Whole-Body Diffusion-Weighted Imaging in Chronic Recurrent Multifocal Osteomyelitis in ChildrenReportar como inadecuado

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Chronic recurrent multifocal osteomyelitis- chronic non-bacterial osteomyelitis CRMO- CNO is a rare auto-inflammatory disease and typically manifests in terms of musculoskeletal pain. Because of a high frequency of musculoskeletal disorders in children- adolescents, it can be quite challenging to distinguish CRMO- CNO from nonspecific musculosketetal pain or from malignancies. The purpose of this study was to evaluate the visibility of CRMO lesions in a whole-body diffusion-weighted imaging WB-DWI technique and its potential clinical value to better characterize MR-visible lesions.

Material and Methods

Whole-body imaging at 3T was performed in 16 patients average: 13 years with confirmed CRMO. The protocol included 2D Short Tau Inversion Recovery STIR imaging in coronal and axial orientation as well as diffusion-weighted imaging in axial orientation. Visibility of lesions in DWI and STIR was evaluated by two readers in consensus. The apparent diffusion coefficient ADC was measured for every lesion and corresponding reference locations.


A total of 33 lesions on average 2 per patient visible in STIR and DWI images b = 800 s-mm2 and ADC maps were included, predominantly located in the long bones. With a mean value of 1283 mm2-s in lesions, the ADC was significantly higher than in corresponding reference regions 782 mm2-s. By calculating the ratio lesion to reference, 82% of all lesions showed a relative signal increase of 10% or higher and 76% 25 lesions showed a signal increase of more than 15%. The median relative signal increase was 69%.


This study shows that WB-DWI can be reliably performed in children at 3T and predominantly, the ADC values were substantially elevated in CRMO lesions. WB-DWI in conjunction with clinical data is seen as a promising technique to distinguish benign inflammatory processes in terms of increased ADC values from particular malignancies.

Autor: Nadine Leclair , Gregor Thörmer, Ina Sorge, Lutz Ritter, Volker Schuster, Franz Wolfgang Hirsch

Fuente: http://plos.srce.hr/


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