CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2025; 35(01): 109-122
DOI: 10.1055/s-0044-1790238
Mini-Symposium

Chronic Noninfectious Osteomyelitis: A Review of Imaging Findings

1   Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
,
Narendra Bagri
2   Division of Paediatric Rheumatology, Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
,
Savvas Andronikou
3   Department of Radiology, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
A.V. Ramanan
4   Department of Paediatric Rheumatology, Bristol Royal Hospital for Children & Translational Health Sciences, University of Bristol, Bristol, United Kingdom
,
Manisha Jana
1   Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
› Institutsangaben
Funding None.

Abstract

Chronic noninfectious osteomyelitis or chronic nonbacterial osteomyelitis (CNO), also known as chronic recurrent multifocal osteomyelitis, is an autoinflammatory bone disorder primarily affecting the pediatric age group. Currently, it is diagnosed on the basis of clinical, laboratory, and imaging features. Imaging plays a crucial role in the diagnosis and follow-up of CNO with whole body magnetic resonance imaging (WBMRI) being the main modality. Radiographs assist in exclusion of common differential diagnoses like infections and malignancy. WBMRI aids in disease detection and exclusion of differential diagnoses, identifies additional lesions, and has a role in ascertaining the pattern of bony involvement which helps with prognostication and grading. Recent recognition of specific morphological and distribution patterns on WBMRI is increasingly allowing an upfront diagnosis of this entity to be made on imaging alone. It is also helpful for assessment of response to therapy during follow-up. This review aims to summarize the role of imaging in the evaluation of CNO, with special emphasis on WBMRI in its assessment.



