HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Averill, L. W. Articles by Jaramillo, D. Search for Related Content PubMed PubMed Citation Articles by Averill, L. W. Articles by Jaramillo, D. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?

Diagnosis of Osteomyelitis in Children: Utility of Fat-Suppressed Contrast-Enhanced MRI

¹ Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA 19104.
² Present address: Department of Medical Imaging, Alfred I. duPont Hospital for Children, 1600 Rockland Rd., Wilmington, DE 19803.

OBJECTIVE. The purpose of this study was to determine whether the use of fat-suppressed contrast-enhanced MRI, compared with unenhanced MRI alone, increases reader confidence in the diagnosis of osteomyelitis and its complications in children.

MATERIALS AND METHODS. MRI studies of 78 skeletally immature children and adolescents (median age, 3.6 years) with suspected nonspinal osteomyelitis were reviewed in consensus by two readers. Unenhanced images were evaluated first and then contrast-enhanced MR images. Images were scored for the presence or absence of osteomyelitis, abscess, septic arthritis, and physeal involvement on a 5-point scale ranging from definitely absent to definitely present. Forty-two additional studies were evaluated to test interobserver agreement.

RESULTS. Osteomyelitis was clinically diagnosed in 40 cases (51%). There was no significant difference between the sensitivity and specificity of unenhanced MRI (p = 1.0) and those of contrast-enhanced MRI (p = 0.77) for the diagnosis of osteomyelitis. Nonetheless, there was a significant (p < 0.001) increase in confidence in the diagnosis of osteomyelitis and its complications. This increase in confidence was most pronounced for the diagnosis of abscess (46%). The addition of contrast enhancement was least useful in findings deemed definitely absent on unenhanced MR images.

CONCLUSION. Although it does not increase the sensitivity or specificity of the diagnosis, use of contrast-enhanced MRI does increase reader confidence in the diagnosis of osteomyelitis and its complications in cases in which bone or soft-tissue edema is found on unenhanced images. In the clear absence of edema on unenhanced images, however, contrast enhancement is not needed.

Keywords: children • contrast material • gadolinium • MRI • osteomyelitis

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?