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FIGURE 1. AHO: MRI performed for diagnostic uncertainty. (A) High tracer localization and uptake are shown in right proximal tibial metaphysis on angiographic-, tissue-, and skeletal-phase images of 13-y-old boy. Findings are typical and highly supportive of diagnosis of AHO. (B) Based entirely on clinical concerns, referring orthopedist obtained MRI. Sagittal fast spin echo inversion recovery MR image shows high signal intensity indicative of marrow edema in right proximal tibial epiphysis, metaphysis, and diaphysis. (C) Sagittal T1-weighted MR image after gadolinium administration shows small (<5 mm) nonenhancing regions indicative of intraosseous abscesses in metaphysis. Although these findings are no more specific than those shown by skeletal scintigraphy, combined results of 2 examinations were clinically regarded as confirmatory of AHO. Patient’s symptoms abated and his erythrocyte sedimentation rate returned to normal during treatment with antibiotics.
