MRI in chronic recurrent multifocal osteomyelitis

Abstract

Objective: To review our experience of chronic recurrent multifocal osteomyelitis (CRMO) and to assess the value of MRI in this rare disease, which mainly affects children and adolescents.

Design and patients: Seventeen patients from our departments were reviewed. All underwent conventional radiography and MRI, and most had bone scintigraphy. All had undergone bone biopsy, with microbiological and histopathological examinations, to exclude infectious disease, tumours and tumour-like lesions.

Results and conclusion: CRMO affects predominantly the tubular bones of the limbs, followed by the clavicle and the spine. Other locations are rare. Diagnosis is important in avoiding unnecessary diagnostic procedures and to initiate appropriate therapy, and is usually based on a characteristic course and the appearances on radiography. However, CRMO lesions of tubular bones and the spine exhibit quite characteristic MRI features which support the diagnosis, while the appearance of the early clavicular lesion is non-specific. At all sites of CRMO in the skeleton, MRI is valuable in assessing the extent and activity of the lesion. It may exclude pyogenic involvement of the bone and soft tissues and guide effective biopsy.