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Xu Y, Wang G, Wang Y, Wang W, Kan Y, Yang J. Diagnostic Role of FDG PET/CT in Pediatric Patients With Chronic Recurrent Multifocal Osteomyelitis. Clin Nucl Med 2024; 49:536-539. [PMID: 38598512 DOI: 10.1097/rlu.0000000000005216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
PURPOSE Chronic recurrent multifocal osteomyelitis (CRMO), or chronic nonbacterial osteomyelitis, is difficult to diagnose. The accurate diagnosis of CRMO relies on comprehensive imaging examinations because of its multifocal nature. In this regard, 18 F-FDG PET/CT has demonstrated significant utility in inflammatory diseases. This study tries to determine the value of FDG PET/CT in the evaluation of CRMO. PATIENTS AND METHODS We retrospectively collected imaging data from pediatric CRMO patients who underwent FDG PET/CT scans. Lesions exhibiting abnormal metabolism with/without structural abnormalities on FDG PET/CT were identified as CRMO lesions, and their location and SUV max were recorded. RESULTS A total of 21 pediatric patients with CRMO were included in this study. The median age at diagnosis was 9.4 years. Total 131 foci of abnormal activity were identified using FDG PET/CT imaging. The distribution pattern showed a higher prevalence of lower limbs and pelvis involvement. Among all identified lesions, abnormalities were detected on both PET and CT images of 93 lesions, whereas exclusively positive findings on 18 F-FDG PET alone were observed for 38 of them. CONCLUSIONS Our study findings suggest a higher prevalence of lesions in the bones of the lower limbs and pelvis among children with CRMO. Compared with CT scans, FDG PET exhibits superior sensitivity in detecting these lesions.
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Affiliation(s)
- Yanfeng Xu
- From the Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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2
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Jin J, Yu H. Treatment of Chronic Nonbacterial Osteomyelitis with Bisphosphonates. Indian J Pediatr 2024; 91:510-511. [PMID: 37428311 DOI: 10.1007/s12098-023-04688-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/16/2023] [Indexed: 07/11/2023]
Affiliation(s)
- Jing Jin
- Department of Rheumatology and Immunology, Children's Hospital of Nanjing Medical University, Jiangsu, China
| | - Haiguo Yu
- Department of Rheumatology and Immunology, Children's Hospital of Nanjing Medical University, Jiangsu, China.
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3
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Saffarzadeh M, Haydar S, Chan D, Andrews G, Ouellette H, Mallinson P, Munk PL, Sheikh A. A clinico-radiological review of chronic non-bacterial osteomyelitis in paediatrics, adolescents, and adults: demystifying a forgotten differential. Clin Radiol 2024; 79:170-178. [PMID: 38160105 DOI: 10.1016/j.crad.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 12/05/2023] [Indexed: 01/03/2024]
Abstract
Chronic non-bacterial osteomyelitis (CNO), also known as non-bacterial osteitis, is a chronic autoinflammatory disease of unknown aetiology that primarily occurs in the paediatric population, although rare cases of adult-onset disease also exist. CNO has non-specific clinical and radiological presentations, and the affected population often present with bone pain of insidious onset secondary to sterile bony inflammation that can be associated with swelling, focal tenderness, and warmth at the affected sites. The pattern of bony involvement appears to be dependent on the age of onset, with adults frequently having axial skeletal lesions and children and adolescents often being affected in the appendicular skeletal sites. CNO is a diagnosis of exclusion, and imaging is heavily relied on to identify and characterise the bony lesions in addition to exclude diseases that can mimic CNO. Magnetic resonance imaging is often the reference standard with biochemical and histopathological findings being complementary. Although combining imaging methods can be used to facilitate the diagnosis, a single technique could be adequate depending on the clinical picture. Given the relatively rare incidence of CNO, limited awareness of the disease among care providers, and its similarity in clinical and radiological presentation to various bony diseases, there are often long delays in diagnosis, with adults being unfavourably affected compared to paediatrics and adolescents. This review of CNO will describe the condition, overview its clinical presentation, highlight the radiological features, and emphasise clinical pearls that can aid in diagnosis and ruling out the mimics.
