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MRI features of spinal chronic recurrent multifocal osteomyelitis/chronic non-bacterial osteomyelitis in children

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Abstract

Background

Spinal lesions in pediatric chronic recurrent multifocal osteomyelitis/chronic non-bacterial osteomyelitis (CRMO/CNO) can cause permanent sequelae; thus, early recognition of these is vital for management.

Objective

To characterize the MR imaging features and patterns of pediatric spinal CRMO/CNO.

Materials and methods

This cross-section study received IRB approval. The first available MRI with documented spine involvement in children with CRMO/CNO was reviewed by a pediatric radiologist. Descriptive statistics were used to describe the characteristics of vertebral lesions, disc involvement, and soft tissue abnormality.

Results

Forty-two patients were included (F:M, 30:12); median age was 10 years (range 4–17). At diagnosis, 34/42 (81%) had spine involvement. Kyphosis in 9/42 (21%) and scoliosis in 4/42 (9.5%) patients were present at the time of spinal disease recognition. Vertebral involvement was multifocal in 25/42 (59.5%). Disc involvement was found in 11/42 (26%) patients, commonly in the thoracic spine and often with adjacent vertebrae height loss. Posterior element abnormalities were present in 18/42 patients (43%) and soft tissue involvement in 7/42 (17%). One hundred nineteen vertebrae were affected, commonly the thoracic vertebrae (69/119; 58%). Vertebral body edema was focal in 77/119 (65%) and frequently superior (42/77; 54%). Sclerosis and endplate abnormality were present in 15/119 (13%) and 31/119 (26%) vertebrae, respectively. Height loss was present in 41/119 (34%).

Conclusion

Chronic non-bacterial osteomyelitis of spine is usually thoracic. Vertebral body edema is often focal at the superior vertebral body. Kyphosis and scoliosis occur in a quarter and vertebral height loss in a third of children at spinal disease recognition.

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Authors and Affiliations

  1. Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Andressa Guariento, Parth Sharma & Savvas Andronikou

  2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Savvas Andronikou

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Contributions

S.A. conceived, supervised, supported the study, and interpreted the images. A.G. conceived the study, collated, and analyzed the data, performed the statistical analysis and drafted the initial manuscript. P.S. collected the data. All authors reviewed and approved the final manuscript.

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Correspondence to Savvas Andronikou.

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Guariento, A., Sharma, P. & Andronikou, S. MRI features of spinal chronic recurrent multifocal osteomyelitis/chronic non-bacterial osteomyelitis in children. Pediatr Radiol 53, 2092–2103 (2023). https://doi.org/10.1007/s00247-023-05688-5

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