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

Susan A. Connolly1, Leonard P. Connolly2, Laura A. Drubach2, David Zurakowski1,3 and Diego Jaramillo4

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.


Figure 1
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  		Fig. 1 —Scatterplot shows empiric data for erythrocyte sedimentation rate (ESR) for each of 38 patients in our study segregated by whether they had an abscess on MRI. Those 21 patients with abscess are segregated by whether abscess required drainage. Horizontal lines indicate mean ESR values for the 21 patients with abscess and the 17 patients with no abscess (74 and 56 mm/h, respectively). Student's t test indicated that patients with abscess have significantly elevated ESR.

 

Figure 2
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  		Fig. 2 —Theoretic curve based on logistic regression analysis depicts estimated probability of abscess according to patient's erythrocyte sedimentation rate (ESR). Positive relationship was observed with higher sedimentation rates among patients who had abscess identified on MRI (p < 0.01). This relationship was independent of age, sex, duration of symptoms, presence of fever, and serum WBC.

 

Figure 3
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  		Fig. 3A —12-year-old boy with 1-week history of right buttock pain. Coronal STIR image shows bone marrow and soft-tissue edema in metaphyseal equivalent of right ischial tuberosity (arrow).

 

Figure 4
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  		Fig. 3B —12-year-old boy with 1-week history of right buttock pain. Gadolinium-enhanced axial T1-weighted fatsaturated image shows enhancing edema in ischium and soft tissues (arrow), and no abscess.

 

Figure 5
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  		Fig. 4A —10-year-old boy with 6-day history of left hip pain who underwent aspiration of sterile left hip joint effusion 1 day before MRI. Axial T2-weighted fat-saturated image shows edema of left acetabulum, ileum, and pubis centered at metaphyseal equivalent of triradiate cartilage (asterisk). Edema and enlargement of left obturator internus muscle is seen (arrow). Note left hip effusion.

 

Figure 6
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  		Fig. 4B —10-year-old boy with 6-day history of left hip pain who underwent aspiration of sterile left hip joint effusion 1 day before MRI. Gadolinium-enhanced coronal T1-weighted fatsaturated image shows small nonenhancing fluid collection and abscess (arrow) in obturator muscle.

 

Figure 7
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  		Fig. 5A —Osteomyelitis of left anterior superior iliac spine, metaphyseal equivalent, in 7-year-old boy with 4-day history of left hip pain. Axial T1-weighted gadolinium-enhanced fat-saturated images show marrow edema in left ileum and surrounding soft tissues. Two nonenhancing fluid collections, abscesses, are seen. One is intraosseous and other is in gluteal soft tissues (arrow).

 

Figure 8
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  		Fig. 5B —Osteomyelitis of left anterior superior iliac spine, metaphyseal equivalent, in 7-year-old boy with 4-day history of left hip pain. Axial T1-weighted gadolinium-enhanced fat-saturated images show marrow edema in left ileum and surrounding soft tissues. Two nonenhancing fluid collections, abscesses, are seen. One is intraosseous and other is in gluteal soft tissues (arrow).

 

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