Nuclear magnetic resonance (NMR) imaging in the diagnosis of spinal osteomyelitis

Nuclear Magnetic Resonance Imaging (NMR) was performed on two patients whose clinical radiograph and bone scanning suggested spinal osteomyelitis before and after successful antimicrobial therapy. The images obtained suggest that NMR may be more useful in the diagnosis of this condition than other conventional imaging techniques. Hitherto NMR has not been considered particularly useful for the diagnosis of bone disease. This may be true for cortical bone, from which no signal is obtained using the NMR technique, but for medullary bone it appears to be a potentially useful, non-invasive and safe method of diagnosis.     

Magnetic resonance imaging: application in musculoskeletal infection

Forty-two patients with clinically suspected osteomyelitis were examined using magnetic resonance imaging (MRI). Twenty-seven patients (64%) had previous surgery or fracture, and 15 (36%) were referred for differentiation of acute osteomyelitis from bone tumors or other pathologic conditions. MRI was compared with computed tomography in 12 cases and with 111In-labeled leukocytes scans in 22. With MRI, 92% of proved infections were detected, and bone and soft-tissue changes were more evident than with routine radiographs, tomography, or computed tomography. In patients with negative cultures and no previous surgery or fracture, it was difficult for MRI to differentiate operative changes from infection. In these patients, 111In-labeled leukocyte images were more specific than MRI.     

A systematic approach to magnetic resonance imaging evaluation of epiphyseal lesions

Magnetic Resonance Imaging (MRI) is the preferred modality of choice to image epiphyseal lesions. It provides excellent soft tissue resolution and extent of disease. A wide spectrum of tumor and tumor like lesions can involve the epiphysis. Early and accurate diagnosis as well as appropriate management of epiphyseal lesions is critical as these conditions may lead to disabling complications such as, limb length discrepancy, angular or joint surface deformities and secondary osteoarthritis. In this article, we discuss the role of conventional sequences, such as T1W, fluid sensitive T2W and intravenous (IV) Gadolinium enhanced sequences as well as the additional value of problem solving MRI sequences such as, chemical shift and diffusion weighted imaging. Based on the imaging findings on various MRI sequences and lesion characteristics, a systematic approach directed to the diagnoses of epiphyseal lesions is presented and discussed. MRI features of clinically and biopsy proven examples of the epiphyseal lesions, such as osteomyelitis, intra-osseous abscess, infiltrative malignancy, metastases, transient osteoporosis, subchondral insufficiency fracture, avascular necrosis, osteochondral fracture, osteochondritis dissecans, eosinophilic granuloma and geode are demonstrated. Using this systematic approach, the reader will be able to better characterize epiphyseal lesions with a potential to positively affect patient management.     

MRI and diabetic foot infections

The role of magnetic resonance imaging and plain radiographs in evaluating osteomyelitis in the diabetic foot was studied. Fifty patients were prospectively examined by magnetic resonance imaging and plain radiographs to determine the extent of infection. Thirty-seven patients had positive MRI for osteomyelitis and 19 were positive with conventional radiography. Thirteen patients had negative MRI healed with short course of antibiotics. Five patients with positive MRI received four weeks' course of intravenous antibiotics with two still having persistent infection in the six weeks follow-up. Thirty-two patients underwent surgery with favorable results. Sixty-two bone specimens were obtained for histologic evaluation of osteomyelitis. In cases with histologic proof of diagnosis, magnetic resonance sensitivity was 99%, specificity was 81%, and accuracy was 94%. Thus magnetic resonance imaging was shown to have a high sensitivity, specificity, and accuracy in detecting osteomyelitis.     

Osteomyelitis: Sensitivity of 0.064 T MRI, three-phase bone scanning and indium scanning with biopsy proof

We compared the ability of magnetic resonance imaging (MRI) using a 0.064 T permanent magnet, three-phase bone scanning, and indium-labeled white blood cell (¹¹¹In-WBC) scanning, to diagnose osteomyelitis. Twenty-three patients underwent biopsy. All patients were examined at presentation with all three modalities. Sensitivities for each modality were calculated using biopsy as a gold standard. The results were 72% for MRI, 68% for bone scan, and 45% for ¹¹¹In-WBC. Specificities were not calculated because of lack of negative biopsies. MRI was as sensitive as bone scanning in the diagnosis of osteomyelitis. All modalities had lower than previously reported sensitivities for imaging osteomyelitis.