Department of Radiology, Saitama Children's Medical Center, Saitama, Japan.
Department of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan.
J Ultrasound Med. 2024 Jul;43(7):1223-1234. doi: 10.1002/jum.16446. Epub 2024 Mar 8.
To demonstrate the usefulness of ultrasonography for differentiating soft tissue infections with or without osteomyelitis in pediatric patients who underwent ultrasonography and subsequent magnetic resonance imaging (MRI).
Twenty-three patients were classified into 2 groups: 12 patients with and 11 patients without osteomyelitis based on MRI. Osteomyelitis using ultrasound is characterized by the presence of bone cortex irregularity and/or subperiosteal abscess formation. The diagnostic performance of ultrasonography for detecting osteomyelitis and subperiosteal abscess formation was compared with that of MRI. Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were calculated with 95% confidence intervals (CIs).
Of 12 osteomyelitis cases, 11 had abnormal bone marrow enhancement (one residual case did not undergo contrast enhancement study) and 5 had subperiosteal abscesses. The diagnostic accuracy of ultrasonography for osteomyelitis was 82.6% (number of correct diagnosis of osteomyelitis/total number = 19/23; 95% CI, 61.2-95.0) and for detecting periosteal abscess was 95.7% (number of correct diagnosis of periosteal abscess/total number = 22/23; 95% CI, 78.1-99.9), respectively. The sensitivity and specificity of ultrasonography for detecting osteomyelitis were 66.7% (95% CI, 34.9-90.1) and 100% (95% CI, 71.5-100), respectively. The sensitivity and specificity of ultrasonography for detecting periosteal abscess were 80% (95% CI, 28.4-99.5), and 100% (95% CI, 81.5-100), respectively. One-third of osteomyelitis cases could not be detected using ultrasonography.
Ultrasonography may be useful for diagnosing osteomyelitis in pediatric patients; however, the technique appears limited by low sensitivity. However, it is more accurate for diagnosis of periosteal abscess in these patients.
展示超声在小儿患者中对伴或不伴骨髓炎的软组织感染进行鉴别诊断的作用，这些患者均接受了超声和随后的磁共振成像（MRI）检查。
根据 MRI 将 23 名患者分为两组：12 名患者患有骨髓炎，11 名患者未患有骨髓炎。超声检查骨髓炎的特征是骨皮质不规则和/或骨膜下脓肿形成。比较了超声检查检测骨髓炎和骨膜下脓肿形成的诊断性能与 MRI 的诊断性能。使用 95%置信区间（CI）计算诊断准确性、敏感度、特异度、阳性预测值和阴性预测值。
12 例骨髓炎病例中，11 例有异常骨髓增强（1 例残留病例未行对比增强研究），5 例有骨膜下脓肿。超声检查骨髓炎的诊断准确性为 82.6%（正确诊断骨髓炎的病例数/总病例数=19/23；95%CI，61.2-95.0），检测骨膜下脓肿的诊断准确性为 95.7%（正确诊断骨膜下脓肿的病例数/总病例数=22/23；95%CI，78.1-99.9）。超声检查骨髓炎的敏感度和特异度分别为 66.7%（95%CI，34.9-90.1）和 100%（95%CI，71.5-100）。超声检查骨膜下脓肿的敏感度和特异度分别为 80%（95%CI，28.4-99.5）和 100%（95%CI，81.5-100）。三分之一的骨髓炎病例无法通过超声检查检测到。
超声检查可能有助于诊断小儿患者的骨髓炎；然而，该技术的敏感度似乎较低，因此存在一定局限性。然而，它在诊断这些患者的骨膜下脓肿方面更为准确。
