Zusammenfassung.
Ziel: Zu ermitteln, ob zum Ausschluss einer Osteomyelitis nach unauffälliger Short-Tau
Inversion-Recovery Sequenz (STIR) weitere, insbesondere kontrastangehobene Sequenzen
notwendig sind. Material und Methode: Es wurden 112 MRT Untersuchungen von 79 Patienten mit der Fragestellung Osteomyelitis
retrospektiv ausgewertet. Bei sämtlichen Untersuchungen waren bei 0,5 T sowohl eine
STIR als auch T1-gewichtete Spinechosequenz (T1-SE) vor und nach Kontrastmittelgabe verfügbar. In 93 Fällen lagen auch T2-gewichtete Spinechosequenzen (T2-SE) vor. Zwei Radiologen werteten die Untersuchungen in der Reihenfolge STIR-Sequenz,
T1-SE-Bilder vor und nach Gabe von Gd-DTPA, T2-SE-Bilder unter der Fragestellung Osteomyelitis aus. Die Diagnosesicherung erfolgte
operativ (22), bioptisch (10) und durch Verlaufskontrolle (80). Ergebnisse: Bei 53 Untersuchungen lag eine Osteomyelitis, in 59 Fällen eine andere Diagnose vor.
Die Sensitivität der STIR-Technik lag bei 100 %, die Spezifität bei 49,2 %. Durch
zusätzliche T1-SE-Bilder ließ sich die Spezifität auf 79,7 % vor und 83,1 % nach Kontrastmittelgabe
steigern. Durch zusätzliche T2-gewichtete Untersuchungen ließ sich keine zusätzliche Information gewinnen. Schlussfolgerungen: Zur Diagnostik der Osteomyelitis weist die Kombination aus STIR und T1-SE-Bildern eine hohe Sensitivität und Spezifität auf. Bei unauffälliger STIR-Sequenz
kann eine Osteomyelitis ohne Durchführung weiterer Untersuchungen ausgeschlossen werden.
MRI of Osteomyelitis. Sensitivity and Specificity of STIR Sequences in Comparison
to Contrast-Enhanced T1 Spin Echo Sequences.
Purpose: To evaluate the need for additional MR sequences including administration of Gd-DTPA
after inconspicuous Short-Tau Inversion-Recovery (STIR) sequence to exclude the diagnosis
of osteomyelitis. Material and Methods: 112 MR examinations of 79 patients acquired for the detection of possible osteomyelitis
were analyzed retrospectively. All examinations were performed at 0.5 T including
STIR, T1-weighted spin echo sequences (T1 SE) before and after application of Gd-DTPA. Additionally, 93 T2-weighted spin echo sequences were available. The examinations were analyzed by two
experienced radiologists. First, the STIR sequences were studied, followed by the
T1 SE images before and after administration of contrast material. Finally, the T2-weighted images were evaluated. Diagnoses were confirmed by operation (22), biopsy
(10), and follow-up (80). Results: In 53 cases osteomyelitis was diagnosed, while the remaining 59 cases suffered from
another disease. The sensitivity of the STIR sequence was 100 % while the specificity
for osteomyelitis was 49.2 %. The specificity increased to 79.7 % by including T1 SE images into the analysis and reached 83.1 % after considering the contrast enhanced
images. T2-weighted images yielded no additional information. Conclusion: The combination of STIR and T1SE images shows a high sensitivity and specificity for osteomyelitis, thus obviating
the need for any additional examinations.
Schlüsselwörter:
Osteomyelitis, Diagnose - MRT - Gadolinium
Key words:
Osteomyelitis/Diagnosis - MRI - Gadolinium
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Dr. med. Andreas H. Mahnken
Klinik für Radiologische Diagnostik Universitätsklinikum der RWTH Aachen
Pauwelsstraße 30
52057 Aachen
eMail: mahnken@rad.rwth-aachen.de
