for MRI in 179 (84%) of the children, including 79 (92%) of 86 with a final diagnosis of AHO. In no instance was the diagnosis of AHO indicated only by MRI. Treatment and diagnosis were accomplished without referral for MRI in 146 (69%) of all cases and 46 (53%) of the AHO cases. Abscesses that required drainage were found in 3 (6%) of 48 cases of major-long-bone AHO. Each of these 3 had exhibited a slow therapeutic response before MRI. Drainable abscesses were found in 5 (20%) of 25 cases affecting the pelvis, which was the other preponderant location of AHO. These were found with pelvic foci both when MRI was performed at diagnosis and when MRI was performed during treatment.
CONCLUSION: An imaging strategy in which skeletal scintigraphy is the first test used…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 213 participants or records.
Read the paper
Related studies
- Benign periarticular, bone and joint lipomatous lesions
- A review of the physiological and histological effects of laser osteotomy
- Quality of bone healing: perspectives and assessment techniques
- Effects of bioactive lipids and lipoproteins on bone
- Bone structure and function
- Quantifying bone structure, micro-architecture, and pathophysiology with MRI.
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.