Early recognition of deep seated infections (osteomyelitis and abscesses) in the pediatric population may be difficult, given nonspecific symptoms and signs but remains crucial in the management. There is increasing emphasis on ionizing radiation dose reduction, making whole-body MRI (WBMRI) with short TI inversion recovery (STIR) the advanced imaging modality of choice over bone scintigraphy and CT-scans.
A retrospective chart review of pediatric patients, <19 years, at Palmetto Health, Columbia, SC who had WBMRI with infectious indications during 9/2011 to 12/2013 was performed. The aims of this research were to describe complications related to sedation/contrast, to determine what portion of patients had new evidence of deep seated infections and to obtain initial evidence for effectiveness of WBMRI.
20 patients were included with male predominance (12; 60%). 9/20 patients < 12 months old and 4 between the ages of 12-70 months. The most common comorbidity was sickle cell syndrome (n=6) and 16/20 patients had a recent/current central venous catheter. The reasons for imaging were fever (9, 45%), pain/swelling (5, 25%), and abnormal labs/imaging (6, 30%). 19 patients had other diagnostics studies prior to WBMRI, 17 of whom had ionizing radiation using studies (X-rays / CT scans). 10/19 also had additional trips to the radiology department for focal MRIs. Duration of sedation for WBMRI averaged 88 minutes, with propofol (10/14) being the most common agent used. No complications from the sedation or the MRI contrast were recorded. WBMRI found an average of 1-4 areas of osteomyelitis in 11 patients and up to 8 other locations of deep seated infections in 15 patients. 11/20 had post WBMRI surgical intervention of debridement/drainage. Gram-positive cocci were isolated from 10/17 patients with positive blood/tissue cultures. Of those, 6 were methicillin-resistant Staphylococcus aureus.
Utilized as an early imaging modality in pediatric patients with persistent bacteremia/fevers, WBMRI commonly facilitated timely definitive interventions while sparing the patient exposure to ionizing radiation. WBMRI with STIR was safe and is likely to be cost effective.
A. K. Burch, None
M. Marcus, None
H. Albrecht, None
K. Sanasi-Bhola, None