Chronic recurrent multifocal osteomyelitis (CRMO): a longitudinal case series review

Background Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory disorder that is currently diagnosed based on clinical, radiologic, pathological and longitudinal findings. Objective To provide detailed descriptions of CRMO lesion patterns seen on radiographs and MRI and to sugges...

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Bibliographic Details
Published in:Pediatric radiology 2013-03, Vol.43 (3), p.355-375
Main Authors: Falip, Céline, Alison, Marianne, Boutry, Nathalie, Job-Deslandre, Chantal, Cotten, Anne, Azoulay, Robin, Adamsbaum, Catherine
Format: Article
Language:English
Subjects:
Adolescent
Child
Child, Preschool
Female
Humans
Imaging
Longitudinal Studies
Magnetic Resonance Imaging - methods
Male
Medicine
Medicine & Public Health
Neuroradiology
Nuclear Medicine
Oncology
Original Article
Osteomyelitis - pathology
Pediatrics
Radiology
Recurrence
Reproducibility of Results
Retrospective Studies
Sensitivity and Specificity
Ultrasound
Whole Body Imaging - methods
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Summary:Background Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory disorder that is currently diagnosed based on clinical, radiologic, pathological and longitudinal findings. Objective To provide detailed descriptions of CRMO lesion patterns seen on radiographs and MRI and to suggest clinical use of whole-body MRI and propose noninvasive diagnostic strategy. Materials and methods Retrospective longitudinal study (1989–2010) of 31 children (22 girls, 9 boys) diagnosed with CRMO. Imaging data were evaluated by two pediatric radiologists. Results Mean age at diagnosis was 11 years (3–17). A total of 108 lesions were investigated. The most common sites were the long bone metaphyses (56 lesions in 24 children) especially femoral and tibial (20/24); pelvis (10/31); spine (9/31); clavicle (6/31) and mandible (3/31). In long bones, the radiologic appearance was normal (22/56), mixed lytic and sclerotic (20/56), sclerotic (8/56) or lytic (6/56) often juxtaphyseal (36/56), with hyperostosis or periosteal thickening (10/56). Vertebral involvement was often multifocal (6/9). Medullary edema was seen on MRI (42) with epiphyseal (23/42) or soft-tissue (22/42) inflammation and juxtaphyseal nodule-like appearance (7/42). Whole-body MRI (15/31) was key in detecting subclinical lesions. Conclusion CRMO is a polymorphous disorder in which whole-body MRI is extremely useful for showing subclinical edema. Vertebral collapse requires long-term monitoring.
ISSN:0301-0449
1432-1998
DOI:10.1007/s00247-012-2544-6