Gadolinium-DTPA: value in MR imaging of extraspinal musculoskeletal infections

To determine if paramagnetic contrast agents can improve the detection, delineation, and characterization of extraspinal musculoskeletal infections (MSI) on magnetic resonance (MR) imaging, 42 patients with clinical suspicion of MSI underwent MR imaging before and after intravenous administration of gadolinium-DTPA. The lesions consisted of 27 proven infections and 15 noninfective conditions. Specificity and accuracy in identifying infective lesions averaged 80% and 84%, respectively, on precontrast studies and 80% and 89% on the enhanced examinations, with no statistically significant difference. Rim enhancement around abscess loculi was the only pathognomonic sign of infection seen in ten patients with chronic osteomyelitis and pyogenic or tuberculous infections. In 17 patients with acute osteomyelitis, brucellosis, or mycetoma, detection and delineation of the lesions were best on precontrast studies, while postcontrast examinations resulted in underestimation of the extent of abnormalities in all cases. We conclude that intravenous gadolinium-DTPA has limited usefulness in the MR evaluation of extraspinal MSI.