The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Osteomyelitis or Septic Arthritis-Child Typical management of uncomplicated osteomyelitis in the pediatric population consists initially of intravenous (IV) antibiotic therapy followed by a prolonged course of outpatient antibiotics, either oral or IV. However, surgical debridement may be indicated in certain scenarios, such as in the setting of subperiosteal collections, necrosis, or failure to respond to initial management. Typical management of septic arthritis consists of antibiotics, arthrotomy, irrigation, and debridement [16]. Imaging plays a critical role in characterizing and differentiating septic arthritis from osteomyelitis. Please note that chronic recurrent multifocal osteomyelitis, which affects the pediatric population and typically manifests with multiple sites of involvement, is a nonbacterial autoinflammatory disorder and as such will not be discussed in this document, which will focus on acute musculoskeletal infection. Special Imaging Considerations Evaluation for pediatric musculoskeletal infection in the setting of existing orthopedic hardware can be impacted by artifact. On CT, beam hardening artifact occurs, which can be reduced on conventional CT by corrective software, as well as filtration and calibration connection [18,19]. With the advent of dual-energy CT, metal artifact reduction can be performed to reduce beam hardening by acquisition of data at two distinct energy spectra in order to create a virtual monochromatic image to optimize visualization of bone or soft tissue [19].
Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Osteomyelitis or Septic Arthritis-Child Typical management of uncomplicated osteomyelitis in the pediatric population consists initially of intravenous (IV) antibiotic therapy followed by a prolonged course of outpatient antibiotics, either oral or IV. However, surgical debridement may be indicated in certain scenarios, such as in the setting of subperiosteal collections, necrosis, or failure to respond to initial management. Typical management of septic arthritis consists of antibiotics, arthrotomy, irrigation, and debridement [16]. Imaging plays a critical role in characterizing and differentiating septic arthritis from osteomyelitis. Please note that chronic recurrent multifocal osteomyelitis, which affects the pediatric population and typically manifests with multiple sites of involvement, is a nonbacterial autoinflammatory disorder and as such will not be discussed in this document, which will focus on acute musculoskeletal infection. Special Imaging Considerations Evaluation for pediatric musculoskeletal infection in the setting of existing orthopedic hardware can be impacted by artifact. On CT, beam hardening artifact occurs, which can be reduced on conventional CT by corrective software, as well as filtration and calibration connection [18,19]. With the advent of dual-energy CT, metal artifact reduction can be performed to reduce beam hardening by acquisition of data at two distinct energy spectra in order to create a virtual monochromatic image to optimize visualization of bone or soft tissue [19].