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Affiliation(s)
- M Saffarzadeh
- Faculty of Medicine, The University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada.
| | - S Haydar
- Department of Radiology, Vancouver General Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - D Chan
- Department of Radiology, Vancouver General Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - G Andrews
- Faculty of Medicine, The University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Department of Radiology, Vancouver General Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - H Ouellette
- Faculty of Medicine, The University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Department of Radiology, Vancouver General Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - P Mallinson
- Faculty of Medicine, The University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Department of Radiology, Vancouver General Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - P L Munk
- Faculty of Medicine, The University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Department of Radiology, Vancouver General Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - A Sheikh
- Faculty of Medicine, The University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Department of Radiology, Vancouver General Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
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Huang S, Wen J, Zhang Y, Bai X, Cui ZK. Choosing the right animal model for osteomyelitis research: Considerations and challenges. J Orthop Translat 2023; 43:47-65. [PMID: 38094261 PMCID: PMC10716383 DOI: 10.1016/j.jot.2023.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 03/22/2024] Open
Abstract
Osteomyelitis is a debilitating bone disorder characterized by an inflammatory process involving the bone marrow, bone cortex, periosteum, and surrounding soft tissue, which can ultimately result in bone destruction. The etiology of osteomyelitis can be infectious, caused by various microorganisms, or noninfectious, such as chronic nonbacterial osteomyelitis (CNO) and chronic recurrent multifocal osteomyelitis (CRMO). Researchers have turned to animal models to study the pathophysiology of osteomyelitis. However, selecting an appropriate animal model that accurately recapitulates the human pathology of osteomyelitis while controlling for multiple variables that influence different clinical presentations remains a significant challenge. In this review, we present an overview of various animal models used in osteomyelitis research, including rodent, rabbit, avian/chicken, porcine, minipig, canine, sheep, and goat models. We discuss the characteristics of each animal model and the corresponding clinical scenarios that can provide a basic rationale for experimental selection. This review highlights the importance of selecting an appropriate animal model for osteomyelitis research to improve the accuracy of the results and facilitate the development of novel treatment and management strategies.
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Affiliation(s)
| | | | - Yiqing Zhang
- Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Xiaochun Bai
- Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Zhong-Kai Cui
- Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
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Ramachandran S, Zhao Y, Ferguson PJ. Update on treatment responses and outcome measure development in chronic nonbacterial osteomyelitis (CNO). Curr Opin Rheumatol 2023:00002281-990000000-00062. [PMID: 37433220 DOI: 10.1097/bor.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
PURPOSE OF REVIEW To review recent trends in treatment and recent progress in developing outcome measures needed for chronic nonbacterial osteomyelitis (CNO) clinical trials. RECENT FINDINGS CNO is an autoinflammatory bone disease. In a minority of patients, the disease is genetically driven, and diagnosis can be made by DNA sequencing. However, for nonsyndromic CNO there is no diagnostic test. The number of children with CNO appears to be increasing and damage is common. Increases in CNO diagnosis is due to raised awareness, increased availability of whole-body magnetic resonance imaging and rising incidence. Treatment remains empiric and it is unclear which second line treatment is superior. Tumor necrosis factor inhibitors (TNFi) and bisphosphonates continue to be used as second line agents for nonsteroidal anti-inflammatory drugs (NSAID) refractory CNO; newer immune modulatory medications are used if this fails. Validated classification criteria, clinical outcome measures and imaging scoring standards are needed for successful clinical trials. SUMMARY Best treatment for NSAID refractory CNO remains unclear. Classification criteria, clinical outcomes measures and standardized imaging scoring have been developed or are near completion. This will facilitate robust clinical trials in CNO with the goal of having approved medications for this painful disease.
