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[Magnetic resonance tomography in the diagnosis of mandibular osteomyelitis]
S Köhnlein1, G Brinkmann, T Körner
1Klinik für Radiologische Diagnostik, Christian-Albrechts-Universität zu Kiel.
Purpose:
A prospective study of the value of MRI in the diagnosis of osteomyelitis of the mandible with special reference to the suitability of different MR sequences.
Material And Methods:
In 13 patients, average age 55 years (12-82), with clinical suspicion of osteomyelitis of the mandible, 18 MRI examinations were carried out (STIR, TSE T2, proton and SE T1 weighted scans with and without contrast, slice thickness 3.5 to 6 mm). Image quality of the sequences was evaluated as well as the suitability of the various sequences for showing the lesion, its location and extent. Activity of the osteomyelitis was judged by the degree of contrast uptake and was correlated with 3-phase bone scintigraphy and with histological findings.
Results:
In 9 of the 14 cases the findings on MRI and of the scintigraphy agreed with the histology. In two patients the activity of the inflammatory process was exaggerated by the MRI. In another follow-up examination it was slightly underestimated. All lesions were shown to be highly active by the histology were recognized as such by MRI. For the localisation and recognition of the extent of the inflammatory processes STIR sequences and T1 weighted non-enhanced SE sequences proved the most suitable. Contrast medium is essential to evaluate the inflammatory activity.
Conclusion:
MRI is a sensitive diagnostic method; it is as good as 3-phase bone scintigraphy in demonstrating osteomyelitis of the mandible and of its activity but is superior for showing the pathological anatomy.
Insights
Magnetic Resonance Imaging (MRI) is a sensitive method for diagnosing mandibular osteomyelitis. It is comparable to bone scintigraphy for assessing disease activity but offers superior visualization of pathological anatomy.
Area of Science:
- Radiology
- Medical Imaging
- Oral and Maxillofacial Surgery
Background:
- Osteomyelitis of the mandible presents diagnostic challenges.
- Accurate assessment of disease extent and activity is crucial for effective treatment.
Purpose of the Study:
- To evaluate the diagnostic value of MRI in mandibular osteomyelitis.
- To determine the suitability of different MRI sequences for diagnosis.
- To compare MRI findings with bone scintigraphy and histology.
Main Methods:
- Prospective study involving 13 patients with suspected mandibular osteomyelitis.
- 18 MRI examinations using various sequences (STIR, TSE T2, T1 weighted with/without contrast).
- Image quality, lesion depiction, and inflammatory activity (contrast uptake) were assessed and correlated with scintigraphy and histology.
Main Results:
- MRI findings agreed with histology in 9 out of 14 cases.
- STIR and non-enhanced T1 SE sequences were most suitable for localization and extent.
- Contrast-enhanced MRI is essential for evaluating inflammatory activity, though occasional over/underestimation occurred.
Conclusions:
- MRI is a sensitive diagnostic tool for mandibular osteomyelitis.
- MRI is comparable to 3-phase bone scintigraphy in demonstrating disease and activity.
- MRI provides superior visualization of pathological anatomy compared to scintigraphy.