Fig. 14
From: Lesions involving the outer surface of the bone in children: a pictorial review
Chronic recurrent multifocal osteomyelitis (CRMO) in an 8-year-old girl. An anteroposterior radiograph of the right elbow a reveals an eccentric, mostly lucent lesion at the lateral distal humerus (arrow) with surrounding periosteal reaction. Corresponding coronal T2 STIR image b reveals hyperintense, abnormal signal eccentrically along the distal lateral humerus with overlying periosteal reaction and surrounding soft-tissue edema. Tc-99m-labeled MDP bone scan reveals increased radiotracer uptake at the distal right humerus c and the right sphenoid d, suggesting multifocality of the process. The patient had a chronic course with recurrent exacerbations. Axial STIR e and coronal T1 post-contrast f MR images obtained 2 years after the initial presentation reveal STIR hyperintense, enhancing abnormality along the lateral distal humerus (thin arrows on e, thick arrow on f). The abnormality is peripheral, and involves the cortex and overlying periosteum. A non-contrast axial CT image g obtained at the same time for biopsy guidance shows cortical irregularity through the affected portion of the lateral distal humerus with significant overlying periosteal reaction (arrow)