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Affiliation(s)
- Shwetha Ramachandran
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Yongdong Zhao
- Department of Pediatrics, Seattle Children's Hospital. Seattle, Washington, USA
| | - Polly J Ferguson
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Fu Z, Wang X, Zou L, Zhang Z, Lu M, Zong J, Wang S. Transcriptome analysis based on machine learning reveals a role for autoinflammatory genes of chronic nonbacterial osteomyelitis (CNO). Sci Rep 2023; 13:6514. [PMID: 37085667 PMCID: PMC10121556 DOI: 10.1038/s41598-023-33759-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 04/18/2023] [Indexed: 04/23/2023] Open
Abstract
Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disorder. The origin and development of CNO involve many complex immune processes, resulting in delayed diagnosis and a lack of effective treatment. Although bioinformatics analysis has been utilized to seek key genes and pathways in CNO, only a few bioinformatics studies that focus on CNO pathogenesis and mechanisms have been reported. This study aimed to identify key biomarkers that could serve as early diagnostic or therapeutic markers for CNO. Two RNA-seq datasets (GSE133378 and GSE187429) were obtained from the Gene Expression Omnibus (GEO). Weighted gene coexpression network analysis (WGCNA) and differentially expressed gene (DEG) analysis were conducted to identify the genes associated with CNO. Then, the autoinflammatory genes most associated with CNO were identified based on the GeneCards database and a CNO prediction model, which was created by the LASSO machine learning algorithm. The accuracy of the model and effects of the autoinflammatory genes according to receiver operating characteristic (ROC) curves were verified in external datasets (GSE7014). Finally, we performed clustering analysis with ConsensusClusterPlus. In total, eighty CNO-related genes were identified and were significantly enriched in the biological processes regulation of actin filament organization, cell-cell junction organization and gamma-catenin binding. The main enriched pathways were adherens junctions, viral carcinogenesis and systemic lupus erythematosus. Two autoinflammatory genes with high expression in CNO samples were identified by combining an optimal machine learning algorithm (LASSO) with the GeneCards database. An external validation dataset (GSE187429) was utilized for ROC analysis of the prediction model and two genes, and the results indicated good efficiency. Then, based on consensus clustering analysis, we found that the expression of UTS2 and MPO differed between clusters. Finally, the ceRNA network of lncRNAs and the small molecule compounds targeting the two autoinflammatory genes were predicted. The identification of two autoinflammatory genes, the HCG18/has-mir-147a/UTS2/MPO axis and signalling pathways in this study can help us understand the molecular mechanism of CNO formation and provides candidate targets for the diagnosis and treatment of CNO.
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Affiliation(s)
- Zhuodong Fu
- Department of Orthopedic Surgery, the First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China
| | - Xingkai Wang
- Department of Orthopedic Surgery, the First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China
| | - Linxuan Zou
- Department of Orthopedic Surgery, the First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China
| | - Zhe Zhang
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, Liaoning, China
| | - Ming Lu
- Trauma and Tissue Repair Surgery Department, Dalian Municipal Central Hospital, Dalian, China.
| | - Junwei Zong
- Department of Orthopedic Surgery, the First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China.
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, Liaoning, China.
| | - Shouyu Wang
- Department of Orthopedic Surgery, the First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China.
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, Liaoning, China.
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ULU K, İŞGÜDER R, Gül KARADAĞ Ş, BAĞLAN E, KAVRUL KAYAALP G, OTAR YENER G, ÖZTÜRK K, SÖNMEZ HE, ÖZDEL S, DEMİR F, MAKAY B, ÜNSAL ŞE, SÖZERİ B, AKTAY AYAZ N, ÇAKAN M. Clinical characteristics and predictors for recurrence in chronic nonbacterial osteomyelitis: a retrospective multicenter analysis. Turk J Med Sci 2023; 53:1105-1111. [PMID: 38813038 PMCID: PMC10763774 DOI: 10.55730/1300-0144.5675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 10/26/2023] [Accepted: 02/28/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim Chronic nonbacterial osteomyelitis (CNO) is a rare disease of unknown etiology and most commonly occurs during childhood or adolescence. The purpose of this study is to collect data on the clinical features, outcomes, and management of the disease and to identify the factors affecting recurrence. Materials and methods This is a retrospective multicenter cross-sectional study of pediatric patients diagnosed with CNO. A total of 87 patients with a diagnosis of CNO followed for at least 6 months in 8 pediatric rheumatology centers across the country between January 2010 and December 2021 were included in this study. Results The study included 87 patients (38 girls, 49 boys; median age: 12.5 years). The median follow-up time was 20 months (IQR: 8.5-40). The median time of diagnostic delay was 9.9 months (IQR: 3-24). Arthralgia and bone pain were the most common presenting symptoms. Multifocal involvement was detected in 86.2% of the cases and a recurrent course was reported in one-third of those included in the study. The most commonly involved bones were the femur and tibia. Vertebrae and clavicles were affected in 19.5% and 20.6% of cases, respectively. The erythrocyte sedimentation rate (ESR) values of 60.9% of the patients were above 20 mm/h and the C-reactive protein values of 44.8% were above 5 mg/L. The remission rate was 13.3% in patients using nonsteroidal antiinflammatory drugs and 75.0% in those using biological drugs. Vertebral and mandibular involvement and high ESR values at the time of diagnosis were associated with recurrence. Conclusion In this multicenter study, CNO with vertebral and mandibular involvement and high ESR at diagnosis were associated with recurrence.
