Clinical impact of gadolinium in the MRI diagnosis of musculoskeletal infection in children.
BACKGROUND
The incremental value of gadolinium in the diagnosis of musculoskeletal infection by MRI is controversial.


OBJECTIVE
To compare diagnostic utility of noncontrast with contrast MRI in the evaluation of pediatric musculoskeletal infections.


METHODS
We reviewed 90 gadolinium-enhanced MRIs in children with suspected musculoskeletal infection. Noncontrast and contrast MRI scans were evaluated to determine sensitivity and specificity in the diagnosis of musculoskeletal infection and identification of abscesses.


RESULTS
Pre- and post-contrast diagnosis of osteomyelitis sensitivity was 89% and 91% (P = 1.00) and specificity was 96% and 96% (P = 1.00), respectively; septic arthritis sensitivity was 50% and 67% (P = 1.00) and specificity was 98% and 98% (P = 1.00), respectively; cellulitis/myositis sensitivity was 100% and 100% (P = 1.00) and specificity was 84% and 88% (P = 0.59), respectively; abscess for the total group was 22 (24.4%) and 42 (46.6%), respectively (P < 0.0001). Abscesses identified only on contrast sequences led to intervention in eight additional children. No child with a final diagnosis of infection had a normal pre-contrast study.


CONCLUSIONS
Intravenous gadolinium should not be routinely administered in the imaging work-up of nonspinal musculoskeletal infections, particularly when pre-contrast images are normal. However, gadolinium contrast significantly increases the detection of abscesses, particularly small ones that might not require surgical intervention.
Kan
J Herman
JH
Department of Radiology and Radiological Sciences, Vanderbilt Children's Hospital, Vanderbilt University, 2200 Children's Way, Nashville, TN 37232, USA. herman.kan@vanderbilt.edu
Young
Robert S
RS
Yu
Chang
C
Hernanz-Schulman
Marta
M
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D010019:Osteomyelitis / Q000175:diagnosis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
D003287:Contrast Media; D019786:Gadolinium DTPA