-
RoFo : Fortschritte Auf Dem Gebiete Der... Apr 2023Hematogenous osteomyelitis has increased over the past quarter century in frequency, virulence, and degree of soft-tissue involvement, bringing about changes in clinical... (Review)
Review
BACKGROUND
Hematogenous osteomyelitis has increased over the past quarter century in frequency, virulence, and degree of soft-tissue involvement, bringing about changes in clinical manifestations and management of the disease especially in children that should be reflected in the current imaging approach. Likewise, the global disease burden of diabetes has increased greatly in the same period, compounding the problem of ascertaining osteomyelitis in diabetic foot.
METHOD
This article provides an updated overview of imaging findings in hematogenous and contiguous osteomyelitis based on the literature and our institutional experience, along with salient features of recent recommendations from expert groups on the diagnostic algorithms and reporting terminology.
RESULTS AND CONCLUSION
Findings on radiography and especially magnetic resonance imaging (MRI) closely reflect pathophysiology in osteomyelitis, whereby the characteristic involvement of the metaphysis or metaphyseal-equivalents, the formation and subperiosteal extension of intramedullary pus collection, and the development of cloaca, sequestrum, and involucrum are all diagnostic clues. Non-enhancing foci within the medullary bone, the penumbra sign, intra- or extramedullary fat globules, and surrounding soft tissue inflammation or abscesses are among key MRI findings. Diabetic foot is a special condition with characteristic pathophysiologic and imaging features that suggest the likelihood of osteomyelitis and the main differential diagnostic consideration of acute on chronic neuropathic osteoarthropathy with or without osteomyelitis.
KEY POINTS
· Imaging closely reflects pathophysiology in hematogenous osteomyelitis.. · Acute hematogenous osteomyelitis predominantly involves metaphyses and metaphyseal equivalent sites.. · MRI clues for hematogenous osteomyelitis include central marrow non-enhancement, intra- or extramedullary fat globules, and the "penumbra" sign.. · An increased fluid-sensitive MRI bone signal abutting a soft tissue ulcer, abscess, or sinus tract suggests a high probability of contact osteomyelitis..
CITATION FORMAT
· Aydingoz U, Imaging Osteomyelitis: An Update. Fortschr Röntgenstr 2023; 195: 297 - 308.
Topics: Child; Humans; Diabetic Foot; Osteomyelitis; Bone Marrow; Magnetic Resonance Imaging; Radiography
PubMed: 36724804
DOI: 10.1055/a-1949-7641 -
Frontiers in Immunology 2022Chronic recurrent and multifocal osteomyelitis (CRMO) is a nonsporadic autoinflammatory disorder. Currently, it is diagnosed based on clinical, radiologic, pathological,... (Review)
Review
Chronic recurrent and multifocal osteomyelitis (CRMO) is a nonsporadic autoinflammatory disorder. Currently, it is diagnosed based on clinical, radiologic, pathological, and longitudinal data. Numerous aspects should be highlighted due to increased knowledge in imaging and immunology. We emphasize the use of whole-body MRI, which is a non-invasive diagnostic strategy. A literature review was carried out on longitudinal studies. Commonly, the mean age at diagnosis is 11 years, ranging between 3 and 17. The most common sites are the long bone metaphysis, particularly femoral and tibial metaphysis. In addition, the pelvis, spine, clavicle, and mandible may be involved. In long bones, the radiologic appearance can show typical structure, mixed lytic and sclerotic, sclerotic or lytic. It is frequently metaphyseal or juxta-physeal, with hyperostosis or periosteal thickening. The involvement of the vertebral skeleton is often multifocal. Therefore, whole-body MRI is essential in identifying subclinical lesions. CRMO is a polymorphic disorder in which whole-body MRI is beneficial to demonstrate subclinical edema. Vertebral collapse requires long-term monitoring.
