Optimal imaging strategy for community-acquired Staphylococcus aureus musculoskeletal infections in children.
BACKGROUND
Invasive musculoskeletal infections from community-acquired methicillin-resistant and methicillin-susceptible Staphylococcus aureus (CA-SA) are increasingly encountered in children. Imaging is frequently requested in these children for diagnosis and planning of therapeutic interventions.


OBJECTIVE
To appraise the diagnostic efficacy of imaging practices performed for CA-SA osteomyelitis and its complications.


METHODS
A retrospective review was conducted of the clinical charts and imaging studies of CA-SA osteomyelitis cases since 2001 at a large children's hospital.


RESULTS
Of 199 children diagnosed with CA-SA osteomyelitis, 160 underwent MRI examination and 35 underwent bone scintigraphy. The sensitivity of MRI and bone scintigraphy for CA-SA osteomyelitis was 98% and 53%, respectively. In all discordant cases, MRI was correct compared to bone scintigraphy. Extraosseous complications of CA-SA osteomyelitis detected only by MRI included subperiosteal abscesses (n = 77), pyomyositis (n = 43), septic arthritis (n = 31), and deep venous thrombosis (n = 12).


CONCLUSIONS
MRI is the preferred imaging modality for the investigation of pediatric CA-SA musculoskeletal infection because it offers superior sensitivity for osteomyelitis compared to bone scintigraphy and detects extraosseous complications that occur in a substantial proportion of patients.
Edward B Singleton Department of Diagnostic Imaging, Texas Children's Hospital, Houston, TX 77030, USA. lxbrowne@texaschildrenshospital.org
Lorna P
LP
Browne
Edward O
EO
Mason
Sheldon L
SL
Kaplan
Christopher I
CI
Cassady
Rajesh
R
Krishnamurthy
R Paul
RP
Guillerman
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000175:diagnosis; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D010019:Osteomyelitis / Q000175:diagnosis*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013203:Staphylococcal Infections / Q000175:diagnosis*; D013669:Technetium Tc 99m Medronate; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
D019275:Radiopharmaceuticals; D013669:Technetium Tc 99m Medronate