Table 2 Differential diagnosis of acute and chronic osteomyelitis in children
Differential diagnosis | Major imaging or clinical feature |
|---|---|
Acute osteomyelitis | |
Vaso-occlusive disease | Linear hypointense on T1- and T2-weighted changes in meta- and epiphysis |
Septic emboli | Growth plate involvement in fulminant meningococcemia |
Septic arthritis | Fluid in joints |
Spondylodiscitis | Imaging shows low signal of the disc with fluid/abscess around it with destruction of the vertebrae, rim enhancement after gadolinium. (image 9) |
Osteoid osteoma | Cortical sclerotic lesion with typical lucent nidus |
ALL | Diffuse bone marrow changes, T1 low signal and T2 heterogeneous |
Stress fracture | Linear lesions show hypointense changes on T1, without enhancement |
Metastastic neuroblastoma | Multiple lesions with high signal on STIR. In context of neuroblastoma |
Ewing’s sarcoma | Large soft tissue mass, onion-skin periostitis, metastasis |
Osteosarcoma | Codman’s triangle, sunburst spiculated periostitis, cortical destruction |
Self-limiting sternal tumours of childhood (SELSTOC) | Ultrasound shows dumbbell-shaped lesions extending to the area behind the sternal bone, involving the cartilage, leading to increased distance between ossification centres |
Chronic osteomyelitis | |
Ewing’s sarcoma | Large soft tissue mass, onion-skin periostitis, metastasis |
LCH | Typical punched-out lesion on conventional imaging. Whole-body MRI STIR can be used for screening |
Metastasis | Multifocal lesions, no inflammation parameters |
CRMO | STIR and T2 series show multiple spots of high signal intensity, and series after contrast show enhancement. Imaging characteristics are comparable with acute osteomyelitis. Focus of osteomyelitis and symptoms can change over time. PET scan can also show multiple sites of uptake |