European radiology
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Review Comparative Study
Current imaging concepts in pediatric osteomyelitis.
The diagnosis of osteomyelitis remains a difficult diagnostic dilemma. In this article, which is particularly aimed at those whose practice does not include a large paediatric population, we review the pathophysiology of paediatric osteomyelitis and contrast it with the available imaging modalities. ⋯ The most useful imaging findings to look for and their significance are assessed and we evaluate their usefulness in each case. Close cooperation between clinicians and imagers remains the key to early and adequate diagnosis of paediatric osteomyelitis.
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Appendicitis is the commonest acute surgical emergency of childhood, and occurs in approximately 2-4 per 1000 infants. It is usually seen in infants older than 5 years but can occur at any age. Atypical clinical findings are seen in 30-50% of children, especially the younger ones, and often leads to a delayed diagnosis. ⋯ The reported sensitivity of US varied between 87 and 95%, vs 95-97% for helical CT, while the specificity ranged between 85 and 98% for US and 94 and 97% for helical CT. Only one truly randomised study was found, showing that compared with US alone, a combination of US and helical CT increased the sensitivity from 86 to 99%, while the specificity decreased from 95 to 89%. We conclude that imaging should be performed in all children with suspected appendicitis and that US should be the initial procedure with CT as a complementary tool.
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This review article includes infections of the vertebral body, intervertebral disc, ligaments and paravertebral soft tissues, epidural space, meninges and subarachnoid space, and the spinal cord. A wide range of infective organisms may be implicated and the incidence of some, notably tuberculosis, is rising due to increased immunocompromise and other factors. Imaging plays a key role in early diagnosis of these diseases, which may be severe and potentially life threatening. ⋯ Although many signs are non-specific, indication is given of where appearances raise strong suspicion of infection. The extent of the inflammatory process is well evaluated by imaging, particularly in terms of severity and morbidity of clinical sequelae, which may be severe. Early investigation is mandatory and as MRI presently has the key role in investigation, it should be employed at an early stage of clinical suspicion.
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Vertebral infection represents 2-4% of all cases of osteomyelitis. An increase in the incidence of pyogenic as well as granulomatous spondylitis has been noticed. Early radiological diagnosis is of great importance for prompt treatment and prevention of clinically significant consequences which include neural compromise and late spinal deformities. ⋯ This is the reason that MRI frequently has become the first imaging modality in clinically suspect spinal infection. The MRI is the method of choice for direct demonstration of extension of infection, especially of eventual epidural abscess or phlegmon and consecutive neural compression. Using MRI monitoring of therapeutic efficiency is possible.