Publikationsverlauf

Artikel online veröffentlicht:
03. September 2024

© 2024. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Giedion A, Holthusen W, Masel LF, Vischer D. Subacute and chronic “symmetrical” osteomyelitis. Ann Radiol (Paris) 1972; 15 (03) 329-342
  • 2 Hofmann SR, Kapplusch F, Girschick HJ. et al. Chronic recurrent multifocal osteomyelitis (CRMO): presentation, pathogenesis, and treatment. Curr Osteoporos Rep 2017; 15 (06) 542-554
  • 3 Nico MA, Araújo FF, Guimarães JB, da Cruz IA, Silva FD, Carneiro BC. Chronic non-bacterial osteomyelitis: the role of whole-body MRI. Insights Imaging 2022; 13 (01) 1-2
  • 4 Sergi CM, Miller E, Demellawy DE, Shen F, Zhang M. Chronic recurrent multifocal osteomyelitis. A narrative and pictorial review. Front Immunol 2022; 13: 959575
  • 5 Ferguson PJ, Chen S, Tayeh MK. et al. Homozygous mutations in LPIN2 are responsible for the syndrome of chronic recurrent multifocal osteomyelitis and congenital dyserythropoietic anaemia (Majeed syndrome). J Med Genet 2005; 42 (07) 551-557
  • 6 Martinez-Rios C, Jariwala MP, Highmore K. et al. Imaging findings of sterile pyogenic arthritis, pyoderma gangrenosum and acne (PAPA) syndrome: differential diagnosis and review of the literature. Pediatr Radiol 2019; 49 (01) 23-36
  • 7 Hedrich CM, Morbach H, Reiser C, Girschick HJ. New insights into adult and paediatric chronic non-bacterial osteomyelitis CNO. Curr Rheumatol Rep 2020; 22 (09) 52
  • 8 Zhao Y, Ferguson PJ. Chronic non-bacterial osteomyelitis and chronic recurrent multifocal osteomyelitis in children. Pediatr Clin North Am 2018; 65 (04) 783-800
  • 9 Hedrich CM, Hofmann SR, Pablik J, Morbach H, Girschick HJ. Autoinflammatory bone disorders with special focus on chronic recurrent multifocal osteomyelitis (CRMO). Pediatr Rheumatol Online J 2013; 11 (01) 47
  • 10 Andronikou S, Kraft JK, Offiah AC. et al. Whole-body MRI in the diagnosis of paediatric CNO/CRMO. Rheumatology (Oxford) 2020; 59 (10) 2671-2680
  • 11 Falip C, Alison M, Boutry N. et al. Chronic recurrent multifocal osteomyelitis (CRMO): a longitudinal case series review. Pediatr Radiol 2013; 43 (03) 355-375
  • 12 Jansson A, Renner ED, Ramser J. et al. Classification of non-bacterial osteitis: retrospective study of clinical, immunological and genetic aspects in 89 patients. Rheumatology (Oxford) 2007; 46 (01) 154-160
  • 13 Rivas Felice J, González Herranz P, Mejía Casado A, Pérez Navarro R, Hernández Díaz R. Chronic recurrent osteomyelitis: a diagnostic and therapeutic challenge [in Spanish]. Rev Esp Cir Ortop Traumatol 2017; 61 (01) 35-42
  • 14 Roderick MR, Shah R, Rogers V, Finn A, Ramanan AV. Chronic recurrent multifocal osteomyelitis (CRMO) - advancing the diagnosis. Pediatr Rheumatol Online J 2016; 14 (01) 47
  • 15 Patel AM, Lee K, Kim A. OA02 Validation of newly proposed ACR/EULAR classification criteria for paediatric chronic non-bacterial osteomyelitis. Rheumatology 2023; 62 (Suppl. 03) kead 323-002
  • 16 Iyer RS, Thapa MM, Chew FS. Chronic recurrent multifocal osteomyelitis: review. AJR Am J Roentgenol 2011; 196 (6, suppl): S87-S91
  • 17 Arnoldi AP, Schlett CL, Douis H. et al. Whole-body MRI in patients with non-bacterial osteitis: radiological findings and correlation with clinical data. Eur Radiol 2017; 27 (06) 2391-2399
  • 18 Andronikou S, Mendes da Costa T, Hussien M, Ramanan AV. Radiological diagnosis of chronic recurrent multifocal osteomyelitis using whole-body MRI-based lesion distribution patterns. Clin Radiol 2019; 74 (09) 737.e3-737.e15
  • 19 Guérin-Pfyffer S, Guillaume-Czitrom S, Tammam S, Koné-Paut I. Evaluation of chronic recurrent multifocal osteitis in children by whole-body magnetic resonance imaging. Joint Bone Spine 2012; 79 (06) 616-620
  • 20 Von Kalle T, Heim N, Hospach T, Langendörfer M, Winkler P, Stuber T. Typical patterns of bone involvement in whole-body MRI of patients with chronic recurrent multifocal osteomyelitis (CRMO). In: RöFo-Fortschritte auf demGebiet der Röntgenstrahlen und der bildgebenden Verfahren. 2013. Georg ThiemeVerlag KG:; Stuttgart, Germany:: 655-661
  • 21 Girschick HJ, Raab P, Surbaum S. et al. Chronic non-bacterial osteomyelitis in children. Ann Rheum Dis 2005; 64 (02) 279-285
  • 22 Khanna G, Sato TS, Ferguson P. Imaging of chronic recurrent multifocal osteomyelitis. Radiographics 2009; 29 (04) 1159-1177
  • 23 Damasio MB, Magnaguagno F, Stagnaro G. Whole-body MRI: non-oncological applications in paediatrics. Radiol Med 2016; 121 (05) 454-461
  • 24 Voit AM, Arnoldi AP, Douis H. et al. Whole-body magnetic resonance imaging in chronic recurrent multifocal osteomyelitis: clinical longterm assessment may underestimate activity. J Rheumatol 2015; 42 (08) 1455-1462
