Weaver Jennifer S, Omar Imran M, Mar Winnie A, Klauser Andrea S, Winegar Blair A, Mlady Gary W, McCurdy Wendy E, Taljanovic Mihra S
Department of Radiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.
Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Pol J Radiol. 2022 Mar 5;87:e141-e162. doi: 10.5114/pjr.2022.113825. eCollection 2022.
Magnetic resonance imaging (MRI) is a powerful imaging modality in the evaluation of musculoskeletal (MSK) soft tissue, joint, and bone infections. It allows prompt diagnosis and assessment of the extent of disease, which permits timely treatment to optimize long-term clinical outcomes. MRI is highly sensitive and specific in detecting the common findings of MSK infections, such as superficial and deep soft tissue oedema, joint, bursal and tendon sheath effusions, lymphadenopathy, bone marrow oedema, erosive bone changes and periostitis, and bone and cartilage destruction and sequestration. Contrast-enhanced MRI allows detection of non-enhancing fluid collections and necrotic tissues, rim-enhancing abscesses, heterogeneously or diffusely enhancing phlegmons, and enhancing active synovitis. Diffusion-weighted imaging (DWI) is useful in detecting soft-tissue abscesses, particularly in patients who cannot receive gadolinium-based intravenous contrast. MRI is less sensitive than computed tomography (CT) in detecting soft-tissue gas. This article describes the pathophysiology of pyogenic MSK infections, including the route of contamination and common causative organisms, typical MR imaging findings of various soft tissue infections including cellulitis, superficial and deep fasciitis and necrotizing fasciitis, pyomyositis, infectious bursitis, infectious tenosynovitis, and infectious lymphadenitis, and of joint and bone infections including septic arthritis and osteomyelitis (acute, subacute, and chronic). The authors also discuss MRI findings and pitfalls related to infected hardware and diabetic foot infections, and briefly review standards of treatment of various pyogenic MSK infections.
磁共振成像(MRI)是评估肌肉骨骼(MSK)软组织、关节和骨感染的一种强大的成像方式。它能够迅速诊断并评估疾病范围,从而允许及时治疗以优化长期临床结果。MRI在检测MSK感染的常见表现方面具有高度敏感性和特异性,如浅表和深部软组织水肿、关节、滑囊和腱鞘积液、淋巴结病、骨髓水肿、骨质侵蚀性改变和骨膜炎,以及骨和软骨破坏与死骨形成。对比增强MRI能够检测到无强化的液性聚集和坏死组织、环形强化的脓肿、不均匀或弥漫性强化的蜂窝织炎,以及强化的活动性滑膜炎。扩散加权成像(DWI)在检测软组织脓肿方面很有用,特别是在无法接受基于钆的静脉内对比剂的患者中。MRI在检测软组织气体方面不如计算机断层扫描(CT)敏感。本文描述了化脓性MSK感染的病理生理学,包括污染途径和常见病原体、各种软组织感染(包括蜂窝织炎、浅表和深部筋膜炎以及坏死性筋膜炎、脓性肌炎、感染性滑囊炎、感染性腱鞘炎和感染性淋巴结炎)以及关节和骨感染(包括化脓性关节炎和骨髓炎(急性、亚急性和慢性))的典型MR成像表现。作者还讨论了与感染的植入物和糖尿病足感染相关的MRI表现及陷阱,并简要回顾了各种化脓性MSK感染的治疗标准。