Whole body MRI and CNO/CRMO

The project "Whole-Body Magnetic Resonance Imaging (WB-MRI) in children. Novel work on age related normative findings to identify true pathology", is a prospective, multicentre cross-sectional study, with the inclusion period running over 2-3 years. The first part is a descriptive study on WBMRI findings in 200 healthy children, and the second part is a case-control study comparing healthy children with age-equivalent children with chronic non-bacterial osteomyelitis (CNO). The results will have immediate clinical impact, both nationally and internationally. The project is led by Dr. Lil-Sofie Ording Müller, PhD, at the department of paediatric radiology, Oslo University Hospital and Dr. Derk Avenarius, PhD, University Hospital North Norway / UiT, in close collaboration with members of our research group (Rosendahl co-supervisor for Zadig). Funding for two PhD fellows; Elisabeth von Brandis, MD, at OUS (RH) and Pia Zadig, MD, at UNN has been secured. A third PhD fellow, Dr.Laura Tanturri de Horatio, UNN (from OPBG in Rome) was recently funded by HelseNord for the period 2021-2024 (main supervisor Derk Avenarius, UNN/UiT). A fourth PhD fellow, Dr. Torgrim Lysen Skiaker, received a PhD from Helse Nord in 2022. Recently, a fifth PhD fellow from OUS (RH) has been included.   

WB-MRI is a relatively new tool for assessment of multifocal bone pathology. It allows for the detection and characterisation of disease at an early, and sometimes pre-clinical stage, without using ionising radiation. The method has already been embraced for clinical use although, to date, no studies addressing its precision, accuracy and clinical validity in children exists.

The maturation of bone during childhood has a significant impact on the MRI appearances. First, cellular red bone marrow is replaced by fatty marrow, second, the constitution of the remaining red marrow changes and third, there is an ongoing ossification process. Moreover, the skeleton in children is softer and more vascular than that of adults. These features, amongst others, lead to signal changes which may easily be mistaken for pathology, such as inflammation or tumour. Research aiming to establish normative MRI data in children is highly encouraged and supported by the main European Paediatric Radiology research communities, namely the paediatric ‘arm’ of the European Imaging for Biomedical Imaging Research (EIBIR)-initiative and the European Society for Pediatric Radiology (ESPR) research group (www.espr.org).

Preliminary results, suggesting that there are numerous oedema-like changes in nearly all bones during maturation/growth, were presented at ESPR (European Society of Pediatric Radiology) congress in Helsinki, May 2019, and was honoured with the ESPR Young investigator prize. Hietherto, seven papers have been published.