Utility of unenhanced fat-suppressed T1-weighted MRI in children with sickle cell disease — can it differentiate bone infarcts from acute osteomyelitis?

Jorge Delgado, Maria A. Bedoya, Abby M. Green, Diego Jaramillo, Victor Ho-Fung

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Background: Children with sickle cell disease (SCD) are at risk of bone infarcts and acute osteomyelitis. The clinical differentiation between a bone infarct and acute osteomyelitis is a diagnostic challenge. Unenhanced T1-W fat-saturated MR images have been proposed as a potential tool to differentiate bone infarcts from osteomyelitis. Objective: To evaluate the reliability of unenhanced T1-W fat-saturated MRI for differentiation between bone infarcts and acute osteomyelitis in children with SCD. Materials and methods: We retrospectively reviewed the records of 31 children (20 boys, 11 girls; mean age 10.6 years, range 1.1–17.9 years) with SCD and acute bone pain who underwent MR imaging including unenhanced T1-W fat-saturated images from 2005 to 2010. Complete clinical charts were reviewed by a pediatric hematologist with training in infectious diseases to determine a clinical standard to define the presence or absence of osteomyelitis. A pediatric radiologist reviewed all MR imaging and was blinded to clinical information. Based on the signal intensity in T1-W fat-saturated images, the children were further classified as positive for osteomyelitis (low bone marrow signal intensity) or positive for bone infarct (high bone marrow signal intensity). Results: Based on the clinical standard, 5 children were classified as positive for osteomyelitis and 26 children as positive for bone infarct (negative for osteomyelitis). The bone marrow signal intensity on T1-W fat-saturated imaging was not significant for the differentiation between bone infarct and osteomyelitis (P = 0.56). None of the additional evaluated imaging parameters on unenhanced MRI proved reliable in differentiating these diagnoses. Conclusion: The bone marrow signal intensity on unenhanced T1-W fat-saturated MR images is not a reliable criterion to differentiate bone infarcts from osteomyelitis in children.

Original languageEnglish
Pages (from-to)1981-1987
Number of pages7
JournalPediatric radiology
Volume45
Issue number13
DOIs
StatePublished - Dec 1 2015

Keywords

  • Bone infarction
  • Children
  • Magnetic resonance imaging
  • Osteomyelitis
  • Sickle cell disease

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