The purpose of this study was to assess whether gadolinium-enhanced magnetic resonance imaging (MRI) provides diagnostic information beyond that given by nonenhanced imaging in the evaluation of musculoskeletal infectious processes and whether it can be used for differentiating infectious from noninfectious inflammatory lesions. Magnetic resonance images performed with and without intravenous gadolinium-DTPA in 34 cases in which musculoskeletal infection had been clinically suspected were reviewed. Infectious lesionsincluding osteomyelitis, pyarthrosis, abscess, and cellulitis-were confirmed in a total of 22 cases: in 15 by biopsy or drainage and in 7 by clinical course. Our results show that gadolinium-DTPA-enhanced MRI is a highly sensitive technique in diagnosing musculoskeletal infectious lesions. It is especially useful in distinguishing abscesses from surrounding cellulitis/myositis. Lack of contrast enhancement rules out infection with a high degree of certainty. However, contrast enhancement cannot be used to reliably distinguish infectious from noninfectious inflammatory conditions.