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Affiliation(s)
- Kadir ULU
- Department of Pediatric Rheumatology, Ümraniye Training and Research Hospital, University of Health Sciences, İstanbul,
Turkiye
| | - Rana İŞGÜDER
- Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, İzmir,
Turkiye
| | - Şerife Gül KARADAĞ
- Department of Pediatric Rheumatology, Faculty of Medicine, İstanbul University, İstanbul,
Turkiye
| | - Esra BAĞLAN
- Department of Pediatric Rheumatology, Dr. Sami Ulus Maternity and Child Health and Diseases Research and Training Hospital, University of Health Sciences, Ankara,
Turkiye
| | - Gülşah KAVRUL KAYAALP
- Department of Pediatric Rheumatology, Faculty of Medicine, İstanbul University, İstanbul,
Turkiye
| | - Gülçin OTAR YENER
- Department of Pediatric Rheumatology, Medical Point Hospital, Gaziantep,
Turkiye
| | - Kübra ÖZTÜRK
- Department of Pediatric Rheumatology, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, İstanbul Medeniyet University, İstanbul,
Turkiye
| | - Hafize Emine SÖNMEZ
- Department of Pediatric Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli,
Turkiye
| | - Semanur ÖZDEL
- Department of Pediatric Rheumatology, Dr. Sami Ulus Maternity and Child Health and Diseases Research and Training Hospital, University of Health Sciences, Ankara,
Turkiye
| | - Ferhat DEMİR
- Department of Pediatric Rheumatology, Acıbadem Hospital, İstanbul,
Turkiye
| | - Balahan MAKAY
- Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, İzmir,
Turkiye
| | - Şevket Erbil ÜNSAL
- Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, İzmir,
Turkiye
| | - Betül SÖZERİ
- Department of Pediatric Rheumatology, Ümraniye Training and Research Hospital, University of Health Sciences, İstanbul,
Turkiye
| | - Nuray AKTAY AYAZ
- Department of Pediatric Rheumatology, Faculty of Medicine, İstanbul University, İstanbul,
Turkiye
| | - Mustafa ÇAKAN
- Department of Pediatric Rheumatology, Ümraniye Training and Research Hospital, University of Health Sciences, İstanbul,
Turkiye
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Hosokawa T, Ohnishi T, Sato S, Tanami Y, Oguma E. Ultrasound evaluation of inflammation in patients with chronic recurrent multifocal osteomyelitis involving the mandible: report of three cases. Radiol Case Rep 2021; 17:802-807. [PMID: 35024080 PMCID: PMC8732335 DOI: 10.1016/j.radcr.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 11/28/2021] [Accepted: 12/03/2021] [Indexed: 11/02/2022] Open
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is aseptic and can be diagnosed by excluding other diseases, such as bacterial osteomyelitis, scurvy, metabolic disorders, and malignant diseases; therefore, bone biopsy is usually performed to confirm the diagnosis. To prevent misdiagnosis, the appropriate timing and location for biopsy should be determined from an active phase of inflammation. We presented 3 cases of CRMO involving the mandible: Case 1: A 2-year-old girl diagnosed with CRMO in the chronic phase. A sonogram showed a slightly low echoic area adjacent to the bone cortex. Pathological examination revealed a slight accumulation of leukocytes and plasma cells, as well as predominant fibrous stroma. Case 2: A 9-year-old girl diagnosed with CRMO with massive new osteoid formation. A sonogram showed a massive inhomogeneous low echoic area adjacent to the bone cortex. Pathological examination revealed massive osteoid formation and scattered inflammatory cells infiltration. Case 3: A 3-year-old girl diagnosed with CRMO in the active phase. A sonogram showed a massive hypoechoic area adjacent to the bone cortex and hyperechogenicity associated with a muscular and subcutaneous edema. Pathological examination revealed massive bone destruction and neutrophils infiltration within damaged osteoid. Ultrasound was able to visualize the degree of inflammation in the mandible corresponding to that of the surrounding soft tissue in all 3 cases. Therefore, ultrasound would be useful in determining the appropriate timing and location for bone biopsy.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, 1-2 Shintoshin Chuo-ku, 330-8777, Saitama, Japan,Corresponding author.
| | - Takuma Ohnishi
- Department of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan
| | - Satoshi Sato
- Department of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, 1-2 Shintoshin Chuo-ku, 330-8777, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, 1-2 Shintoshin Chuo-ku, 330-8777, Saitama, Japan
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