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T1-weighted MRI imaging features of pathologically proven non-pedal osteomyelitis
Benjamin Matthew Howe1, Doris E Wenger, Jay Mandrekar
1Department of Radiology, Mayo Clinic-Rochester, Rochester, MN 55902, USA. howe.benjamin@mayo.edu
Rationale And Objectives:
The objective of our study was to determine if the T1-weighted magnetic resonance imaging (MRI) features associated with diabetic pedal osteomyelitis are present in histopathologically proven cases of non-pedal osteomyelitis.
Materials And Methods:
Seventy-five patients with a histopathologically proven diagnosis of non-pedal osteomyelitis and a preoperative MRI were identified between 2000 and 2007. The MRIs were retrospectively reviewed for signal characterization of T1-weighted images, including the signal intensity compared with skeletal muscle, distribution of abnormal signal intensity, and pattern of abnormal signal intensity. A subsequent chart review was performed to identify potential clinical factors that were more associated with atypical T1 features of osteomyelitis. Fisher's exact test was performed to determine if there was a statistically significant difference in the T1-weighted imaging features of the hematogenous and nonhematogenous mechanisms of infection.
Results:
Seventy of 75 cases demonstrated T1-weighted imaging features typical of pedal osteomyelitis with a confluent region of decreased signal intensity, hypointense, or isointense relative to skeletal muscle in a geographic pattern with medullary distribution. Of the 5 cases that did not demonstrate the typical T1 features associated with pedal osteomyelitis, 4 were considered to have a hematologic mechanism of infection given the absence of surgery, skin ulceration, or a penetrating injury.
Conclusion:
The majority of cases of non-pedal osteomyelitis in our study demonstrate the typical T1-weighted imaging features previously documented to correlate with the diagnosis of pedal osteomyelitis. The cases in our series that did not demonstrate the typical T1-weighted features were predominantly secondary to a hematologic mechanism of infection.
Insights
T1-weighted magnetic resonance imaging (MRI) features typical of diabetic pedal osteomyelitis are also present in most non-pedal osteomyelitis cases. Cases lacking these typical T1 MRI features were often due to hematologic infection mechanisms.
Area of Science:
- Radiology
- Orthopedic Surgery
- Infectious Diseases
Background:
- Diabetic pedal osteomyelitis has characteristic T1-weighted MRI features.
- It is unclear if these features are specific to pedal osteomyelitis.
Purpose of the Study:
- To investigate if T1-weighted MRI findings typical of diabetic pedal osteomyelitis are present in non-pedal osteomyelitis.
Main Methods:
- Retrospective review of 75 patients with histopathologically proven non-pedal osteomyelitis and preoperative MRI.
- Analysis of T1-weighted MRI signal intensity, distribution, and pattern.
- Fisher's exact test to compare hematogenous and nonhematogenous infection mechanisms.
Main Results:
- 70 out of 75 (93%) non-pedal osteomyelitis cases showed typical T1-weighted MRI features of pedal osteomyelitis.
- The remaining 5 cases, mostly with hematologic origins, lacked these typical features.
Conclusions:
- Typical T1-weighted MRI features for pedal osteomyelitis are common in non-pedal osteomyelitis.
- Hematologic mechanisms are associated with atypical T1 MRI findings in osteomyelitis.
