Fig. 12

A 10-year-old boy who complained of pain in his left ankle and presented with a metaphyseal lesion in the distal tibia (a) which was initially suspected of bacterial osteomyelitis, despite negative biopsy and culture. In 2017, a foot examination showed a lesion in the second metatarsal of the left foot (b) and in the following year, lesions in the distal fibula were detected (c), which led to the hypothesis of CNO. WB-MRI was then performed and showed multiple lesions dispersed throughout the skeleton, in typical bilateral locations, confirming the diagnosis of CNO. WB-MRI DWI (d) and STIR (e) detected involvement of the iliac bones (d.1), anterior acetabulum column (d.2), bilateral tibial proximal metaphysis (d.3) and bones of the metatarsus (d.4) in correspondence with the STIR sequence of the whole body (e)