MR Imaging of Chronic Osteomyelitis

Quinn, Stephen F.; Murray, William T.; Clark, Robert A.; Cochran, Courtney

doi:10.1097/00004728-198801000-00022

Cited by 58 publications

(10 citation statements)

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“…Early reports indicate that MRI may play an important role in the evaluation of musculoskeletal infections in acute and chronic stages [1,2,3,19,24]. The advantages of MRI over computed tomography (CT) include improved soft tissue contrast resolution, absence of beam hardening artifacts from bone, and multiplanar imaging capability.…”

Section: Discussionmentioning

confidence: 99%

“…Magnetic resonance imaging (MRI) has recently been introduced as a new diagnostic technique for evaluating musculoskeletal infections, and preliminary results in experimental animals and humans indicate that it is highly accurate in diagnosing and revealing the extent of infection [1,2,19,24]. This study was undertaken as an attempt to assess the potential role of MRI in evaluating patients with diabetic foot.…”

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confidence: 99%

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The diabetic foot: magnetic resonance imaging evaluation

et al. 1990

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Fourteen diabetic patients with suspected foot infection and/or neuropathic joint (Charcot Joint) were evaluated with magnetic resonance imaging (MRI) in an attempt to assess the extent of the infection and also to distinguish infection from the changes seen with neuroarthropathy. The majority of patients with infection had more than one site of involvement and the following diagnoses were made by MRI evaluation: osteomyelitis (n = 8), abscess (n = 7), neuropathic joint (n = 5), septic arthritis (n = 4), and tenosynovitis (n = 4). Clinical or surgical/pathological confirmation of the MRI diagnoses was obtained in all but nine sites of infection or cases of neuropathic joint. If the two diagnostic categories of septic arthritis and tenosynovitis are excluded, all but four of the MRI diagnoses were confirmed. A distinctive pattern for neuroarthropathy was identified in five cases, consisting of low signal intensity on T1- and T2-weighted images within the bone marrow space adjacent to the involved joint. We conclude that MRI is a valuable adjunct in the evaluation of the diabetic foot, and that it provides accurate information regarding the presence and extent of infection in this subset of patients. MRI has proven particularly helpful in differentiating neuroarthropathy from osteomyelitis.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

The diabetic foot: magnetic resonance imaging evaluation

et al. 1990

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“…Bone involvement in osteomyelitis was defined by the presence of intramedullary low T1 signal intensity; increased signal intensity on fluid-sensitive sequences; findings attributable to edema, hyperemia, or exudate [18][19][20][21][22]; or evidence of contrast-enhanced enhancement of the vascularized inflamed tissue [23][24][25]. The presence of joint effusion was subjectively defined by visualization on MRI of a supraphysiologic amount of fluid in the joint space.…”

Section: Imaging Review and Analysismentioning

confidence: 99%

Septic Arthritis in Children: Frequency of Coexisting Unsuspected Osteomyelitis and Implications on Imaging Work-Up and Management

Monsalve

et al. 2015

American Journal of Roentgenology

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In children who underwent MRI for suspected musculoskeletal infection, septic arthritis was more prevalent in children under the age of 2 years than in older children. However, both septic arthritis and osteomyelitis were found frequently in older children. Musculoskeletal infection imaging workup guidelines for children of all ages should address the frequent association of osteomyelitis and septic arthritis. We recommend that MRI should be used in the evaluation of suspected musculoskeletal infections in children, and the nearest joint should always be included to evaluate the extent of articular disease.

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“…T1-weighted SE images were obtained with one to four signals averaged, with TR of 500±650 ms and TE of 12±20 ms. T2-weighted images were obtained using a turbo spin-echo technique (TSE) with one to four signals averaged and TR/ TE = 3200±4700/70±90 ms. T2-weighted images with fat saturation were obtained using TSE technique with one to four signals averaged TR/TE = 3750±5500/ 80±132 ms. T1-weighted images after contrast administration (Dotarem, Guerbet, Aulnay-Sous-Bois, France; 0.1 mmol/kg body weight) were obtained approximately 3±5 min after injection using conventional SE technique (TR/TE = 540±800/15±17 ms). T1-weighted fat-suppressed images were acquired by using selective saturation of lipid resonances with one to four signals averaged and TR/TE = 720±970/15±20 ms. We applied the same criteria for diagnosis of osteomyelitis as already reported [5,9,10]: focal marrow abnormalities with low signal intensity on T1-weighted images and high signal intensity on T2-weighted images were considered positive for osteomyelitis if additional contrast enhancement was also present on T1-weighted images [3]. Postsurgical chronic fibrosis and scarring were diagnosed when there was decreased marrow signal on T1-weighted images and no increase in signal on T2-weighted images [11].…”

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confidence: 99%

Pitfalls and limitations of magnetic resonance imaging in chronic posttraumatic osteomyelitis

et al. 2000

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The aim of this study was to evaluate pitfalls and technical limitations of MR imaging in diagnosing relapse of chronic posttraumatic osteomyelitis of the lower extremities. Retrospective analysis of MR examinations in 15 patients (17 body areas) with suspected relapse of chronic posttraumatic osteomyelitis (at least 1.5 years duration/mean number of surgical procedures per patient: 5.8). The MRI findings were compared with postoperative bacteriology (n = 11) and clinical follow-up (n = 4). Five patients had additional CT examination. Magnetic resonance imaging identified all infected areas correctly, but five uninfected regions were diagnosed false positive due to postoperative scarring/oedema in bone defects (n = 4) and soft tissue (n = 1). Specificity of MRI in diagnosing active bone infection was 63% and sensitivity 100%. Additional CT was preoperatively necessary in 5 patients (33%) to further examine osteomyelitic and reparative bone remodeling. Metal artefacts were present in 11 patients, rendering complete evaluation impossible (n = 2) or considerably more difficult (n = 4). Scarring/oedema in postoperative bone defects occurs up to 13 months postoperatively and represents a major pitfall leading to low specificity. Definitive evaluation of suspected fistula, bony fragments and mineralization by MRI may be limited in this special patient group and requires additional CT in one third of patients. Metal artefacts occur in most patients and may impair or even prevent correct film evaluation in 23 and 11%, respectively.

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MR Imaging of Chronic Osteomyelitis

Cited by 58 publications

References 0 publications

The diabetic foot: magnetic resonance imaging evaluation

The diabetic foot: magnetic resonance imaging evaluation

Septic Arthritis in Children: Frequency of Coexisting Unsuspected Osteomyelitis and Implications on Imaging Work-Up and Management

Pitfalls and limitations of magnetic resonance imaging in chronic posttraumatic osteomyelitis

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