MRI-guided percutaneous core needle biopsy of lesions only visible on MR images is safe and provides a high diagnostic yield for the diagnosis of chronic recurrent multifocal osteomyelitis (CRMO) in children, according to a paper presented at the 2009 annual meeting of the Radiological Society of North America in Chicago earlier this month.
According to Jan Fritz, MD, from Johns Hopkins School of Medicine in Baltimore, and colleagues, while bone biopsy is used to support the diagnosis of CRMO and rule out malignancy, obtaining material for diagnosis by use of fluoroscopy or CT guidance can be difficult for lesions only visible on MRI. Consquently, the authors wanted to study the utility of using percutaneous MRI guided core-needle biopsy of osseous CRMO lesions in children.
The authors conducted a retrospective analysis of MRI-guided core-needle biopsy performed on 10 children (five boys and five girls ranging in age from 11 to 14 years) who had a high clinical suspicion of CRMO. MRI-guided procedures were performed using a 0.2 Tesla open MR system (Magnetom Open/Concerto, Siemens Healthcare) or a 1.5T MR system (Magnetom Espree, Siemens).
Core biopsy was obtained by using an MRI-compatible 18 G manual or automatic drill system and conscious sedation or intubation anesthesia was used on the patients. The procedure lasted anywhere from a low of 64 minutes to a high of 107 minutes.
According to the authors, the procedure was successful in all cases and specimens obtained were sufficient for a histopathological diagnosis. Chronic non-specific inflammation consisting of lymphocytes, plasma cells and histiocytes characteristic of CRMO was found in eight of the 10 cases and edema with no inflammatory cells in the other two cases.
Malignancy was excluded in all 10 cases, and confirmed by a mean follow-up of 44 months.
The authors concluded that not only was the procedure safe for children but yielded high technical and diagnostic accuracy for the diagnosis of CRMO in lesions not visible on radiography and CT.