Skip to main content

Advertisement

SpringerLink
Log in

Imaging mimics of chronic recurrent multifocal osteomyelitis: avoiding pitfalls in a diagnosis of exclusion

  • Pictorial Essay
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Chronic recurrent multifocal osteomyelitis (CRMO) is a pediatric autoinflammatory disorder that is characterized by multiple sterile inflammatory bone lesions with a relapsing and remitting course. CRMO belongs to the autoinflammatory family of rheumatologic disorders based on absence of significant titers of autoantibodies and autoreactive T-lymphocytes. In absence of pathognomonic clinical, radiographic or pathological features, diagnosis can be challenging. CRMO shares imaging features with other diseases. It is important for radiologists to be able to differentiate other diseases from CRMO because prognosis varies from completely benign to frankly malignant. In this article we first present the clinical and imaging features of CRMO to help readers gain an understanding of the disease process, then discuss our imaging approach to CRMO and review other disease processes that sometimes share similar imaging findings to CRMO and review differentiating features to help avoid misdiagnoses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12

Similar content being viewed by others

References

  1. Wipff J, Costantino F, Lemelle I et al (2015) A large national cohort of French patients with chronic recurrent multifocal osteitis. Arthritis Rheumatol 67:1128–1137

    Article  CAS  Google Scholar 

  2. Jansson A, Renner ED, Ramser J et al (2006) Classification of non-bacterial osteitis: retrospective study of clinical, immunological and genetic aspects in 89 patients. Rheumatology 46:154–160

    Article  Google Scholar 

  3. Girschick H, Finetti M, Orlando F et al (2018) The multifaceted presentation of chronic recurrent multifocal osteomyelitis: a series of 486 cases from the Eurofever International Registry. Rheumatology 57:1504–1504

    Article  Google Scholar 

  4. Schnabel A, Range U, Hahn G et al (2016) Unexpectedly high incidences of chronic non-bacterial as compared to bacterial osteomyelitis in children. Rheumatol Int 36:1737–1745

    Article  CAS  Google Scholar 

  5. Zhao Y, Ferguson PJ (2018) Chronic nonbacterial osteomyelitis and chronic recurrent multifocal osteomyelitis in children. Pediatr Clin N Am 65:783–800

    Article  Google Scholar 

  6. Schooler GR, Davis JT, Daldrup-Link HE, Frush DP (2018) Current utilization and procedural practices in pediatric whole-body MRI. Pediatr Radiol 48:1101–1107

    Article  Google Scholar 

  7. Arnoldi AP, Schlett CL, Douis H et al (2017) Whole-body MRI in patients with non-bacterial osteitis: radiological findings and correlation with clinical data. Eur Radiol 27:2391–2399

    Article  CAS  Google Scholar 

  8. Twilt M, Laxer RM (2011) Clinical care of children with sterile bone inflammation. Curr Opin Rheumatol 23:424–431

    Article  CAS  Google Scholar 

  9. Khanna G, Sato TS, Ferguson P (2009) Imaging of chronic recurrent multifocal osteomyelitis. Radiographics 29:1159–1177

    Article  Google Scholar 

  10. Greenwood S, Leone A, Cassar-Pullicino VN (2017) SAPHO and recurrent multifocal osteomyelitis. Radiol Clin N Am 55:1035–1053

    Article  Google Scholar 

  11. Fritz J, Tzaribatchev N, Claussen CD et al (2009) Chronic recurrent multifocal osteomyelitis: comparison of whole-body MR imaging with radiography and correlation with clinical and laboratory data. Radiology 252:842–851

    Article  Google Scholar 

  12. Falip C, Alison M, Boutry N et al (2013) Chronic recurrent multifocal osteomyelitis (CRMO): a longitudinal case series review. Pediatr Radiol 43:355–375

    Article  Google Scholar 

  13. Leclair N, Thormer G, Sorge I et al (2016) Whole-body diffusion-weighted imaging in chronic recurrent multifocal osteomyelitis in children. PLoS One 11:e0147523

    Article  Google Scholar 

  14. Merlini L, Carpentier M, Ferrey S et al (2017) Whole-body MRI in children: would a 3D STIR sequence alone be sufficient for investigating common paediatric conditions? A comparative study. Eur J Radiol 88:155–162

    Article  Google Scholar 

  15. van Schuppen J, van Doorn MM, van Rijn RR (2012) Childhood osteomyelitis: imaging characteristics. Insights Imaging 3:519–533

    Article  Google Scholar 

  16. Jaramillo D, Dormans JP, Delgado J et al (2017) Hematogenous osteomyelitis in infants and children: imaging of a changing disease. Radiology 283:629–643

    Article  Google Scholar 

  17. Riise OR, Kirkhus E, Handeland KS et al (2008) Childhood osteomyelitis-incidence and differentiation from other acute onset musculoskeletal features in a population-based study. BMC Pediatr 8:45

    Article  Google Scholar 

  18. Teo HE, Peh WC (2004) Skeletal tuberculosis in children. Pediatr Radiol 34:853–860

    Article  Google Scholar 

  19. Moorthy S, Prabhu NK (2002) Spectrum of MR imaging findings in spinal tuberculosis. AJR Am J Roentgenol 179:979–983

    Article  Google Scholar 

  20. Ledermann HP, Schweitzer ME, Morrison WB, Carrino JA (2003) MR imaging findings in spinal infections: rules or myths? Radiology 228:506–514

