case_images: PMC8008083_01
case_images: An 11-year-old-girl with chronic recurrent multifocal osteomyelitis: Initial plain radiograph of the pelvis demonstrated diffuse sclerosis of the right iliac wing (arrows).
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case_images: Initial imaging included a plain radiograph of the pelvis including both hip joints (Figure 1).
case_images: Magnetic resonance imaging of the pelvis performed without and with gadolinium: (a) Axial T2 fat-saturated image of the pelvis showing heterogeneous marrow signal within the right iliac wing with marrow expansion (red arrows). Diffuse layered periosteal reaction was noted with increased T2 signal in the adjacent part of the iliacus and gluteal muscles (yellow arrow). (b) Coronal short tau inversion recovery (STIR) image of the pelvis showing layers of periosteal reaction (yellow arrow). Increased marrow signal could be seen extending close to the acetabular roof but without intra-articular extension (red arrows). (c) Coronal fat-saturated image gadolinium enhanced T1 weighted image indicated mild sacroiliitis with post contrast enhancement (green arrow) and heterogeneous marrow enhancement (blue arrow). In addition, there was enhancement of the adjacent muscles.
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case_images: Magnetic resonance imaging of the pelvis was then performed both without and with gadolinium contrast (Figure 2).
case_images: Follow-up imaging with a radiograph of the pelvis and whole-body magnetic resonance imaging (MRI) performed 3 months after treatment: (a) Plain radiograph of the pelvis showing similar findings of sclerosis of right iliac wing. (b) Magnified fat-saturated T2 weighted coronal image on whole-body MRI shows significant improvement of the oedema and surrounding periosteal reaction (arrow). Note the absence of adjacent muscle inflammation. (c) Magnified section of the whole-body MRI, coronal T2 weighted fat-saturated MR image of the left lower leg showing increased marrow signal involving the inferior talus, cuboid (arrows) and base of 5th metatarsal bone (not shown). This involvement of multiple bones with regression of inflammation in the ilium after conservative treatment confirms the diagnosis of chronic recurrent multifocal osteomyelitis.
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case_images: Follow-up imaging with a pelvic radiograph and whole-body MRI were performed 3 months after treatment (Figure 3).