Hackenberg Roslind K, Schmitt-Sánchez Fabio, Endler Christoph, Tischler Verena, Surendar Jayagopi, Kabir Koroush, Welle Kristian, Burger Christof, Wirtz Dieter C, Schildberg Frank A
Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany.
Department of Orthopedics and Trauma Surgery, University Hospital Bonn, 53127 Bonn, Germany.
J Clin Med. 2025 Jul 9;14(14):4877. doi: 10.3390/jcm14144877.
Osteomyelitis, particularly affecting the lower extremities, is a serious and increasingly common complication. Accurate diagnosis is essential for successful treatment, yet standardized evidence-based protocols are lacking and diagnostic knowledge remains limited. This study aimed to identify characteristic histological and MRI findings in osteomyelitis to support diagnostic accuracy and guide treatment decisions. In a prospective case-control pilot study conducted from February 2020 to January 2021, all patients with suspected osteomyelitis of the lower limbs were included. Each underwent contrast-enhanced MRI and sampling for microbiological and histological analysis. Findings from five confirmed osteomyelitis cases were compared to five controls where osteomyelitis was ruled out. All osteomyelitis cases showed typical MRI signs, including contrast-enhancing bone edema. Two had early, and two had pronounced intramedullary abscesses. In three controls, contrast-enhancing edema was limited to soft tissue; two showed mild adjacent bone edema. Histologically, all osteomyelitis samples revealed bone fragmentation and inflammatory cell infiltration-absent in controls. Additionally, four showed medullary fibrosis and one fibrin deposits. A comprehensive understanding of both histological and radiological findings is key to effective osteomyelitis treatment. This pilot study is the first to systematically compare MRI and histology findings side by side, offering valuable insights that may enhance diagnostic precision and support evidence-based treatment decisions.
骨髓炎，尤其是累及下肢的骨髓炎，是一种严重且日益常见的并发症。准确诊断对于成功治疗至关重要，但目前缺乏标准化的循证方案，诊断知识也仍然有限。本研究旨在确定骨髓炎的特征性组织学和MRI表现，以提高诊断准确性并指导治疗决策。在一项于2020年2月至2021年1月进行的前瞻性病例对照试点研究中，纳入了所有疑似下肢骨髓炎的患者。每位患者均接受了对比增强MRI检查，并进行了微生物学和组织学分析采样。将5例确诊骨髓炎病例的结果与5例排除骨髓炎的对照病例进行了比较。所有骨髓炎病例均显示出典型的MRI征象，包括对比增强的骨水肿。2例有早期髓内脓肿，2例有明显的髓内脓肿。在3例对照病例中，对比增强水肿仅限于软组织；2例显示轻度的相邻骨水肿。组织学上，所有骨髓炎样本均显示骨碎片和炎症细胞浸润，而对照病例中则无。此外，4例显示髓质纤维化，1例显示纤维蛋白沉积。全面了解组织学和影像学表现是有效治疗骨髓炎的关键。这项试点研究首次系统地并列比较了MRI和组织学结果，提供了有价值的见解，可能会提高诊断精度并支持循证治疗决策。
