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MRI for Detection of Abscess in Acute Osteomyelitis of the Pelvis in Children

¹ Department of Radiology, Children's Hospital Boston, 300 Longwood Ave., Main 2, Boston, MA 02115.
² Division of Nuclear Medicine, Children's Hospital Boston, Boston, MA.
³ Department of Orthopedic Surgery, Children's Hospital Boston, Boston, MA.
⁴ Department of Radiology, Children's Hospital of Philadelphia, PA.

OBJECTIVE. We analyzed our experience with MRI of pelvic acute hematogenous osteomyelitis (AHO) to address the following questions: What does MRI reveal about bone involvement? How often are fluid collections indicative of abscess shown? Are clinical parameters predictive of the cases in which MRI would be more beneficial?

MATERIALS AND METHODS. We retrospectively reviewed the imaging studies and medical records from the past 5 years of 38 children ranging in age from 25 to 211 months who were diagnosed with pelvic osteomyelitis using MRI. Statistical analysis of demographic and clinical variables was compared between patients with an abscess (n = 21) and those without (n = 17) who were identified on MRI.

RESULTS. Osteomyelitis involved metaphyseal equivalent sites in every case (n = 38), with single bone involvement in 24 (63%) and contiguous bone involvement in the remaining 14 (37%). Fluid collections indicative of an abscess were seen in 21 cases (55%), and abscess drainage was performed in 10 (26%). Univariate analysis of demographic and clinical variables between patients with and without an abscess indicated no significant differences for any variable except erythrocyte sedimentation rate (ESR) (74 ± 19 vs 56 ± 24 mm/h; p< 0.05, Student's t test).

CONCLUSION. Childhood pelvic AHO is relatively uncommon and produces variable signs and symptoms that are often attributed to another process. The results of our study show the ability of MRI to provide additional information that affected patient management in cases of pelvic abscess. We therefore advocate the use of MRI as the imaging technique of choice for any child suspected of having pelvic AHO.

Keywords: MRI • pediatric imaging • pelvic abscess • pelvic osteomyelitis

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