O.22. THE ROLE OF THE MRI IN THE DIAGNOSIS AND
TREATMENT OF THE PELVIC OSTEOMYELITIS
Martson M., Rebane I. (Estonia)
INTRODUCTION
MRI is stated as the best modality for detection of acute osteomyelitis, particularly of
the pelvic bones. MRI is available in Tallinn, but not in our hospital. The difficulties
of arrangement of the MRI investigations, particularly in emergency basis, arise
sometimes hesitations concerning its necessity.
OBJECTIVE
The aim of current study is evaluate the role of MRI in diagnosis of the pelvic
osteomyelitis in our hospital.
MATERIALS & METHODS
Retrospective analysis of paediatric patients with pelvic osteomyelitis treated in our
hospital 2004-2011.
RESULTS
10 patients (age 3-15 years) were found in medical records. In 9 of 10 cases MRI
investigation was performed. In 5 cases the right diagnose were confirmed. Two
patients (3 and 6 year old) were investigated repeatedly in sedation due to movement
artefacts and wrong negative diagnosis at first MRI. Two patients had intrapelvical
fluid collections (abscesses?) without bone focuses. The bone involvement was
detected at repeated MRI in one case and suspected by findings at surgery in another
case. 4 of 10 patients were treated surgically because of detection of the intrapelvical
abscesses at MRI (3 pt) or clinically obvious soft tissue abscess outside the pelvic ring
(1 pt). The hospital stay was shorter (14 ± 5 days) in the group of patients treated
surgically compared to the group of patients treated conservatively (23 ± 7 days). 4
patients were followed up to 6 months with repeated MRI. Despite to the pathological
findings on the MRI scan, any changes in the treatment scheme or restriction of the
physical activity were not commenced.
CONCLUSIONS
The MRI is valuable for diagnosing pelvic osteomyelitis and planning of surgical
treatment, which can lead to rapid improvement and shorter hospital stay. For
avoiding the wrong-negative results, the investigation in younger patients must be
done in sedation. The role of the MRI in follow up of these patients is doubtful.