title: Whole-body Magnetic Resonance Imaging in Chronic Recurrent Multifocal Osteomyelitis: Clinical Longterm Assessment May Underestimate Activity.
abstract: OBJECTIVE
  (1) To examine how many patients have clinically and/or radiologically active chronic recurrent multifocal osteomyelitis (CRMO) ≥ 10 years after first onset of symptoms, and (2) to compare clinical and whole-body magnetic resonance imaging (WB-MRI) findings.
  
  
  METHODS
  Seventeen patients (82% women) who were diagnosed with childhood-onset CRMO at least 10 years (average 12) before reexamination were reevaluated. Patients completed a standardized questionnaire, and underwent clinical and laboratory investigation and WB-MRI. Clinical features were compared with imaging findings.
  
  
  RESULTS
  Five patients were found to be in clinical and radiological remission. One of these patients demonstrated 1 radiologically inactive lesion on WB-MRI. Four patients showed radiologically active lesions despite full clinical remission, 2 of them in 3 vertebral bodies. Spinal involvement in 6 patients (35%) caused vertebral compression fractures, vertebra plana, or vertebral hemifusion. Eight patients presented with ongoing clinical disease activity. When applying a CRMO activity score based on clinical and imaging findings, 2 patients were identified as having pain amplification. Overall, 22/55 known CRMO lesions were identified; 11 of them were radiologically active lesions. Additionally, 14 so far unknown clinically silent lesions were detected: 8 radiologically active lesions and 6 radiologically inactive lesions.
  
  
  CONCLUSIONS
  CRMO activity on longterm followup might have been underestimated. Our study demonstrates that clinical remission does not necessarily mean radiological remission. We therefore propose that all patients with CRMO, including patients in clinical remission, require longterm clinical followup and should undergo evaluation with WB-MRI on a regular basis until radiological remission or a steady state of disease is achieved.
authors.affiliation: From the Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; Institute for Clinical Radiology, Ludwig Maximilians University of Munich, Munich; Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; and the Department of Radiology, Royal Orthopaedic Hospital, Birmingham, UK.A.M. Voit*, MD, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; A.P. Arnoldi*, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich; H. Douis, MD, Department of Radiology, Royal Orthopaedic Hospital; F. Bleisteiner, MD; M.K. Jansson, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; M.F. Reiser, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich; S. Weckbach*, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich, and Diagnostic and Interventional Radiology, University Hospital Heidelberg; A.F. Jansson*, MD, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University.
authors.forename: Agnes M
authors.initials: AM
authors.lastname: Voit
authors.affiliation: From the Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; Institute for Clinical Radiology, Ludwig Maximilians University of Munich, Munich; Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; and the Department of Radiology, Royal Orthopaedic Hospital, Birmingham, UK.A.M. Voit*, MD, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; A.P. Arnoldi*, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich; H. Douis, MD, Department of Radiology, Royal Orthopaedic Hospital; F. Bleisteiner, MD; M.K. Jansson, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; M.F. Reiser, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich; S. Weckbach*, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich, and Diagnostic and Interventional Radiology, University Hospital Heidelberg; A.F. Jansson*, MD, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University.
authors.forename: Andreas P
authors.initials: AP
authors.lastname: Arnoldi
authors.affiliation: From the Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; Institute for Clinical Radiology, Ludwig Maximilians University of Munich, Munich; Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; and the Department of Radiology, Royal Orthopaedic Hospital, Birmingham, UK.A.M. Voit*, MD, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; A.P. Arnoldi*, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich; H. Douis, MD, Department of Radiology, Royal Orthopaedic Hospital; F. Bleisteiner, MD; M.K. Jansson, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; M.F. Reiser, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich; S. Weckbach*, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich, and Diagnostic and Interventional Radiology, University Hospital Heidelberg; A.F. Jansson*, MD, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University.
authors.forename: Hassan
authors.initials: H
authors.lastname: Douis
authors.affiliation: From the Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; Institute for Clinical Radiology, Ludwig Maximilians University of Munich, Munich; Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; and the Department of Radiology, Royal Orthopaedic Hospital, Birmingham, UK.A.M. Voit*, MD, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; A.P. Arnoldi*, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich; H. Douis, MD, Department of Radiology, Royal Orthopaedic Hospital; F. Bleisteiner, MD; M.K. Jansson, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; M.F. Reiser, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich; S. Weckbach*, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich, and Diagnostic and Interventional Radiology, University Hospital Heidelberg; A.F. Jansson*, MD, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University.
authors.forename: Felicitas
authors.initials: F
authors.lastname: Bleisteiner
authors.affiliation: From the Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; Institute for Clinical Radiology, Ludwig Maximilians University of Munich, Munich; Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; and the Department of Radiology, Royal Orthopaedic Hospital, Birmingham, UK.A.M. Voit*, MD, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; A.P. Arnoldi*, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich; H. Douis, MD, Department of Radiology, Royal Orthopaedic Hospital; F. Bleisteiner, MD; M.K. Jansson, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; M.F. Reiser, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich; S. Weckbach*, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich, and Diagnostic and Interventional Radiology, University Hospital Heidelberg; A.F. Jansson*, MD, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University.
authors.forename: Moritz K
authors.initials: MK
authors.lastname: Jansson
authors.affiliation: From the Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; Institute for Clinical Radiology, Ludwig Maximilians University of Munich, Munich; Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; and the Department of Radiology, Royal Orthopaedic Hospital, Birmingham, UK.A.M. Voit*, MD, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; A.P. Arnoldi*, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich; H. Douis, MD, Department of Radiology, Royal Orthopaedic Hospital; F. Bleisteiner, MD; M.K. Jansson, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; M.F. Reiser, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich; S. Weckbach*, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich, and Diagnostic and Interventional Radiology, University Hospital Heidelberg; A.F. Jansson*, MD, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University.
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Reiser
authors.affiliation: From the Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; Institute for Clinical Radiology, Ludwig Maximilians University of Munich, Munich; Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; and the Department of Radiology, Royal Orthopaedic Hospital, Birmingham, UK.A.M. Voit*, MD, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; A.P. Arnoldi*, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich; H. Douis, MD, Department of Radiology, Royal Orthopaedic Hospital; F. Bleisteiner, MD; M.K. Jansson, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; M.F. Reiser, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich; S. Weckbach*, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich, and Diagnostic and Interventional Radiology, University Hospital Heidelberg; A.F. Jansson*, MD, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University. sabine.weckbach@med.uni-heidelberg.de.
authors.forename: Sabine
authors.initials: S
authors.lastname: Weckbach
authors.affiliation: From the Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; Institute for Clinical Radiology, Ludwig Maximilians University of Munich, Munich; Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; and the Department of Radiology, Royal Orthopaedic Hospital, Birmingham, UK.A.M. Voit*, MD, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; A.P. Arnoldi*, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich; H. Douis, MD, Department of Radiology, Royal Orthopaedic Hospital; F. Bleisteiner, MD; M.K. Jansson, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; M.F. Reiser, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich; S. Weckbach*, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich, and Diagnostic and Interventional Radiology, University Hospital Heidelberg; A.F. Jansson*, MD, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University.
authors.forename: Annette F
authors.initials: AF
authors.lastname: Jansson
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010019:Osteomyelitis / Q000175:diagnosis*; D012008:Recurrence; D012720:Severity of Illness Index; D051598:Whole Body Imaging; D055815:Young Adult
keywords: DISEASE ACTIVITY SCORE; OSTEOMYELITIS; REMISSION