Department of Paediatric Radiology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK; Department of Pediatric Radiology, the Children's Hospital of Philadelphia, Civic Center Boulevard, Philadelphia, USA.
Department of Paediatric Radiology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK.
Clin Radiol. 2019 Sep;74(9):737.e3-737.e15. doi: 10.1016/j.crad.2019.02.021. Epub 2019 Jul 4.
To explore the distribution patterns and extent of chronic recurrent multifocal osteomyelitis (CRMO) using whole-body magnetic resonance imaging (WBMRI).
Children with established diagnoses of CRMO, who had undergone WBMRI, had their images reviewed by three radiologists using a novel pictorial mapping system for determining lesion load and distribution patterns.
Thirty-seven children (mean 12 years; range 2-18 years) had 317 lesions (8.6 lesions per patient [LPP]; range 2-27). Multifocal involvement was noted in 33 (89%) and unifocal in four (11%). The tibia was most frequently involved (68% of patients; 29% of lesions). Clavicular involvement was noted in 38% and spinal lesions in 19% of patients. Bilateral disease involved the fibulas (80%), tibias (68%), and foot phalanges (67%) most frequently. In 93% of bilateral disease, there was also symmetry. A "tibio-appendicular multi-focal pattern" (tibial but no clavicular involvement) was present in 54% whereas a "claviculo-spinal pauci-focal pattern" (clavicular lesions, no tibial involvement; few additional lesions mainly of the spine) was present in 24%. Only 14% had synchronous involvement of the clavicle and tibia. In the long bones, 65% of lesions were metaphyseal (distal metaphysis 42%) and 35% epiphyseal (173 peri-physeal lesions). Epiphyseal lesions were minimal in 60% whereas metaphyseal lesions were extensive in 75%. Sixty-six percent of tibial symmetric lesions and 100% of symmetric lesions of the radius, humerus, and ulna were of equal severity.
CRMO lesions are often multifocal and can have typical long bone distal metaphyseal locations. Two main phenotypic patterns have emerged: multifocal predominantly tibial involvement or pauci-focal clavicular and spinal disease.
利用全身磁共振成像（WBMRI）探讨慢性复发性多灶性骨髓炎（CRMO）的分布模式和范围。
对经 WBMRI 确诊为 CRMO 的患儿，由 3 名放射科医生使用新的图像图谱系统评估其图像，以确定病变负荷和分布模式。
37 例患儿（平均年龄 12 岁；范围 2-18 岁）共 317 处病灶（每个患者 8.6 处病灶[LPP]；范围 2-27 处）。33 例（89%）为多灶性受累，4 例（11%）为单灶性受累。胫骨最常受累（68%的患者；29%的病灶）。38%的患儿锁骨受累，19%的患儿脊柱受累。双侧疾病最常累及腓骨（80%）、胫骨（68%）和足部趾骨（67%）。93%的双侧疾病存在对称性。54%的患儿存在“胫骨附肢多灶模式”（胫骨受累而锁骨不累及），24%的患儿存在“锁骨-脊柱少灶模式”（锁骨病变，胫骨不累及；脊柱病变较少，主要为脊柱）。仅有 14%的患儿同时累及锁骨和胫骨。在长骨中，65%的病灶位于干骺端（远侧干骺端 42%），35%位于骺端（173 处骺周病灶）。60%的骺端病灶较轻，75%的干骺端病灶广泛。66%的胫骨对称病灶和 100%的桡骨、肱骨和尺骨对称病灶严重程度相同。
CRMO 病灶常为多灶性，且常位于长骨干骺端远侧。已出现两种主要表型模式：多灶性主要累及胫骨或少灶性锁骨和脊柱病变。
