Extended field of view magnetic resonance imaging for suspected osteomyelitis in very young children: is it useful?

Abstract

Osteomyelitis is a challenging diagnosis for clinicians, particularly in very young children. At our institution, the magnetic resonance imaging (MRI) protocol in suspected osteomyelitis for children 5years of age or younger includes a large field of imaging regardless of the clinical site of concern. To determine if extended field of view (FOV) MRI contributes important information in young children with suspected osteomyelitis. A retrospective study was performed including children 5years of age or younger with suspected osteomyelitis from January 2011 to September 2015. All children underwent coronal fluid-sensitive MRI from neck to feet. Focused imaging was performed as necessary on abnormal sites depicted on survey imaging. Two radiologists reviewed the imaging findings, which were compared to the clinical outcome. We studied 51 children with a mean age of 2.2years (range: 21days-5.5years); 53% were boys. Osteomyelitis was depicted by MRI in 20 subjects (39.2%). Survey coronal fluid-sensitive imaging was accomplished by adding a single fluid-sensitive series in 1 child, 2 series in 31 children, 3 series in 16 children and 4 series in 3 children. Survey imaging added a median total time of 6:51min to the examination (range: 2.29-20.54min). Extended FOV imaging added important information in 11/51 subjects (21.6%), in 6 cases (11.8%) of infection and in 5 cases (9.8%) by suggesting alternative diagnoses. The addition of extended FOV MRI in young children with suspected osteomyelitis added important clinical information in 21.6% of patients while only adding a median of 6:51min to the examination. It is our experience that in children ≤5years of age with suspected osteomyelitis, extended FOV imaging adds important information and may result in changes in management.