Magnetic Resonance Imaging of Musculoskeletal Infections: Systematic Diagnostic Assessment and Key Points

Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 601 North Caroline Street, Baltimore, MD 21287.
Academic radiology (Impact Factor: 1.75). 08/2012; 19(11):1434-43. DOI: 10.1016/j.acra.2012.05.022
Source: PubMed


Prompt diagnosis and treatment are essential in preventing the complications of musculoskeletal infection. In this context, imaging is often used to confirm clinically suspected diagnoses, define the extent of infection, and ensure appropriate management. Because of its superior soft-tissue contrast resolution, magnetic resonance imaging (MRI) is the modality of choice for evaluating musculoskeletal infections. This article describes the MRI features along the full spectrum of musculoskeletal infections and provides several illustrative case examples.

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    • "MRI is an essential part of the clinical diagnostic routine in acute injury, musculoskeletal disease, pathologies of the brain such as stroke or neurodegenerative disease, detection and staging of cancer, and in cardiac imaging. However, for the diagnosis of infectious disease, both bacterial and viral, its application is limited and it is primarily used to detect local inflammation, edema formation and other manifestations of the immune response, but not to detect the infectious agent directly or follow the spread of metastatic infections [1] [2] [3]. This lack of application is astonishing, since infectious disease is still one of the major unsolved problems in health care worldwide. "
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    ABSTRACT: The investigation of microbial infections relies to a large part on animal models of infection, if host pathogen interactions or the host response are considered. Especially for the assessment of novel therapeutic agents, animal models are required. Non-invasive imaging methods to study such models have gained increasing importance over the recent years. In particular, magnetic resonance imaging (MRI) affords a variety of diagnostic options, and can be used for longitudinal studies. In this review, we introduce the most important MRI modalities that show how MRI has been used for the investigation of animal models of infection previously and how it may be applied in the future.
    Journal of pharmaceutical and biomedical analysis 11/2013; 93. DOI:10.1016/j.jpba.2013.10.034 · 2.98 Impact Factor
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    • "Haematomas may simulate a cyst but can be differentiated by its signal intensity which depends on blood products’ age (haemoglobin degradation products) [53–55]. Abscesses that can also mimic cysts are associated with infection and inflammation in the surrounding soft tissues and occasionally underlying osteomyelitis [55–57]. Contrast enhancement is necessary for the correct diagnosis and for unmasking a possible sinus tract (Figs. 23, 24 and 25). "
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    ABSTRACT: Objectives and methods: A variety of benign cystic or "cyst-like" lesions may be encountered during a routine magnetic resonance imaging (MRI) of the knee. These lesions comprise a diverse group of entities from benign cysts to complications of underlying diseases. In addition, normal anatomic bursae and recesses may be misdiagnosed as an intra-articular cystic lesion when they are distended. However, the majority of the aforementioned lesions have characteristic MR appearances that allow a confident diagnosis, thus obviating the need for additional imaging or interventional procedures. Results: This article includes a comprehensive pictorial essay of the characteristic MRI features of common and uncommon benign cysts and "cyst-like" lesions in and around the knee joint. Discussion: For accurate assessment of the "cystic structure", a radiologist should be able to identify typical MRI patterns that contribute in establishing the correct diagnosis and thus guiding specific therapy and avoiding unwarranted interventional procedures such as biopsy or arthroscopy. Teaching points: • Cystic lesions are common in knee MRI and the commonest, the Baker's cyst, has an incidence of 38 %. • Synovial cysts, meniscal cysts, normal knee bursae and recesses have characteristic MR appearances. • Miscellaneous "cyst-like" lesions may require a more dedicated MR protocol for a correct diagnosis.
    Insights into Imaging 03/2013; 4(3). DOI:10.1007/s13244-013-0240-1
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    ABSTRACT: Objective: The purposes of this article are to discuss the technical considerations for performing quantitative diffusion-weighted MRI (DWI) with apparent diffusion coefficient (ADC) mapping, examine the role of DWI in whole-body MRI, and review how DWI with ADC mapping can serve as an adjunct to information gleaned from conventional MRI in the radiologic evaluation of musculoskeletal lesions. Conclusion: The primary role of whole-body DWI is in tumor detection; localized DWI is helpful in differentiating malignant bone and soft-tissue lesions. After treatment, an increase in tumor ADC values correlates with response to cytotoxic therapy. The use of DWI in the evaluation of musculoskeletal lesions requires knowledge of potential diagnostic pitfalls that stem from technical challenges and confounding biochemical factors that influence ADC maps but are unrelated to lesion cellularity.
    American Journal of Roentgenology 09/2014; 203(3):560-72. DOI:10.2214/AJR.13.12165 · 2.73 Impact Factor
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