Abstract:

Introduction: the diagnosis of osteomyelitis in children and adolescents in early stages is the key to successful treatment of this formidable disease. Timely treatment will avoid a deterioration in the quality of life of patients, which is extremely important for adolescent patients. In recent decades, there has been an increase in the percentage of patients with osteomyelitis in childhood and adolescence.

Non-specific clinical manifestations of the disease and the absence of manifestations on radiographs for a long time lead to an incorrect interpretation of clinical and radiological data.

Aim: was to demonstrate possibilities of magnetic resonance imaging (MRI) and ultrasound (ultrasound) in diagnosis of osteomyelitis in case of adverse anatomical localization.

Material and methods: we present a case report of complex radiation diagnosis of inflammatory lesions of the musculoskeletal system of adverse anatomical localization in a teenager. Clinically patient suffered from severe pain in left hip joint with pain radiation to the left thigh, limitation of movements in the joint concerned, swelling of soft tissues of the left thigh and gluteal region against the background of hyperthermia.

Results: according to data of digital radiography, the patient did not reveal signs of the destructive process of bone tissue. Changes in the form of psoit and coxitis were detected by ultrasound. Examination was supplemented by MRI, according to which on T2 FatSat in coronal and axial projections the left-sided synovitis was confirmed, without inflammatory changes in the bone tissue. 10 days after, MRI revealed inflammatory changes in the bone marrow of the head of left femur, left pubic and iliac bones, adjacent soft tissues and left-sided synovitis, regarded as a manifestation of acute hematogenous osteomyelitis. Patient underwent surgical and symptomatic treatment with a positive result.

Conclusions:

1. Absence of pathological changes according to x-ray examinations in children and adolescents (radiography and MSCT) does not exclude the presence of osteomyelitis, due to the absence of manifestations on radiographs for a long time.

2. At early stages of disease, especially in young children, as well as at stages of conservative and surgical treatment, the most appropriate use of ultrasound and MRI.

3. Conducting MSCT is advisable after obtaining ultrasound and MRI data on the presence of bonedestructive changes.

References

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Abstract:

Aim: was to study features of ultrasonic imaging of local and septic forms of acute hematogenic osteomyelitis (AHO) in children.

Materials and methods: 59 patients with AHO, treated in Children's hospital No. 4 of Tomsk, for the period from 2000 to 2010 - were examined. All patients with suspicion on osteomyelitis (n = 59; 100%) underwent x-ray of defeated area and ultrasonic diagnostics on the Ultrasonix 2,6 with the use of linear sensor of 9-12 MHz. All patients with AHO underwent surgical operation (n=59; 100%).

Results: 47 patients had local form of disease. Each patient had one phase of osteomyelitis. Extramedullary phase, the development of which was due to the disease duration - was prevalencing^^,^. Prevalence of quantity of AHO phases (n=19) over total number of patients with a septic forms of disease (n=12), reflected existence of multiple osteomyelitis in four patients. In each patient with septic form of the AHO we found defeat of several bones in identical or different phases of an inflammation.

Conclusion: obtained results will help the earlier identification of AHO signs and determination of disease phase in patients with local and generalized forms of disease. All that will help to proceed modern sanation of osteomyelitic defeat.

Reference

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Abstract:

Aim: was to evaluate pedal vascularisation in diabetic patients with using contrast MR-angiography.

Material and methods: 23 patients (15 male, 8 female; mean age 56±14,6) with suspicion on osteomyelitis (OM) underwent MR-angiography (Gadobutrol 15ml). Imaging analysis included blood-flow's speed, vascular architectonic's condition and character of contrast's accumulation, microcirculation was especially estimated. Results were compared with white blood cells-scan in identification of pyoinflamation. Osteomyelitis was verified according to operations in all cases.

Results: all patients were divided in 3 groups: neuropathic (n=9; 39,0%), neuroischemic (n=10; 43,5%), ischemic (n=4; 17,5%) forms of diabetic foot. First-pass MR-angiography detected significant delay in contrast's arrival in ischemic group. There were no significant differences between values of neuropathic and neuroischemic forms of diabetic foot. There were no pedal vessels in patients in ischemic and neuroischemic groups. Contrast MR-angiography revealed three types of contrast distribution in soft tissues: uniform, local increase and local absence. Osteomyelitis was characterized as diffuse enhanced contrast accumulation in all cases.

Conclusions: MRI blood vessel imaging is a promising and valuable method for examining peripheral arterial changes in diabetic foot and may be useful for treatment planning in different forms of diabetic foot. 

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8.     Li J., Zhao J.G., Li M.H. Lower limb vascular disease in diabetic patients: a study with calf compression contrast-enhanced magnetic resonance angiography at 3.0 Tesla. Acad Radiol. 2011; 18(6): 755-63.