Radiologist’s Perspectives on the Use of Imaging for Diagnosis and Monitoring of Chronic Nonbacterial Osteomyelitis 

Abstract Background. Radiological imaging is integral to the diagnosis of chronic nonbacterial osteomyelitis (CNO). Objectives of this study were: 1) to determine imaging modalities and features deemed important by radiologists in the diagnostic workup of suspected CNO cases; 2) to generate input from radiologists regarding monitoring of patients with CNO.Methods. The population targeted were actively practicing radiologist physician members of the Society of Skeletal Radiology. The survey was administered online through RedCap. Fisher's exact test was used to examine associations between any two categorical variables. FDR adjusted p-values were used for the pairwise comparisons of proportions for more than 2 groups. A mixed effects logistic regression model was used to assess the association between variables.Results. Half of the survey respondents were pediatric radiologists, subspecializing in musculoskeletal radiology and 54% had >10 years of experience. Radiologists considered CNO in the radiological imaging interpretation differential diagnosis an average of 10 cases per year. 79% and 45% of respondents reported high confidence in identifying imaging features of CNO on whole body MRI (WBMRI) and localized MRI, respectively. The level of confidence dropped to 25% and 19% when interpreting X-rays or bone scintigraphy. Among all imaging modalities interpreted “always” in the initial diagnostic workup of potential cases of CNO, X-rays (52%) were most commonly interpreted, followed by localized MRI (46%) and WBMRI (35%). In established cases of CNO, wherein WBMRI was the most frequently requested (48%), followed by localized MRI (26%) and X-rays (25%). Conclusions. By radiologists, WBMRI is currently considered the most useful imaging modality for initial diagnosis and monitoring of CNO by radiologists. Findings from this survey will promote discussion within a focused group to develop imaging recommendations for the diagnostic workup and disease monitoring in CNO.