This study states that Chronic nonbacterial osteitis (CNO), also termed chronic recurrent multifocal disease (CRMO), is a rare autoinflammatory disease characterized by recurrent flares of inflammatory bone pain related to aseptic osteomyelitis1,2,3. It usually affects children and adolescents and the clinical presentations range from mild and limited unifocal disease to severe chronic inflammation in multiple bones4,5,6. The long tubular bones of the lower extremities are most commonly involved, followed by the spine and the clavicles2,3; there may be extraskeletal skin and bowel manifestations such as palmoplantar pustulosis, psoriasis, and Crohn disease7.

Diagnostic imaging in CNO relies on a multimodality approach usually consisting of radiography followed by magnetic resonance imaging (MRI)2. Because bone marrow edema (BME) is characteristic for active lesions, fat-saturated fluid sensitive MRI sequences such as short-tau inversion recovery (STIR) and T2-weighted fat-saturated sequence are ideal for detecting active lesions, whereas T1-weighted sequences are preferable for detecting chronic structural lesions2. The findings by MRI may, however, be nonspecific and the diagnosis is usually a diagnosis of exclusion after ruling out other diseases.

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