Scientific article
Open access

Benefits of diffusion-weighted imaging in pediatric acute osteoarticular infections

Published inPediatric radiology, vol. 52, no. 6, p. 1086-1094
Publication date2022-05
First online date2022-04-04

Background: Contrast-enhanced magnetic resonance imaging (MRI) is recommended for the diagnosis of acute osteoarticular infections in children. Diffusion-weighted imaging (DWI) may be an alternative to the injection of gadolinium.

Objective: To evaluate unenhanced MRI with DWI in comparison to contrast-enhanced MRI for the diagnostic work-up of acute osteoarticular infections in children.

Materials and methods: This retrospective study included 36 children (age range: 7 months-12 years) with extra-spinal osteoarticular infections and MRI performed within 24 h of admission. MRI protocol included short tau inversion recovery (STIR), water-only T2 Dixon, T1, DWI, and gadolinium-enhanced T1 sequences. Two readers reviewed three sets of images: 1) unenhanced sequences, 2) unenhanced sequences with DWI and 3) unenhanced followed by contrast-enhanced sequences (reference standard). Sensitivity and specificity of sets 1 and 2 were compared to set 3 and assessed to identify osteoarticular infections: osteomyelitis (long bones, metaphyseal equivalents), septic arthritis and abscess (soft tissues, bone).

Results: All 14 cases of osteomyelitis in the metaphyses and diaphyses of long bones and all 27 cases of septic arthritis were identified by unenhanced sequences, but 4/16 abscesses were missed. For the diagnosis of abscess, DWI increased sensitivity to 100%. Among the 18 osteomyelitis in metaphyseal equivalents, 4 femoral head chondroepiphyses were identified by contrast-enhanced sequences only.

Conclusion: MRI for suspected pediatric acute osteoarticular infections is the best diagnostic modality to guide patient management. An unenhanced protocol with DWI may be an alternative to a contrast-based protocol, even in the presence of an abscess. However, gadolinium remains necessary to assess for chondroepiphyseal involvement of the femoral head.

  • Abscess
  • Children
  • Diffusion-weighted imaging
  • Magnetic resonance imaging
  • Osteoarticular infection
  • Osteomyelitis
  • Septic arthritis
  • Arthritis, Infectious / diagnostic imaging
  • Child
  • Contrast Media
  • Diffusion Magnetic Resonance Imaging / methods
  • Gadolinium
  • Humans
  • Infant
  • Magnetic Resonance Imaging / methods
  • Osteomyelitis / diagnostic imaging
  • Retrospective Studies
  • Sensitivity and Specificity
Citation (ISO format)
HABRE, Céline et al. Benefits of diffusion-weighted imaging in pediatric acute osteoarticular infections. In: Pediatric radiology, 2022, vol. 52, n° 6, p. 1086–1094. doi: 10.1007/s00247-022-05329-3
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ISSN of the journal0301-0449

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