Topics: Bone and Bones; Child; Humans; Longitudinal Studies; Magnetic Resonance Imaging; Osteomyelitis
PubMed: 36072576
DOI: 10.3389/fimmu.2022.959575 -
Biomedical Engineering Online Mar 2021Osteosarcoma (OS) is the most common primary bone malignancy that affects children and young adults. OS is characterized by a high degree of malignancy, strong... (Review)
Review
Osteosarcoma (OS) is the most common primary bone malignancy that affects children and young adults. OS is characterized by a high degree of malignancy, strong invasiveness, rapid disease progression, and extremely high mortality rate; it is considered as a serious threat to the human health globally. The incidence of OS is common in the metaphysis of long tubular bones, but rare in the spine, pelvis, and sacrum areas; moreover, majority of the OS patients present with only a single lesion. OS has a bimodal distribution pattern, that is, its incidence peaks in the second decade of life and in late adulthood. We examine historical and current literature to present a succinct review of OS. In this review, we have discussed the types, clinical diagnosis, and modern and future treatment methods of OS. The purpose of this article is to inspire new ideas to develop more effective therapeutic options.
Topics: Antineoplastic Agents; Bone Neoplasms; Disease Progression; Genetic Therapy; Humans; Immunotherapy; Magnetic Resonance Imaging; Neoplasm Staging; Osteosarcoma; Radiotherapy; Tomography, X-Ray Computed
PubMed: 33653371
DOI: 10.1186/s12938-021-00860-0 -
Cell Stem Cell Dec 2021Multiple distinct types of skeletal progenitors have been shown to contribute to endochondral bone development and maintenance. However, the division of labor and...
Multiple distinct types of skeletal progenitors have been shown to contribute to endochondral bone development and maintenance. However, the division of labor and hierarchical relationship between different progenitor populations remain undetermined. Here we developed dual-recombinase fate-mapping systems to capture the skeletal progenitor transition during postnatal bone formation. We showed that postnatal osteoblasts arose primarily from chondrocytes before adolescence and from Lepr bone marrow stromal cells (BMSCs) after adolescence. This transition occurred in the diaphysis during adolescence and progressively spread to the metaphysis. The osteoblast-forming Lepr BMSCs derived primarily from fetal Col2 cells. Conditional deletion of Runx2 from perinatal chondrocytes and adult Lepr BMSCs impaired bone lengthening and thickening, respectively. Forced running increased osteoblast formation by perinatal chondrocytes but not by adult Lepr BMSCs. Thus, the short-term developmental skeletal progenitors generated the long-term adult skeletal progenitors. They sequentially control the growth and maintenance of endochondral bones.
Topics: Bone Development; Chondrocytes; Mesenchymal Stem Cells; Osteoblasts; Osteogenesis
PubMed: 34499868
DOI: 10.1016/j.stem.2021.08.010 -
Nature Communications Mar 2021Synthetic glucocorticoids (GCs), one of the most effective treatments for chronic inflammatory and autoimmune conditions in children, have adverse effects on the growing...
Synthetic glucocorticoids (GCs), one of the most effective treatments for chronic inflammatory and autoimmune conditions in children, have adverse effects on the growing skeleton. GCs inhibit angiogenesis in growing bone, but the underlying mechanisms remain unclear. Here, we show that GC treatment in young mice induces vascular endothelial cell senescence in metaphysis of long bone, and that inhibition of endothelial cell senescence improves GC-impaired bone angiogenesis with coupled osteogenesis. We identify angiogenin (ANG), a ribonuclease with pro-angiogenic activity, secreted by osteoclasts as a key factor for protecting the neighboring vascular cells against senescence. ANG maintains the proliferative activity of endothelial cells through plexin-B2 (PLXNB2)-mediated transcription of ribosomal RNA (rRNA). GC treatment inhibits ANG production by suppressing osteoclast formation in metaphysis, resulting in impaired endothelial cell rRNA transcription and subsequent cellular senescence. These findings reveal the role of metaphyseal blood vessel senescence in mediating the action of GCs on growing skeleton and establish the ANG/PLXNB2 axis as a molecular basis for the osteoclast-vascular interplay in skeletal angiogenesis.
Topics: Animals; Apoptosis; Bone Development; Cell Proliferation; Cellular Senescence; Endothelial Cells; Glucocorticoids; Human Umbilical Vein Endothelial Cells; Humans; Immunohistochemistry; In Situ Hybridization, Fluorescence; Methylprednisolone; Mice; Mice, Inbred BALB C; Mice, Inbred C57BL; Neovascularization, Pathologic; Neovascularization, Physiologic; Nerve Tissue Proteins; Osteoclasts; Osteogenesis; RNA, Ribosomal; RNA, Small Interfering; Recombinant Proteins; Ribonuclease, Pancreatic; Signal Transduction; Tomography Scanners, X-Ray Computed
PubMed: 33758201
DOI: 10.1038/s41467-021-22131-1