  • 25 Ley S, Ley-Zaporozhan J, Schenk JP. Whole-body MRI in the pediatric patient. Eur J Radiol 2009; 70 (03) 442-451
  • 26 Darge K, Jaramillo D, Siegel MJ. Whole-body MRI in children: current status and future applications. Eur J Radiol 2008; 68 (02) 289-298
  • 27 Beck C, Morbach H, Beer M. et al. Chronic nonbacterial osteomyelitis in childhood: prospective follow-up during the first year of anti-inflammatory treatment. Arthritis Res Ther 2010; 12 (02) R74
  • 28 Shah A, Rosenkranz M, Thapa M. Review of spinal involvement in chronic recurrent multifocal osteomyelitis (CRMO): what radiologists need to know about CRMO and its imitators. Clin Imaging 2022; 81: 122-135
  • 29 Hospach T, Langendoerfer M, von Kalle T, Maier J, Dannecker GE. Spinal involvement in chronic recurrent multifocal osteomyelitis (CRMO) in childhood and effect of pamidronate. Eur J Pediatr 2010; 169 (09) 1105-1111
  • 30 Guariento A, Sharma P, Andronikou S. MRI features of spinal chronic recurrent multifocal osteomyelitis/chronic non-bacterial osteomyelitis in children. Pediatr Radiol 2023; 53 (10) 2092-2103
  • 31 Taddio A, Zennaro F, Pastore S, Cimaz R. An update on the pathogenesis and treatment of chronic recurrent multifocal osteomyelitis in children. Paediatr Drugs 2017; 19 (03) 165-172
  • 32 Wipff J, Costantino F, Lemelle I. et al. A large national cohort of French patients with chronic recurrent multifocal osteitis. Arthritis Rheumatol 2015; 67 (04) 1128-1137
  • 33 Leclair N, Thörmer G, Sorge I, Ritter L, Schuster V, Hirsch FW. Whole-body diffusion-weighted imaging in chronic recurrent multifocal osteomyelitis in children. PLoS One 2016; 11 (01) e0147523
  • 34 Fritz J, Tzaribatchev N, Claussen CD, Carrino JA, Horger MS. Chronic recurrent multifocal osteomyelitis: comparison of whole-body MR imaging with radiography and correlation with clinical and laboratory data. Radiology 2009; 252 (03) 842-851
  • 35 Walsh P, Manners PJ, Vercoe J, Burgner D, Murray KJ. Chronic recurrent multifocal osteomyelitis in children: nine years' experience at a statewide tertiary paediatric rheumatology referral centre. Rheumatology (Oxford) 2015; 54 (09) 1688-1691
  • 36 Huber AM, Lam PY, Duffy CM. et al. Chronic recurrent multifocal osteomyelitis: clinical outcomes after more than five years of follow-up. J Pediatr 2002; 141 (02) 198-203
  • 37 Jansson AF, Grote V. ESPED Study Group. Nonbacterial osteitis in children: data of a German Incidence Surveillance Study. Acta Paediatr 2011; 100 (08) 1150-1157
  • 38 Menashe SJ, Aboughalia H, Zhao Y. et al. The many faces of pediatric chronic recurrent multifocal osteomyelitis (CRMO): a practical location- and case-based approach to differentiate CRMO from its mimics. J Magn Reson Imaging 2021; 54 (02) 391-400
  • 39 Pal CR, Tasker AD, Ostlere SJ, Watson MS. Heterogeneous signal in bone marrow on MRI of children's feet: a normal finding?. Skeletal Radiol 1999; 28 (05) 274-278
  • 40 Schaal MC, Gendler L, Ammann B. et al. Imaging in non-bacterial osteomyelitis in children and adolescents: diagnosis, differential diagnosis and follow-up-an educational review based on a literature survey and own clinical experiences. Insights Imaging 2021; 12 (01) 113
  • 41 Panwar J, Tolend M, Lim L. et al. Whole-body MRI quantification for assessment of bone lesions in chronic non-bacterial osteomyelitis patients treated with pamidronate: a prevalence, reproducibility, and responsiveness study. J Rheumatol 2021; 48 (05) 751-759
  • 42 Kieninger A, Schäfer JF, Tsiflikas I. et al. Early diagnosis and response assessment in chronic recurrent multifocal osteomyelitis: changes in lesion volume and signal intensity assessed by whole-body MRI. Br J Radiol 2022; 95 (1130) 20211091
  • 43 Menashe SJ, Iyer RS, Ngo AV, Rosenwasser NL, Zhao Y, Maloney E. Whole-body MRI at initial presentation of pediatric chronic recurrent multifocal osteomyelitis and correlation with clinical assessment. Pediatr Radiol 2022; 52 (12) 2377-2387
  • 44 Zhao Y, Sato TS, Nielsen SM. et al. Development of a scoring tool for chronic non-bacterial osteomyelitis magnetic resonance imaging and evaluation of its interrater reliability. J Rheumatol 2020; 47 (05) 739-747
  • 45 Capponi M, Pires Marafon D, Rivosecchi F. et al. Assessment of disease activity using a whole-body MRI derived radiological activity index in chronic nonbacterial osteomyelitis. Pediatr Rheumatol Online J 2021; 19 (01) 123
  • 46 Bhat CS, Chopra M, Andronikou S. et al. Artificial intelligence for interpretation of segments of whole body MRI in CNO: pilot study comparing radiologists versus machine learning algorithm. Pediatr Rheumatol Online J 2020; 18 (01) 47