Ultrasonography for the Detection of Osteomyelitis in Pediatric Patients With Soft Tissue Infection: A Pilot Study

Takahiro Hosokawa; Kuntaro Deguchi; Haruka Takei; Yumiko Sato; Yutaka Tanami; Eiji Oguma

doi:10.1002/jum.16446

Ultrasonography for the Detection of Osteomyelitis in Pediatric Patients With Soft Tissue Infection: A Pilot Study

J Ultrasound Med. 2024 Mar 8. doi: 10.1002/jum.16446. Online ahead of print.

Authors

Takahiro Hosokawa¹, Kuntaro Deguchi², Haruka Takei², Yumiko Sato¹, Yutaka Tanami¹, Eiji Oguma¹

Affiliations

¹ Department of Radiology, Saitama Children's Medical Center, Saitama, Japan.
² Department of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan.

PMID: 38456324
DOI: 10.1002/jum.16446

Abstract

Objectives: To demonstrate the usefulness of ultrasonography for differentiating soft tissue infections with or without osteomyelitis in pediatric patients who underwent ultrasonography and subsequent magnetic resonance imaging (MRI).

Methods: Twenty-three patients were classified into 2 groups: 12 patients with and 11 patients without osteomyelitis based on MRI. Osteomyelitis using ultrasound is characterized by the presence of bone cortex irregularity and/or subperiosteal abscess formation. The diagnostic performance of ultrasonography for detecting osteomyelitis and subperiosteal abscess formation was compared with that of MRI. Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were calculated with 95% confidence intervals (CIs).

Results: Of 12 osteomyelitis cases, 11 had abnormal bone marrow enhancement (one residual case did not undergo contrast enhancement study) and 5 had subperiosteal abscesses. The diagnostic accuracy of ultrasonography for osteomyelitis was 82.6% (number of correct diagnosis of osteomyelitis/total number = 19/23; 95% CI, 61.2-95.0) and for detecting periosteal abscess was 95.7% (number of correct diagnosis of periosteal abscess/total number = 22/23; 95% CI, 78.1-99.9), respectively. The sensitivity and specificity of ultrasonography for detecting osteomyelitis were 66.7% (95% CI, 34.9-90.1) and 100% (95% CI, 71.5-100), respectively. The sensitivity and specificity of ultrasonography for detecting periosteal abscess were 80% (95% CI, 28.4-99.5), and 100% (95% CI, 81.5-100), respectively. One-third of osteomyelitis cases could not be detected using ultrasonography.

Conclusions: Ultrasonography may be useful for diagnosing osteomyelitis in pediatric patients; however, the technique appears limited by low sensitivity. However, it is more accurate for diagnosis of periosteal abscess in these patients.

Keywords: children; osteomyelitis; soft tissue infection; subperiosteal abscess; ultrasonography.