A retrospective study of 96 cases comparing x-ray radiography and MRI for diagnosing paediatric subacute osteomyelitis

Background: Subacute hematogenous osteomyelitis (SAHOM) presents a diagnostic challenge, requiring robust validation of imaging accuracy. Purpose: To determine the superior diagnostic performance of MRI vs. radiography (x-ray) in detecting and classifying SAHOM. Methods: This retrospective study included 96 proven SAHOM cases (2000-2025). Demographic data, involved bones, and microbiological results were collected. Two independent readers assessed x-Ray and MRI for detection of SAHOM, and classified lesions using the modified Roberts classification. Inter-reader disagreements were resolved by consensus. Sensitivity of x-Ray was evaluated against MRI as the reference standard. Results: ). Conclusions: . MRI also provides much better imaging of the involvement of growth cartilage and damage to articular cartilage.