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Updated: Oct 9, 2026
Quantitative Magnetic Resonance Imaging of Skeletal Muscle Disease
Published on: December 18, 2016
[MRI of osteomyelitis: sensitivity and specificity of STIR sequences in comparison with contrast-enhaned T1 spin echo
A H Mahnken1, A Bücker, G Adam
1Klinik für Radiologische Diagnostik, Universitätsklinikum der RWTH Aachen. mahnken@rad.rwth-aachen.de
Purpose:
To evaluate the need for additional MR sequences including administration of Gd-DTPA after inconspicuous Short-Tau Inversion-Recovery (STIR) sequence to exclude the diagnosis of osteomyelitis.
Material And Methods:
112 MR examinations of 79 patients acquired for the detection of possible osteomyelitis were analyzed retrospectively. All examinations were performed at 0.5 T including STIR, T1-weighted spin echo sequences (T1 SE) before and after application of Gd-DTPA. Additionally, 93 T2-weighted spin echo sequences were available. The examinations were analyzed by two experienced radiologists. First, the STIR sequences were studied, followed by the T1 SE images before and after administration of contrast material. Finally, the T2-weighted images were evaluated. Diagnoses were confirmed by operation (22), biopsy (10), and follow-up (80).
Results:
In 53 cases osteomyelitis was diagnosed, while the remaining 59 cases suffered from another disease. The sensitivity of the STIR sequence was 100% while the specificity for osteomyelitis was 49.2%. The specificity increased to 79.7% by including T1 SE images into the analysis and reached 83.1% after considering the contrast enhanced images. T2-weighted images yielded no additional information.
Conclusion:
The combination of STIR and T1SE images shows a high sensitivity and specificity for osteomyelitis, thus obviating the need for any additional examinations.
Insights
Adding T1-weighted spin echo (T1 SE) sequences after Short-Tau Inversion-Recovery (STIR) MRI significantly improves osteomyelitis diagnosis. This combination offers high sensitivity and specificity, eliminating the need for further imaging tests.
Area of Science:
- Radiology
- Medical Imaging
- Orthopedics
Background:
- Osteomyelitis diagnosis can be challenging.
- Short-Tau Inversion-Recovery (STIR) MRI sequences are sensitive but lack specificity.
- Further imaging may be needed to confirm or exclude osteomyelitis.
Purpose of the Study:
- To determine if additional Magnetic Resonance Imaging (MRI) sequences are necessary after an inconspicuous STIR sequence to diagnose osteomyelitis.
- To evaluate the utility of contrast-enhanced T1-weighted spin echo (T1 SE) sequences.
Main Methods:
- Retrospective analysis of 112 MRI exams in 79 patients with suspected osteomyelitis.
- All exams included STIR and T1 SE sequences (pre- and post-Gd-DTPA).
- T2-weighted sequences were also available; diagnoses were confirmed by surgery, biopsy, or follow-up.
Main Results:
- STIR sequences alone had 100% sensitivity but only 49.2% specificity for osteomyelitis.
- Including T1 SE sequences increased specificity to 79.7%.
- Contrast-enhanced T1 SE sequences further improved specificity to 83.1%; T2-weighted images provided no additional benefit.
Conclusions:
- The combination of STIR and T1 SE MRI sequences provides high sensitivity and specificity for diagnosing osteomyelitis.
- This combined approach obviates the need for additional imaging examinations, streamlining the diagnostic process.
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