Infrared Thermal Imaging Shows Inflammation in Chronic Nonbacterial Osteomyelitis

Infrared thermal imaging detected significantly higher bone segment temperatures in the distal tibia and fibula in children with chronic nonbacterial osteomyelitis compared with healthy limbs, according to a pilot study published in Arthritis Care & Research.

Researchers analyzed the use of infrared thermal imaging for detecting elevated temperatures in the lower legs in this proof-of-concept study. Children with confirmed or suspected chronic nonbacterial osteomyelitis (n=30) and healthy control children (n=31) were scanned using infrared thermal imaging in standardized body positions.

Researchers used semi-automated software to divide the lower leg into 3 equal segments and then calculated the minimum, median, 95th percentile, and maximum temperatures for each segment. MRIs completed on children in the chronic nonbacterial osteomyelitis cohort allowed investigators to identify the location and grade the severity of bone marrow hyperintensity. Demographics, clinical data, and laboratory measurements were collected from both cohorts of children.

A comparison of the 2 groups revealed the chronic nonbacterial osteomyelitis cohort had a significantly higher body mass index score (P <.05) and a lower overall body temperature (P =.004). In the chronic nonbacterial osteomyelitis cohort, 19 children had MRI confirmation of bone marrow hyperintensity in their lower legs.

When comparing the inflamed bone segments of children with chronic nonbacterial osteomyelitis and healthy controls, the median, 95th percentile, and maximum temperatures were not significantly different. When comparing inflamed bone segments and uninflamed bone segments within the chronic nonbacterial osteomyelitis cohort, the median, 95th percentile, and maximum temperatures were significantly different (anterior, P <.05; medial, P <.01; lateral, P <.05).

There was also significantly higher median and 95th percentile temperatures of inflamed distal tibia/fibula segments when compared with the same segment in an uninflamed bone of a child with chronic nonbacterial osteomyelitis (P <.01).

Future research should increase the sample size to identify more accurately significant differences between the cohorts and within the cohorts, match the control cohort based on body mass index to calculate heat emission through tissue, and include more extensive MRI examinations.

The researchers identified that infrared thermal scans could detect significant increases in temperature of inflamed distal tibia/fibula segments in children with active chronic nonbacterial osteomyelitis compared with children with inactive chronic nonbacterial osteomyelitis. They note that a “larger and longitudinal study is needed to further evaluate this technique as a convenient, easy, and cost-effective tool to screen for patients suspected to have [chronic nonbacterial osteomyelitis] and needing additional evaluation by MRI.”

Reference

Zhao Y, Iyer RS, Reichley L, et al. A pilot study of infrared thermal imaging to detect active bone lesions in children with chronic nonbacterial osteomyelitis [published online November 2, 2018]. Arthritis Care Res. doi: 10.1002/acr.23804

This article originally appeared on Rheumatology Advisor