Aydingoz Ustun
Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Rofo. 2023 Apr;195(4):297-308. doi: 10.1055/a-1949-7641. Epub 2023 Feb 1.
Hematogenous osteomyelitis has increased over the past quarter century in frequency, virulence, and degree of soft-tissue involvement, bringing about changes in clinical manifestations and management of the disease especially in children that should be reflected in the current imaging approach. Likewise, the global disease burden of diabetes has increased greatly in the same period, compounding the problem of ascertaining osteomyelitis in diabetic foot.
This article provides an updated overview of imaging findings in hematogenous and contiguous osteomyelitis based on the literature and our institutional experience, along with salient features of recent recommendations from expert groups on the diagnostic algorithms and reporting terminology.
Findings on radiography and especially magnetic resonance imaging (MRI) closely reflect pathophysiology in osteomyelitis, whereby the characteristic involvement of the metaphysis or metaphyseal-equivalents, the formation and subperiosteal extension of intramedullary pus collection, and the development of cloaca, sequestrum, and involucrum are all diagnostic clues. Non-enhancing foci within the medullary bone, the penumbra sign, intra- or extramedullary fat globules, and surrounding soft tissue inflammation or abscesses are among key MRI findings. Diabetic foot is a special condition with characteristic pathophysiologic and imaging features that suggest the likelihood of osteomyelitis and the main differential diagnostic consideration of acute on chronic neuropathic osteoarthropathy with or without osteomyelitis.
· Imaging closely reflects pathophysiology in hematogenous osteomyelitis.. · Acute hematogenous osteomyelitis predominantly involves metaphyses and metaphyseal equivalent sites.. · MRI clues for hematogenous osteomyelitis include central marrow non-enhancement, intra- or extramedullary fat globules, and the "penumbra" sign.. · An increased fluid-sensitive MRI bone signal abutting a soft tissue ulcer, abscess, or sinus tract suggests a high probability of contact osteomyelitis..
· Aydingoz U, Imaging Osteomyelitis: An Update. Fortschr Röntgenstr 2023; 195: 297 - 308.
血源性骨髓炎在过去四分之一个世纪中，在发病率、毒力以及软组织受累程度方面均有所增加，这导致了该疾病临床表现和治疗的变化，尤其是在儿童中，这些变化应反映在当前的影像学检查方法中。同样，同期全球糖尿病疾病负担大幅增加，这使糖尿病足骨髓炎的诊断问题更加复杂。
本文基于文献和我们机构的经验，提供了血源性和连续性骨髓炎影像学表现的最新概述，以及专家组关于诊断算法和报告术语的最新建议的显著特征。
X线摄影尤其是磁共振成像（MRI）的表现密切反映骨髓炎的病理生理过程，其中干骺端或干骺端等效部位的特征性受累、髓腔内脓肿的形成和骨膜下扩展，以及骨瘘、死骨和骨膜新生骨的形成均为诊断线索。骨髓腔内无强化灶、半影征、髓内或髓外脂肪球以及周围软组织炎症或脓肿是MRI的关键表现。糖尿病足是一种特殊情况，具有特征性的病理生理和影像学特征，提示骨髓炎的可能性以及急性或慢性神经性骨关节病伴或不伴骨髓炎的主要鉴别诊断考虑因素。
· 影像学密切反映血源性骨髓炎的病理生理过程。· 急性血源性骨髓炎主要累及干骺端和干骺端等效部位。· 血源性骨髓炎的MRI线索包括骨髓中央无强化、髓内或髓外脂肪球以及“半影”征。· MRI上与软组织溃疡、脓肿或窦道相邻的液体敏感序列骨信号增加提示接触性骨髓炎的可能性很高。
· Aydingoz U, Imaging Osteomyelitis: An Update. Fortschr Röntgenstr 2023; 195: 297 - 308.
