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MR imaging of skeletal soft tissue infection: utility of diffusion-weighted imaging in detecting abscess formation

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Abstract

Purpose

Our objectives were to assess if diffusion-weighted imaging (DWI) can help identify abscess formation in the setting of soft tissue infection and to assess whether abscess formation can be diagnosed confidently with a combination of DWI and other unenhanced sequences.

Methods

Eight cases of soft tissue infection imaged with MRI including DWI were retrospectively reviewed.

Results

Two male and six female patients were studied (age range 23–50 years). Unenhanced MRI including DWI was performed in all patients. Post-contrast images were obtained in seven patients. All patients had clinically or surgically confirmed abscesses. Abscesses demonstrated restricted diffusion. DWI in conjunction with other unenhanced imaging showed similar confidence levels as post-contrast images in diagnosing abscess formation in four cases. In two cases, although the combined use of DWI and other unenhanced imaging yielded the same confidence levels as post-contrast imaging, DWI was more definitive for demonstrating abscess formation. In one case, post-contrast images had a better confidence for suggesting abscess. In one case, DWI helped detected the abscess, where gadolinium could not be administered because of a contraindication.

Conclusion

This preliminary study suggests that DWI is a useful adjunct in the diagnosis of skeletal soft tissue abscesses.

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References

  1. Fayad LM, Carrino JA, Fishman EK. Musuloskeletal infection: role of CT in the emergency department. Radiographics. 2007;27:1723–35.

    Article  PubMed  Google Scholar 

  2. McHenry CR, Piotrowski JJ, Petrinic D, et al. Determinants of mortality for necrotizing soft tissue infections. Ann Surg. 1995;221:558–65.

    Article  CAS  PubMed  Google Scholar 

  3. Struk DW, Munk PL, Lee MJ, Ho SG, Worsley DF. Imaging of soft tissue infections. Radiol Clin North Am. 2001;39:277–303.

    Article  CAS  PubMed  Google Scholar 

  4. Soler R, Rodríguez E, Aguilera C, Fernández R. Magnetic resonance imaging of pyomyositis in 43 cases. Eur J Radiol. 2000;35:59–64.

    Article  CAS  PubMed  Google Scholar 

  5. Yu JS, Habib P. MR imaging of urgent inflammatory and infectious conditions affecting the soft tissues of the musculoskeletal system. Emerg Radiol. 2009;16:267–76.

    Article  PubMed  Google Scholar 

  6. Turecki MB, Taljanovic MS, Stubbs AY et al. Imaging of musculoskeletal soft tissue infections. Skeletal Radiol. 2009 Aug 28.

  7. Arslan A, Pierre-Jerome C, Borthne A. Necrotizing fasciitis: unreliable MRI findings in the preoperative diagnosis. Eur J Radiol. 2000;36:139–43.

    Article  CAS  PubMed  Google Scholar 

  8. Gordon BA, Martinez S, Collins AJ. Pyomyositis: characteristics at CT and MR imaging. Radiology. 1995;197:279–86.

    CAS  PubMed  Google Scholar 

  9. Theodorou SJ, Theodorou DJ, Resnick D. MR findings of pyogenic bacterial myositis (pyomyositis) in patients with local muscle trauma: illustrative cases. Emerg Radiol. 2007;14:89–96.

    Article  PubMed  Google Scholar 

  10. Jelinek JS, Murphey MD, Aboulafia AJ, Dussault RG, Kaplan PA, Snearly WN. Muscle infarction in patients with diabetes mellitus: MR imaging findings. Radiology. 1999;211:241–7.

    CAS  PubMed  Google Scholar 

  11. Parellada AJ, Morrison WB, Reiter SB, et al. Unsuspected lower extremity deep venous thrombosis simulating musculoskeletal pathology. Skeletal Radiol. 2006;35:659–64.

    Article  PubMed  Google Scholar 

  12. Hopkins KL, Li KC, Bergman G. Gadolinium-DTPA-enhanced magnetic resonance imaging of musculoskeletal infectious processes. Skeletal Radiol. 1995;24:325–30.

    Article  CAS  PubMed  Google Scholar 

  13. Miller TT, Randolph Jr DA, Staron RB, Feldman F, Cushin S. Fat-suppressed MRI of musculoskeletal infection: fast T2-weighted techniques versus gadolinium-enhanced T1-weighted images. Skeletal Radiol. 1997;26:654–8.

    Article  CAS  PubMed  Google Scholar 

  14. Bley TA, Wieben O, Uhl M. Diffusion-weighted MR imaging in musculoskeletal radiology: applications in trauma, tumor, and inflammation. Magn Reson Imaging Clin N Am. 2009;17:263–75.

