Magnetic resonance imaging of osteomyelitis

Early diagnosis and detection of osteomyelitis and differentiation of soft-tissue infection from bone involvement is a difficult clinical and imaging problem. Magnetic resonance imaging has proven to be as sensitive as bone scintigraphy in the early detection of osteomyelitis, and, with its superior spatial resolution, MR is often more specific than planar scintigraphy in differentiating bone from soft-tissue infection and separating arthritis, cellulitis, and soft-tissue abscess from osteomyelitis. In several comparative studies, MR has been more advantageous in detecting the presence and determining the extent of osteomyelitis over scintigraphy, CT scan, and conventional radiography. MRI may facilitate differentiation of acute from chronic osteomyelitis and may help to detect foci of active infection in the presence of chronic inflammation or posttraumatic lesions. MRI has a large role in evaluating the presence and extent of spondylitis and epidural abscess and certain distribution features may help recognize tuberculous spondylitis. Gadolinium-enhanced MR could be helpful in delineating the meninges and demonstrating the border and extent of epidural abscesses.