Abstract
To determine if paramagnetic contrast agents can improve the detection, delineation, and characterization of extraspinal musculoskeletal infections (MSI) on magnetic resonance (MR) imaging, 42 patients with clinical suspicion of MSI underwent MR imaging before and after intravenous administration of gadolinium-DTPA. The lesions consisted of 27 proven infections and 15 noninfective conditions. Specificity and accuracy in identifying infective lesions averaged 80% and 84%, respectively, on precontrast studies and 80% and 89% on the enhanced examinations, with no statistically significant difference. Rim enhancement around abscess loculi was the only pathognomonic sign of infection seen in ten patients with chronic osteomyelitis and pyogenic or tuberculous infections. In 17 patients with acute osteomyelitis, brucellosis, or mycetoma, detection and delineation of the lesions were best on precontrast studies, while postcontrast examinations resulted in underestimation of the extent of abnormalities in all cases. We conclude that intravenous gadolinium-DTPA has limited usefulness in the MR evaluation of extraspinal MSI.
Similar content being viewed by others
References
Modic MT, Feiglin DH, Piraino DW, Boumphrey F, Weinstein MA, Duchesneau PM, Rehm S (1985) Vertebral osteomyelitis: assessment using MR. Radiology 157: 157–166
Beltran J, McGhee RB, Shaffer PB, et al. (1988) Experimental infections of the musculoskeletal system: evaluation with MR imaging and Tc-99mm MDP and Ga-67 scintigraphy. Radiology 167: 167–172
Sharif HS, Clark DC, Aabed MY, Haddad MC, Al Deeb SM, Yaqub B, Al Moutaery KR (1990) Granulomatous spinal infections: MR imaging. Radiology 177: 101–107
Traill MR, Sartoris DV (1989) Musculoskeletal system. In: Runge VM (ed) Enhanced Magnetic Resonance Imaging. Mosby, St. Louis, pp 290–300
Beltran J, Noto AM, McGhee RB, Freedy RM, McCalla MS (1987) Infection of the musculoskeletal system: high field strength MR imaging. Radiology 164: 449–454
Unger E, Moldofsky P, Gatenby R, Hartz W, Broder G (1988) Diagnosis of osteomyelitis by MR imaging. AJR 150: 605–610
Tang JS, Gold RH, Bassett LW, Seeger LL (1988) Musculoskeletal infection of the extremities: evaluation with MR imaging. Radiology 166: 205–209
Quinn SF, Murray W, Clark RA, Cochran C (1988) MR imaging of chronic osteomyelitis. J Comp Assist Tomogr 12: 113–117
Gold RH, Hawkins RA, Katz RD (1991) Bacterial osteomyelitis: findings on plain radiography, CT, MR, and scintigraphy. AJR 157: 365–370
Yuh WT, Corson JD, Baraniewski HM, Rezai K, Shamma AR, Kathol MH, Sato Y, El-Khoury GY, Hawes DR, Platz CE, Cooper RR, Corry RJ (1989) Osteomyelitis of the foot in diabetic patients: evaluation with plain film, 99 m-Tc-MDP bone scintigraphy, and MR imaging. AJR 152: 795–800
Mason MD, Zlatkin MB, Esterhai JL, Dalinka MK, Velchik MG, Kressel HY (1989) Chronic complicated osteomyelitis of the lower extremity: evaluation with MR imaging. Radiology 173: 355–359
Saini S, Modic MT, Hamm B, Hahn P (1991) Advances in contrast-enhanced MR imaging. AJR 156: 235–254
Post MJ, Sze G, Quencer RM, Eismont FJ, Green BA, Gahbauer H (1990) Gadolinium-enhanced MR in spinal infection. J Comp Assist Tomogr 14: 721–729
Sandhu J, Dillon WP, Trusuda J (1989) Use of Gadolinium in spinal epidural abscesses detected with MR imaging. Radiology 173 (P): 404
Beltran J, Chandnani V, McGhee RA, Kursunoglu-Brahme S (1991) Gadopentetate Dimeglumine-enhanced MR imaging of the musculoskeletal system. AJR 156: 457–466
Seabold JE, Flickinger FW, Kao SS, Gleason TJ, Kahn D, Nepola JV, Lawrence Marsh J (1990) Indium-111 leukocyte/technetium — 99 m-MDP bone scintigraphy and Magnetic Resonance imaging: difficulty of diagnosing osteomyelitis in patients with neuropathic osteoarthropathy. J Nucl Med 31: 549–556
Erdman WA, Tamburro F, Jayson HT, Weatherall PT, Ferry KB, Peshock RM (1991) Osteomyelitis: characteristics and pitfalls of diagnosis with MR imaging. Radiology 180: 533–539
Simon JH, Szomowski J (1989) Chemical shift imaging with paramagnetic contrast material enhancement for improved lesion depiction. Radiology 171: 539–543
Sharif HS, Clark DC, Aabed MY, Aideyan OA, Mattsson TA, Haddad MC, Ohman SA, Joshi RK, Hasan HA, Haleem A (1991) MR imaging of mycetoma: comparison with CT. Radiology 178: 865–870
Madkour MM, Sharif HS, Aabed MY, Al Fayez MA (1988) Osteoarticular brucellosis: results of bone scintigraphy in 140 patients. AJR 150: 1101–1105
Author information
Authors and Affiliations
Additional information
Correspondence to: M. C. Haddad
Rights and permissions
About this article
Cite this article
Haddad, M.C., Sharif, H.S., Aabed, M.Y. et al. Gadolinium-DTPA: value in MR imaging of extraspinal musculoskeletal infections. Eur. Radiol. 3, 527–535 (1993). https://doi.org/10.1007/BF00169602
Issue Date:
DOI: https://doi.org/10.1007/BF00169602