Chronic recurrent multifocal osteomyelitis: a radiological and clinical investigation of five cases
To make a detailed evaluation of the clinical and radiological course of five children with chronic recurrent multifocal osteomyelitis (CRMO). Emphasis was laid on the correlation between clinical data and radiological findings. Clinical data, histology (n = 11), bone scintigraphy (n = 17), and the plain radiographs (n = 198) of these patients were reviewed. The mean time of observation was 6.6 years (range 1-14.5 years). Thirty-two lesions seen at the time of primary diagnosis (n = 22) or during the course of the disease (n = 10) were evaluated. Twenty-seven foci were located in bone; in five cases the sacroiliac joints were involved. Bone scintigrams showed nearly all foci (31/32) and were especially helpful in clinically asymptomatic lesions (14/32) or foci which were radiographically difficult to detect or not seen at all (8/32). Only 14 of 32 foci were locally symptomatic clinically. In all cases with a short interval (< or = 3 weeks) between the onset of local symptoms and evaluation by plain radiographs (n = 5) osteolysis was shown without a sclerotic margin. All bone lesions with a longer duration of local symptoms (n = 7) revealed a variable radiographic pattern: osteolysis with sclerotic rim in three, a mixed lytic-sclerotic lesion in three and pure sclerosis in one. In two cases low back pain could be ascribed to sacroiliitis. Only careful correlation between clinical, scintigraphy and radiographic features permits an accurate assessment of disease activity in CRMO. The bone lesions detected radiographically soon after the onset of symptoms resemble those of acute osteomyelitis.