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[Magnetic resonance findings in chronic osteomyelitis fistula]
G Capparelli1, D Barresi, B Bertucci
1Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi, Catanzaro.
Introduction:
Osteomyelitis is a common inflammatory process caused by an infection which is usually from gram-positive germs. Acute, subacute and chronic forms can be distinguished both clinically and radiographically, each of them presenting different patterns but which are not always easy to recognize. Besides clinical-laboratory data, imaging methods are also useful to make the diagnosis; in chronic forms, MRI has higher sensitivity in recognizing the active foci and the presence of sinus tracts than the other techniques.
Material And Methods:
We examined nine patients with suspected chronic osteomyelitis with a sinus tract, all of them submitted to radiographic and MR examinations. MRI was performed with a .5 T magnet using a surface coil for joint studies; T1-weighted SE (TR 300-500, TE 20), T2-weighted GE (TR 500-700, TE 20, FA 35 degrees) and FIR sequences with fat suppression (TR 3000, TE 20, TI 100) were performed on the axial, sagittal and coronal planes. Three patients underwent CT too.
Results:
Radiography showed the osteostructural changes as osteolytic and osteosclerotic areas. CT depicted not only the changes seen radiographically, but also increased bone marrow density. MRI demonstrated active foci of bone marrow appearing as low-intensity areas in T1, with increased intensity in T2 GE and fat-suppressed FIR images; it also depicted the sinus tracts as areas of decreased signal on T1 and of increased signal on FIR images.
Conclusions:
Based on our experience and in agreement with the literature data, we believe that MRI is more useful to diagnose the active foci of bone marrow and the sinus tracts in chronic osteomyelitis, especially with T1-weighted SE and fat-suppressed FIR sequences.
Insights
Magnetic Resonance Imaging (MRI) is more effective for diagnosing active bone marrow foci and sinus tracts in chronic osteomyelitis. This advanced imaging technique offers superior sensitivity compared to traditional radiography and CT scans.
Area of Science:
- Orthopedics and Radiology
- Infectious Diseases
- Medical Imaging
Context:
- Osteomyelitis, an infection of the bone, presents in acute, subacute, and chronic forms.
- Chronic osteomyelitis diagnosis can be challenging due to overlapping clinical and radiographic patterns.
- Imaging modalities are crucial for diagnosis, with MRI showing higher sensitivity for active foci and sinus tracts in chronic cases.
Purpose:
- To evaluate the utility of Magnetic Resonance Imaging (MRI) in diagnosing active foci and sinus tracts in chronic osteomyelitis.
- To compare the diagnostic performance of MRI against radiography and Computed Tomography (CT) in chronic osteomyelitis.
- To identify optimal MRI sequences for visualizing disease activity in chronic osteomyelitis.
Summary:
- Nine patients with suspected chronic osteomyelitis and sinus tracts underwent radiography and MRI, with three also having CT.
- MRI, particularly T1-weighted SE and fat-suppressed FIR sequences, effectively identified active bone marrow foci and sinus tracts.
- Radiography showed osteostructural changes, CT revealed increased bone marrow density, while MRI provided detailed visualization of active disease and sinus tracts.
Impact:
- MRI enhances the diagnostic accuracy of chronic osteomyelitis, especially in detecting active disease foci and sinus tracts.
- Findings support the use of specific MRI sequences (T1-weighted SE, fat-suppressed FIR) for improved chronic osteomyelitis diagnosis.
- This study contributes to better management strategies for chronic osteomyelitis through more precise imaging.