Optimal imaging strategy for community-acquired Staphylococcus aureus musculoskeletal infections in children.

Abstract

BACKGROUND:

Invasive musculoskeletal infections from community-acquired methicillin-resistant and methicillin-susceptible Staphylococcus aureus (CA-SA) are increasingly encountered in children. Imaging is frequently requested in these children for diagnosis and planning of therapeutic interventions.

OBJECTIVE:

To appraise the diagnostic efficacy of imaging practices performed for CA-SA osteomyelitis and its complications.

MATERIALS AND METHODS:

A retrospective review was conducted of the clinical charts and imaging studies of CA-SA osteomyelitis cases since 2001 at a large children's hospital.

RESULTS:

Of 199 children diagnosed with CA-SA osteomyelitis, 160 underwent MRI examination and 35 underwent bone scintigraphy. The sensitivity of MRI and bone scintigraphy for CA-SA osteomyelitis was 98% and 53%, respectively. In all discordant cases, MRI was correct compared to bone scintigraphy. Extraosseous complications of CA-SA osteomyelitis detected only by MRI included subperiosteal abscesses (n = 77), pyomyositis (n = 43), septic arthritis (n = 31), and deep venous thrombosis (n = 12).

CONCLUSION:

MRI is the preferred imaging modality for the investigation of pediatric CA-SA musculoskeletal infection because it offers superior sensitivity for osteomyelitis compared to bone scintigraphy and detects extraosseous complications that occur in a substantial proportion of patients.

• Authors: Lorna P Browne, Edward O Mason, Sheldon L Kaplan, Christopher I Cassady, Rajesh Krishnamurthy, R Paul Guillerman
• Journal: Pediatric radiology (Pediatr Radiol) Vol. 38 Issue 8 Pg. 841-7 (Aug 2008) ISSN: 0301-0449 [Print] Germany
• PMID: 18560822 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Radiopharmaceuticals
• Technetium Tc 99m Medronate

Topics

• Adolescent
• Child
• Child, Preschool
• Community-Acquired Infections (diagnosis)
• Female
• Humans
• Infant
• Infant, Newborn
• Magnetic Resonance Imaging (methods)
• Male
• Methicillin-Resistant Staphylococcus aureus
• Osteomyelitis (diagnosis)
• Radiopharmaceuticals
• Reproducibility of Results
• Sensitivity and Specificity
• Staphylococcal Infections (diagnosis)
• Technetium Tc 99m Medronate
• Tomography, Emission-Computed, Single-Photon (methods)