Huang AB, Schweitzer ME, Hume E, Batte WG, et al.
Journal of computer assisted tomography. Date of publication 1998 May 1;volume 22(3):437-43.
1. J Comput Assist Tomogr. 1998 May-Jun;22(3):437-43.
Osteomyelitis of the pelvis/hips in paralyzed patients: accuracy and clinical
utility of MRI.
Huang AB(1), Schweitzer ME, Hume E, Batte WG.
Author information:
(1)Department of Radiology, Thomas Jefferson University Hospital, Philadelphia,
PA 19107, USA.
PURPOSE: The goal of our study was to determine the accuracy and clinical utility
of MRI in the diagnosis of osteomyelitis of the pelvis/hips in paralyzed
patients.
METHOD: In 44 paralyzed patients, 59 consecutive MR examinations of the
pelvis/hips were evaluated prospectively. Criteria for diagnosis of osteomyelitis
were based on those established in previous studies of complex, nonhematogenous
osteomyelitis (diabetic foot). Average follow-up was 3 years. The standard of
reference for the diagnosis of osteomyelitis was histologic/microbiologic results
of surgical biopsy specimens or clinical follow-up. Note was made if decubitus
ulcers, sinus tract, fistula, fluid collection, abscess, septic arthritis, joint
effusion, bursitis, or heterotopic ossification was present on MRI. Comparison of
the extent of infection by MRI and surgical margins was performed. Effect on
surgical treatment was defined by absence of recurrent infection at the surgical
site within 6 weeks of limited resection.
RESULTS: The criteria for diagnosis of osteomyelitis were fulfilled in 49 of 57
MR studies for an overall accuracy of 97%. There was one false-negative MR study.
MRI for the diagnosis of osteomyelitis yielded a sensitivity of 98% and a
specificity of 89%. There were 41 decubitus ulcers, 28 sinus tracts, 2 fistulae,
14 fluid collections, 15 abscesses, 9 hips with septic arthritis, 10 "bland" hip
effusions, 5 cases of trochanteric bursitis, and 30 patients with heterotopic
ossification. Twenty-one patients underwent limited surgical resection guided by
MR findings in which only the enhancing area was resected. There was only one
recurrence of osteomyelitis at the surgical margins.
CONCLUSION: MRI is accurate in the diagnosis of osteomyelitis and associated soft
tissue abnormalities in spinal cord-injured patients. MRI can delineate the
extent of infection in guiding limited surgical resection and preserving viable
tissue.
PMID: 9606387 [Indexed for MEDLINE]