    Article  PubMed  Google Scholar 

  15. Reddy JS, Mishra AM, Behari S, Husain M, Gupta V, Rastogi M, et al. The role of diffusion-weighted imaging in the differential diagnosis of intracranial cystic mass lesions: a report of 147 lesions. Surgical Neurology. 2006;66:246–51.

    Article  PubMed  Google Scholar 

  16. Herneth AM, Ringl H, Memarsadeghi M, et al. Diffusion-weighted imaging in osteoradiology. Top Magn Reson Imaging. 2007;18:203–12.

    Article  PubMed  Google Scholar 

  17. Eastwood JD, Vollmer R, Provenzale JM. Diffusion-weighted imaging in a patient with vertebral and epidural abscesses. AJNR Am J Neuroradiol. 2002;23:496–8.

    PubMed  Google Scholar 

  18. Unal O, Koparan HI, Avcu S, Kalender AM, Kisli E. The diagnostic value of diffusion-weighted magnetic resonance imaging in soft tissue abscesses. Eur J Radiol. 2009 Sep 12.

  19. Paajanen H, Grodd W, Revel D, Engelstad B, Brasch RC. Gadolinium-DTPA enhanced MR imaging of intramuscular abscesses. Magn Reson Imaging. 1987;5:109–15.

    Article  CAS  PubMed  Google Scholar 

  20. Paajanen H, Brasch RC, Schmiedl U, Ogan M. Magnetic resonance imaging of local soft tissue inflammation using gadolinium-DTPA. Acta Radiol. 1987;28:79–783.

    Article  CAS  PubMed  Google Scholar 

  21. Kanal E, Barkovich AJ, Bell C, et al. ACR guidance document for safe MR practices: 2007. AJR Am J Roentgenol. 2007;188:1447–74.

    Article  PubMed  Google Scholar 

  22. Baur A, Reiser MF. Diffusion-weighted imaging of the musculoskeletal system in humans. Skeletal Radiol. 2000;29:555–62.

    Article  CAS  PubMed  Google Scholar 

  23. Schnapauff D, Zeile M, Niederhagen MB, et al. Diffusion-weighted echo planar magnetic resonance imaging for the assessment of tumor cellularity in patients with soft tissue sarcomas. J Magn Reson Imaging. 2009;29:1355–9.

    Article  PubMed  Google Scholar 

  24. Sepahdari AR, Aakalu VK, Kapur R, Michals EA, Saran N, et al. MRI of orbital cellulitis and orbital abscess: the role of diffusion-weighted imaging. AJR. 2009;193:W244–50.

    Article  PubMed  Google Scholar 

  25. Le Bihan D, Turner R, Douek P, Patronas N. Diffusion MR imaging: clinical applications. AJR. 1992;159:591–9.

    PubMed  Google Scholar 

  26. Chien D, Kwong KK, Gress DR, Buonanno FS, Buxton RB, Rosen BR. MR diffusion of cerebral infarction in humans. Am J Neuroradiol. 1992;13:1097–102.

    CAS  PubMed  Google Scholar 

  27. Kastrup O, Wanke I, Maschke. Neuroimaging of infections of the central nervous system. Semin Neurol. 2008;28:511–22.

    Article  PubMed  Google Scholar 

  28. Karchevsky M, Babb JS, Schweitzer ME. Can diffusion-weighted imaging be used to differentiate benign from pathologic fractures? A meta-analysis. Skeletal Radiol. 2008;37:791–5.

    Article  PubMed  Google Scholar 

  29. Gaspersic N, Sersa I, Jevtic V, Tomsic M, Praprotnik S. Monitoring Ankylosing spondylitis therapy by dynamic contrast-enhanced and diffusion-weighted magnetic resonance imaging. Skeletal Radiol. 2008;37:123–31.

    Article  PubMed  Google Scholar 

  30. Qi J, Olsen NJ, Price RR, Winston JA, Park JH. Diffusion-weighted imaging of inflammatory myopathies: polymyositis and dermatomyositis. J Magn Reson Imaging. 2008;27:212–7.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, McMaster University, Hamilton, Ontario, Canada, L8N 2A6

    Srinivasan Harish, Mary M. Chiavaras, Nikhil Kotnis & Ryan Rebello

  2. Department of Diagnostic Imaging, St. Joseph’s Healthcare, Hamilton, Ontario, Canada, L8N 2A6

    Srinivasan Harish & Ryan Rebello

Authors
  1. Srinivasan Harish
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  2. Mary M. Chiavaras
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  3. Nikhil Kotnis
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  4. Ryan Rebello
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Correspondence to Srinivasan Harish.

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Harish, S., Chiavaras, M.M., Kotnis, N. et al. MR imaging of skeletal soft tissue infection: utility of diffusion-weighted imaging in detecting abscess formation. Skeletal Radiol 40, 285–294 (2011). https://doi.org/10.1007/s00256-010-0986-1

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  • DOI: https://doi.org/10.1007/s00256-010-0986-1

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