    Article  Google Scholar 

  21. Kritsaneepaiboon S, Andres MM, Tatco VR et al (2017) Extrapulmonary involvement in pediatric tuberculosis. Pediatr Radiol 47:1249–1259

    Article  Google Scholar 

  22. Brennan CM, Atkins KA, Druzgal CH, Gaskin CM (2012) Magnetic resonance imaging appearance of scurvy with gelatinous bone marrow transformation. Skelet Radiol 41:357–360

    Article  Google Scholar 

  23. Choi SW, Park SW, Kwon YS et al (2007) MR imaging in a child with scurvy: a case report. Korean J Radiol 8:443–447

    Article  Google Scholar 

  24. Zbojniewicz AM, Laor T (2011) Focal periphyseal edema (FOPE) zone on MRI of the adolescent knee: a potentially painful manifestation of physiologic physeal fusion? AJR Am J Roentgenol 197:998–1004

    Article  Google Scholar 

  25. Chan BY, Gill KG, Rebsamen SL, Nguyen JC (2016) MR imaging of pediatric bone marrow. Radiographics 36:1911–1930

    Article  Google Scholar 

  26. Rios AM, Rosenberg ZS, Bencardino JT et al (2011) Bone marrow edema patterns in the ankle and hindfoot: distinguishing MRI features. AJR Am J Roentgenol 197:W720–W729

    Article  Google Scholar 

  27. Rupasov A, Cain U, Montoya S, Blickman JG (2017) Imaging of posttraumatic arthritis, avascular necrosis, septic arthritis, complex regional pain syndrome, and cancer mimicking arthritis. Radiol Clin N Am 55:1111–1130

    Article  Google Scholar 

  28. Sinigaglia R, Gigante C, Bisinella G et al (2008) Musculoskeletal manifestations in pediatric acute leukemia. J Pediatr Orthop 28:20–28

    Article  Google Scholar 

  29. Messina C, Christie D, Zucca E et al (2015) Primary and secondary bone lymphomas. Cancer Treat Rev 41:235–246

    Article  Google Scholar 

  30. Sato TS, Ferguson PJ, Khanna G (2008) Primary multifocal osseous lymphoma in a child. Pediatr Radiol 38:1338–1341

    Article  Google Scholar 

  31. Milks KS, McLean TW, Anthony EY (2016) Imaging of primary pediatric lymphoma of bone. Pediatr Radiol 46:1150–1157

    Article  Google Scholar 

  32. Heyning FH, Kroon HMJA, Hogendoorn PCW et al (2007) MR imaging characteristics in primary lymphoma of bone with emphasis on non-aggressive appearance. Skelet Radiol 36:937–944

    Article  Google Scholar 

  33. Kaste SC (2011) Imaging pediatric bone sarcomas. Radiol Clin N Am 49:749–765

    Article  Google Scholar 

  34. Gupta MM, Bahri NU, Parekh HP et al (2014) Synchronous multifocal osteogenic sarcoma on multimodality imaging including bone scintigraphy. Indian J Nucl Med 29:185–188

    Article  Google Scholar 

  35. Meyer JS, Harty MP, Mahboubi S et al (1995) Langerhans cell histiocytosis: presentation and evolution of radiologic findings with clinical correlation. Radiographics 15:1135–1146

    Article  CAS  Google Scholar 

  36. Park H, Nishino M, Hornick JL, Jacobsen ED (2019) Imaging of histiocytosis in the era of genomic medicine. Radiographics 39:95–114

    Article  Google Scholar 

Download references

Acknowledgments

Dr. Polly J. Ferguson is funded by a National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)/National Institutes of Health (NIH) R01 grant. Special thanks to Nandini Bahri, Department of Diagnostic Radiology, and M. P. Shah, Government Medical College and General Hospital in Gujarat, India, for contributing image for Fig. 5a.

Author information

Authors and Affiliations

  1. Division of Pediatric Radiology, Department of Radiology, Stead Family Children’s Hospital, University of Iowa, 200 Hawkins Drive, 3889 JPP, Iowa City, IA, 52242, USA

    Takashi Shawn Sato & Pankaj Watal

  2. Division of Pediatric Rheumatology, Department of Pediatrics, Stead Family Children’s Hospital, University of Iowa, Iowa City, IA, USA

    Polly J. Ferguson

Authors
  1. Takashi Shawn Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pankaj Watal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Polly J. Ferguson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takashi Shawn Sato.

Ethics declarations

Conflicts of interest

None

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

CME activity

This article has been selected as the CME activity for the current month. Please visit the SPR website at www.pedrad.org on the Education page and follow the instructions for complete this CME activity.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sato, T.S., Watal, P. & Ferguson, P.J. Imaging mimics of chronic recurrent multifocal osteomyelitis: avoiding pitfalls in a diagnosis of exclusion. Pediatr Radiol 50, 124–136 (2020). https://doi.org/10.1007/s00247-019-04510-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-019-04510-5

Keywords

Search

Navigation