Fig. 2
From: Chronic nonbacterial osteomyelitis: the role of whole-body MRI
A 5-year-old boy presented with a swollen and painful right knee. Sagittal fat-saturated T1-weighted image (ceFST1WI) shows synovitis with joint effusion and inflammatory changes in adjacent soft tissues (a). After 5 months, he presented pain in his left thigh. Plain radiograph showed a single-layered periosteal reaction on the proximal diaphysis of the left femur (b) and bone scintigraphy shows uptake on this site (c). Sagittal T1WI (d) and fat saturated T2WI (FST2WI) (e) show edema and periosteal thickening of the proximal diaphysis of the femur. The diagnosis of chronic nonbacterial osteomyelitis was confirmed with histopathological nonspecific inflammatory changes and negative culture results from two bone biopsies. Synovitis occurs in 5–30% of cases of CNO and single lesions and diaphyseal involvement are rare forms of presentation (“SAPHO-like”)