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Clinical impact of gadolinium in the MRI diagnosis of musculoskeletal infection in children

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Abstract

Background

The incremental value of gadolinium in the diagnosis of musculoskeletal infection by MRI is controversial.

Objective

To compare diagnostic utility of noncontrast with contrast MRI in the evaluation of pediatric musculoskeletal infections.

Materials and methods

We reviewed 90 gadolinium-enhanced MRIs in children with suspected musculoskeletal infection. Noncontrast and contrast MRI scans were evaluated to determine sensitivity and specificity in the diagnosis of musculoskeletal infection and identification of abscesses.

Results

Pre- and post-contrast diagnosis of osteomyelitis sensitivity was 89% and 91% (P = 1.00) and specificity was 96% and 96% (P = 1.00), respectively; septic arthritis sensitivity was 50% and 67% (P = 1.00) and specificity was 98% and 98% (P = 1.00), respectively; cellulitis/myositis sensitivity was 100% and 100% (P = 1.00) and specificity was 84% and 88% (P = 0.59), respectively; abscess for the total group was 22 (24.4%) and 42 (46.6%), respectively (P < 0.0001). Abscesses identified only on contrast sequences led to intervention in eight additional children. No child with a final diagnosis of infection had a normal pre-contrast study.

Conclusion

Intravenous gadolinium should not be routinely administered in the imaging work-up of nonspinal musculoskeletal infections, particularly when pre-contrast images are normal. However, gadolinium contrast significantly increases the detection of abscesses, particularly small ones that might not require surgical intervention.

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Acknowledgements

Presented at the 52nd annual meeting of the Society for Pediatric Radiology in Carlsbad, CA, April 21–25, 2009. Statistics supported in part by Vanderbilt CTSA grant UL1 RR024975 from the National Center for Research Resources, National Institutes of Health.

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Authors and Affiliations

  1. Department of Radiology and Radiological Sciences, Vanderbilt Children’s Hospital, Vanderbilt University, 2200 Children’s Way, Nashville, TN, 37232, USA

    J. Herman Kan, Robert S. Young & Marta Hernanz-Schulman

  2. Department of Biostatistics, Vanderbilt University, Nashville, TN, USA

    Chang Yu

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  1. J. Herman Kan
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  2. Robert S. Young
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  4. Marta Hernanz-Schulman
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Correspondence to J. Herman Kan.

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Kan, J.H., Young, R.S., Yu, C. et al. Clinical impact of gadolinium in the MRI diagnosis of musculoskeletal infection in children. Pediatr Radiol 40, 1197–1205 (2010). https://doi.org/10.1007/s00247-010-1557-2

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  • DOI: https://doi.org/10.1007/s00247-010-1557-2

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