Utility of magnetic resonance imaging in the follow-up of children affected by acute osteomyelitis

Acute osteomyelitis is characterized, especially in children, by high morbidity due to extension of the infectious process or its chronicization. No guidelines exist for the post-discharge follow-up of children affected by acute osteomyelitis, especially regarding the utility of magnetic resonance imaging (MRI). To investigate if MRI is useful in the follow-up of AO pediatric patients. We reviewed medical records and MRI studies of children admitted to our Pediatric Department for acute osteomyelitis from 2008 to 2015. All children who had a follow-up MRI performed at least 10 days after diagnosis were included in the study. We analyzed if MRI follow-up prompted a change in patients’ treatment. A total of 28 MRI studies were performed in 27 children (13 males and 14 females). Infection involved the appendicular skeleton in 64.3% of patients. Five (18%) of these studies prompted a change in patients’ treatment. The only statistically significant indication for change in the therapeutic approach was MRI performed for persistence or worsening of the disease (p=0.0058). Change in bone signal at MRI, and time interval (more or less than 28 days) between MRI at diagnosis and at follow-up were not significantly associated with change in the patients’ treatment (p=0.40; p=0.40, respectively). Routine MRI follow-up is not useful in children affected by acute osteomyelitis who adequately respond to antibiotic treatment. It can be useful, in adjunct to clinical evaluation, in non-responders patients. Clinical monitoring remains the mainstay in the follow-up of these patients.