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Relationship between the clinical characteristics of osteomyelitis and the finding of extraosseous fat on MRI in pediatric patients

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Abstract

Background

MRI is frequently utilized to evaluate patients for osteomyelitis. The findings of intramedullary and extramedullary fat globules as well as extramedullary fat-fluid levels can help improve the specificity of MRI for this diagnosis.

Objective

To correlate these MRI findings with the clinical characteristics in children with osteomyelitis.

Materials and methods

A retrospective electronic medical record search for pediatric patient charts from March 2004 to November 2009 that contained the word “osteomyelitis” in the “principal diagnosis” portion of the international classification of disease (ICD) billing code. Each electronic chart was reviewed. MRI examinations of selected children were reviewed by a pediatric radiologist, a general radiologist and a transitional year resident.

Results

A total of 10 patients/11 MRI studies were included. Five of the 11 had the MRI finding of extramedullary globular fat signal. There was a significantly increased likelihood of seeing this finding in children of pubertal or postpubertal age compared to those of prepubertal age (p < 0.05).

Conclusion

This study provides evidence that the MRI finding of extramedullary fat globules in children with acute osteomyelitis is associated with the clinical characteristic of being within or above the age range for puberty.

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References

  1. Lew DP, Waldvogel FA (2004) Osteomyelitis. Lancet 364:369–79

    Article  PubMed  CAS  Google Scholar 

  2. Lazzarini L, Mader JT, Calhoun JH (2004) Osteomyelitis in long bones. J Bone Joint Surg Am 86:2305–2318

    PubMed  Google Scholar 

  3. Song KM, Sloboda JF (2001) Acute hematogenous osteomyelitis in children. J Am Acad Orthop Surg 9:166–175

    PubMed  CAS  Google Scholar 

  4. Rosenburg AE (2005) Bones, joints, and soft tissue tumors. In: Kumar V, Abbas A, Fausto N (eds) Pathological basis of disease, 7th edn. Elsevier Saunders, Pennsylvania, pp 1273–1324

    Google Scholar 

  5. Krogstad P (2004) Osteomyelitis and septic arthritis. In: Feigin RD, Cherry JD, Demmler GJ, Kaplan SL (eds) Textbook of pediatric infectious diseases, 5th edn. Saunders, Philadelphia, pp 713–719

    Google Scholar 

  6. Gutierrez K (2005) Bone and joint infections in children. Pediatr Clin N Am 52:779–794

    Article  Google Scholar 

  7. Brossmann J, Sartoris DJ, Resnick DL (1999) Osseous and soft tissue infection of extraspinal sites. In: Stark DD, Bradley WG 2nd (eds) Magnetic resonance imaging, 3rd edn. Mosby, St. Louis, pp 1037–1056

    Google Scholar 

  8. Davies AM, Hughes DE, Grimer RJ (2005) Intramedullary and extramedullary fat globules on magnetic resonance imaging as a diagnostic sign for osteomyelitis. Eur Radiol 15:2194–2199

    Article  PubMed  CAS  Google Scholar 

  9. Rafii M, Firooznia H, Golimbu C et al (1984) Hematogenous osteomyelitis with fat-fluid level shown by CT. Radiology 153:493–494

    PubMed  CAS  Google Scholar 

  10. Kumar J, Bandhu S, Kumar A et al (2007) Extra-osseous fat fluid level: a specific sign for osteomyelitis. Skeletal Radiol 36:S101–S104

    Article  PubMed  Google Scholar 

  11. Hui CL, Naidoo P (2003) Extramedullary fat fluid level on MRI as a specific sign for osteomyelitis. Australas Radiol 47:443–446

    Article  PubMed  Google Scholar 

  12. Marcell AV (2007) Adolescence. In: Kliegmann RM, Behrman RE, Jenson HB et al (eds) Nelson textbook of pediatrics, 18th edn. Saunders Elsevier, Philadelphia, pp 60–65

    Google Scholar 

  13. Unkila-Kallio L, Kallio MJT, Peltola H et al (1994) Serum C-reactive protein, erythrocyte sedimentation rate, and white blood cell count in acute hematogenous osteomyelitis of children. Pediatrics 93:59–62

    PubMed  CAS  Google Scholar 

  14. Clyne B, Olshaker JS (1999) The C-reactive protein. J Emerg Med 17:1019–1025

    Article  PubMed  CAS  Google Scholar 

  15. Kricun ME (1985) Red-yellow marrow conversion: its effect on the location of some solitary bone lesions. Skeletal Radiol 14:10–19

    Article  PubMed  CAS  Google Scholar 

  16. Resnick D, Sweet DE, Madewell JE (2002) Osteonecrosis: pathogenesis, diagnostic techniques, specific situations, and complications. In: Resnick D (ed) Diagnosis of bone and joint disorders, 4th edn. WB Saunders Co., Philadelphia, pp 3599–3685

    Google Scholar 

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Acknowledgement

We would like to thank Grand Rapids Medical Education Partners (GRMEP) and Dr. Alan Davis for help in preparing this manuscript.

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Authors and Affiliations

  1. Spectrum Health Helen Devos Children’s Hospital, 100 Michigan St. NE, Grand Rapids, MI, 49503, USA

    Tod A. Mattis, Heather L. Borders, Doug M. Ellinger & Joseph J. Junewick

  2. College of Human Medicine, Radiology, Michigan State University, Grand Rapids, MI, USA

    Tod A. Mattis, Heather L. Borders, Doug M. Ellinger & Joseph J. Junewick

  3. Grand Rapids Medical Education Partners, Grand Rapids, MI, USA

    Tod A. Mattis

  4. Advanced Radiology Services, Grand Rapids, MI, USA

    Heather L. Borders, Doug M. Ellinger & Joseph J. Junewick

Authors
  1. Tod A. Mattis
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  2. Heather L. Borders
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  3. Doug M. Ellinger
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  4. Joseph J. Junewick
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Corresponding author

Correspondence to Heather L. Borders.

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Mattis, T.A., Borders, H.L., Ellinger, D.M. et al. Relationship between the clinical characteristics of osteomyelitis and the finding of extraosseous fat on MRI in pediatric patients. Pediatr Radiol 41, 1293–1297 (2011). https://doi.org/10.1007/s00247-011-2073-8

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  • DOI: https://doi.org/10.1007/s00247-011-2073-8

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