Magnetic resonance imaging of pressure sores in spinal cord injured patients: accuracy in predicting osteomyelitis.

OBJECTIVE: Identify key magnetic resonance imaging (MRI) features that have a significant correlation with osteomyelitis of pressure ulcers in spinal injury patients. DESIGN: Retrospective review study. PARTICIPANTS: Adult patients admitted to the National Spinal Injuries Centre with spinal cord injury (SCI) and signs of pressure ulceration investigated with MRI. METHODS: Analysis of MRI examinations and clinical records collected over a 4-year period. Images were independently assessed by 2 experienced radiologists for osteomyelitis based on assigned predictive indicators including cortical bone erosion, soft tissue edema, deep collections, heterotopic new bone, hip effusion, and abnormal signal change of the marrow. RESULTS: Thirty-seven patients underwent 41 MRI scans. The prevalence of osteomyelitis was highly correlated with cortical bone erosion (r = 0.84) and abnormal bone marrow changes on T1-weighted images (r = 0.82).

Combined helical computed tomographic pulmonary angiography and lung perfusion scintigraphy for investigating acute pulmonary embolism.

AIM: To evaluate a diagnostic protocol incorporating helical computed tomographic pulmonary angiography (CTPA) and lung perfusion scintigraphy in the detection or exclusion of pulmonary embolism (PE) in routine clinical practice. MATERIALS AND METHODS: A prospective observational study of 808 consecutive patients with suspected acute PE was undertaken over a 23-month period. Twenty-nine cases who failed to follow the protocol were excluded, leaving 779 cases to be reviewed. The three main outcome measures were negative perfusion scintigraphy, positive CTPA and other significant abnormalities demonstrated on CT. RESULTS: Two hundred and thirty-one (30%) had negative perfusion scintigraphy and no further investigation. CTPA was performed in 548 (70%) and PE confirmed in 193 (25% of all patients). Other significant abnormalities were demonstrated in 25 (3%). CTPA was technically inadequate in 15 (2%). CONCLUSIONS: A confident conclusion was achieved in 449 cases (58%), with PE excluded in 231 (30%), proved in 193 (25%), and relevant alternative abnormalities found in 25 (3%). This protocol using both perfusion scintigraphy and CTPA is practical and more effective than either investigation alone.