The bone scintigraphy in the diagnosis and management in children with febrile osteoarticular pain

##plugins.themes.academic_pro.article.sidebar##

Published Nov 14, 2017
Download
pdf
Vol. 95 No. 2 (2017): Issue Feb 2017

##plugins.themes.academic_pro.article.main##

Imene Yeddes
Imen Meddeb
Sami Bouchoucha
Ihsen Slim
Houda Zgolli
Aida Mhiri
Med Faouzi Ben Slimene

Abstract

Background: Bone and joint infections are common diseases in pediatrics. They still are a public health problem in Tunisia. The diagnosis is based on clinical, biological, radiological and skeletal scintigraphy arguments. The purpose of this study is to determine the contribution of triple phase bone scan in the exploration of musculoskeletal pain febrile child. Methods: This was a descriptive and retrospective study. It was conducted over a period of 5 years. It has interested all children explored in nuclear medicine department with suspected acute osteomyelitis (OMA) , osteoarthritis (OA) or septic arthritis (SA) referred from Orthopaedic Infantile service. All these patients had, alongside the conventional radiologic exams, a triple phase bone scan HMDP-Tc99m. Results: We collected 62 patients. Among the selected diagnoses, there were: 22 OMA, 4 OA, 4 SA. The mean age of the patients was 5.58 years with a male predominance. The main reason for consultation was pain. Fever was ≥ 38° C in 80 % of cases. The preferential localization was the lower limb (93.5 %). The quantitative and qualitative bone scan abnormalities objectified led to a correct diagnosis of: 18 OMA, 3 OA and 2 SA with a respectively estimated sensitivity and specificity of 76.6% and 90.6% in the all population. Conclusions: Bone scan demonstrates early abnormalities allowing osteoaricular infection diagnosis. It highlights the infection site, and draws a map of the lesions. Currently, imaging modalities differ in their availability, their cost, their input and diagnostic accuracy but they are complementary.

Keywords:

Osteomyelitis, osteoarthritis, children, scintigraphy

##plugins.themes.academic_pro.article.details##

References

  1. Timsit S, Pannier S, Glorion C, Chéron G. Infections bactériennes ostéoarticulaires du nourrisson et de l'enfant : expérience sur un an. Arch Pediatr 2005;12:16-22.
  2. Grimprel E, Cohen R. Epidémiologie et physiopathologie des infections ostéoarticulaires chez l'enfant (nouveau-né exclu). Arch Pediatr 2007;14:S81-S5.
  3. Kaabachi O,Nessib MN, Kechrid A, Jelel C, Ben Gachem M. Profil bactériologique de l'infection ostéoarticulaire du nourrisson : l'expérience de l'hôpital d'enfants de Tunis. Med Mal Infect 2001;31:569- 70.
  4. Cadilhac C, Clavier F, Pannier S, Glorion C, Chéron G. Infections ostéoarticulaires chez l'enfant. Encycl Med Chir (Elsevier Masson SAS, Paris), Médecine d'urgence, 2007:1-10.
  5. Trifa M, Bouchoucha S, Smaoui H, M. Frikha, S. Ben Marzouk, M. Ben Ghachem, et al. Microbiological profile of haematogenous osteoarticular infections in children. Orthop Traumatol: Surg Res 2011;97:186-90.
  6. Garcia-Arias M, Balsa A, Martin Mola E. Septic arthritis. Best Pract Res Clin Rheumatol 2011;25:407-21.
  7. Vial J, Chiavassa-Gandois H. Limb infections in children and adults. Diagn Interv Imaging 2012;93:530-46.
  8. Bonhoeffer J, Haeberle B, Schaad B, Heininger U. Diagnosis of acute haematogenous osteomyelitis and septic arthritis: 20 years experience at the University Children's Hospital Basel. Swiss Med Wkly 2001;131:575-81.
  9. Jaramillo D, Treves ST, Kasser JR, Harper M
  10. W, Sundel R, Laor T. Osteomyelitis and Septic Arthritis in Children: Appropriate Use of Imaging to Guide Treatment. Am JR Roentgenol 1995;165:399-403.
  11. Connolly LP, Connolly SA, Drubach LA, Jaramillo D, Treves ST. Acute Hematogenous Osteomyelitis of Children: Assessment of Skeletal Scintigraphy-Based Diagnosis in the Era of MRI. J Nucl Med 2002;43(10):1310-6.
  12. Ben Ghachem M. Quoi de neuf dans les infections ostéoarticulaires hématogènes aigues de l'enfant ?. In: Conférences d'enseignements. Paris: Elsevier Masson SAS; 2008;219-38.
  13. Gras G, Druon J, Floch S, Bernard L. Infection ostéoarticulaire. Encycl Med Chir (Traité de medecine) AKOS. Paris: Elsevier Masson SAS;2014;1-11
  14. Lorrot M, Fitoussi E, Faye A, Mariani P, Job-Deslandre C, Penneçot G-F, et al. Marqueurs de l'inflammation et infection ostéoarticulaire. Arch Pediatr 2007;14:S86-90.
  15. Chihara S, Segreti J. Osteomyelitis. Dis Mon 2010;56:6-31.
  16. Dutronc H, Bocquentin F, Dupont M. Apport de l'imagerie au diagnostic de l'infection ostéoarticulaire. Med Maladies Infectieuses 2004;34:257-63.
  17. Azoulay R, Alison M, Sekkal A, Sebag G, Adamsbaum C. Imagerie des infections ostéoarticulaires de l'enfant. Arch Pediatr 2007;14:113-21
  18. Marin C, Sanchez-Alegre M, Gallego C, Ruiz Y, Collado E. Magnetic Resonance Imaging of osteoarticular infections in Children. Curr Probl Diagn Radiol 2004;33:43-59.
  19. Vittorini E, Del Guidice E, Pizzoli A, Caudana R. MRI versus scintigraphy with 99mTc-HMPAO-labbeled granulocytes in the diagnosis of bone infection. Radiol Med 2005;109:395-403.
  20. Bhat V, Gupta H. The radiological diagnosis of infection. Orthopaedics and Trauma 2014;28(6):409-16.
  21. Chrestian P,Vaylet C, Puech B, Nicaud M, Maximin M-C. L'apport de la scintigraphie dans la pathologie de l'appareil locomoteur de l'enfant et de l'adolescent. Regards croisés du clinicien et du scintigraphiste. Med Nucl 2012;36:128-39.
  22. Alison M, Tanase A, Rega A, Gabor F, Tilea B, Sebag G. Imagerie des infections ostéo-articulaires de l'enfant. Arch Pediatr 2014;21:174-5.
  23. Rouy JC, Tafani M, Guillet J. Médecine nucléaire et pédiatrie : point de vue radiopharmaceutique. Med Nucl 2012;36:124-7
  24. Paycha F, Girma A, Granier P, Barré E, Koulibaly PM, Bruna-Muraille C. Guide pour la rédaction de protocole pour la scintigraphie osseuse. Med Nucl 2012;36:687-97
  25. Brenner AI, Koshy J, Morey J, Lin C, Dipoce J. The Bone Scan. Semin Nucl Med 2012;42:11-26
  26. Love C, Din AS, Tomas MB, Kalapparambath TP, Palestro CJ. Radionuclide bone imaging: an illustrative review. Radiographics 2003;23:341-58.
  27. Maurer AH, Chen DCP, Camargo EE, Wong DF, Wagner HN, Alderson PO. Utility of Three-Phase Skeletal Scintigraphy in Suspected Osteomyelitis: Concise Communication. J Nucl Med 1981;22:941-9.
  28. Goldsmith SJ, Vallabhajosula S. Clinically Proven Radiopharmaceuticals for Infection Imaging: Mechanisms and Applications. Semin Nucl Med 2009;39:2-10.
  29. El Maghrabi TA, Moustafa HM, Pauwels MK. Nuclear medicine methods for evaluation of skeletal infection among other diagnostic modalities .Q J Nucl Med Mol Imaging 2006;50(3):167-92.
  30. Paycha F, Girma A, Granier P. Démarche sémiologique en TEMP/TDM osseuse. Une approche diagnostique intégrée de l'imagerie hybride. Med Nucl 2010;34:490-511.
  31. Rezungles F, Delavigne K, Charlat I. TEMP/TDM : les preuves de l'efficacité pour les pathologies inflammatoires et infectieuses profondes ; localisation des foyers ectopiques. Med Nucl 2007;31:206-13.