# Morphology and Distribution of Fat Globules in Osteomyelitis on Magnetic Resonance Imaging

## TL;DR

This study shows that fat globules on MRI scans are linked to severe osteomyelitis and can help in its diagnosis.

## Contribution

The study identifies fat globules as a specific MRI feature of osteomyelitis with high diagnostic value.

## Key findings

- Fat globules were found in 27.2% of osteomyelitis cases on MRI.
- Patients with fat globules had higher inflammatory indicators than those without.
- Fat globules showed diverse locations and appearances, both inside and outside the bone marrow.

## Abstract

The purpose of this study was to investigate the morphology and distribution characteristics of fat globules in osteomyelitis on magnetic resonance imaging (MRI).

Patients with pathologically-confirmed osteomyelitis and MRI scans were retrospectively enrolled, and fat globules on the MRI images were analyzed.

Among 103 patients with non-traumatic osteomyelitis, 75 were fat globule negative and 28 were positive. There was no statistically significant difference in age and gender between patients with and without fat globules (p>0.05). The inflammatory indicators (CRP, ESR, WBC, and NEUT) in the fat globule positive group were significantly higher (p<0.05) than those in the negative group. The lesions were mainly located in the long bones of the limbs in patients with positive fat globules. Twenty-eight patients (27.2% or 28/103) were detected to have fat globules on MRI images, including 20 males (71%) and 8 females (29%) aged 5-64 years (mean 16 years). The time from onset to MRI examination was 8 days to 4 months. The location of fat globules was in the tibia in 10 patients (35.7%), femur in 8 (28.6%), humerus in 4 (14.3%), radius in 2 (7.1%), ulna in 1 (3.6%), calcaneus in 1 (3.6%), sacrum in 1 (3.6%), and fibula in 1 patient (3.6%). On MRI imaging, 28 cases (100%) showed widely distributed patches or tortuous and sinuous abnormal signals in the bone marrow. In 25 cases (89.2%), a grid-like abnormal signal was found in the subcutaneous soft tissue. In 21 patients (75%), pus was found in the adjacent extraosseous soft tissues. Among 28 patients with fat globules, 17 patients (60.7%) had fat globules only in the adjacent extraosseous soft tissue, 6 patients (21.4%) had only intraosseous fat globules (including 5 cases with halo signs around the fat globules and 1 case (3.6%) with fat globules located at the edge of the pus cavity inside the bone without a halo sign), and 5 patients (17.8%) had both intraosseous and extraosseous fat globules. Of 6 patients (21.4% or 6/28) with liquid levels, the liquid level appeared outside the bone.

The appearance of fat globules on MRI in patients with osteomyelitis indicates severe infection. Fat globules of osteomyelitis may present with diverse shapes inside and outside the bone marrow as one of the MRI signs of osteomyelitis, with a probability of approximately 27.2%. They have high specificity in diagnosing osteomyelitis and can be used for diagnosis and differential diagnosis.