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MR imaging of urgent inflammatory and infectious conditions affecting the soft tissues of the musculoskeletal system

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Abstract

Soft tissue infections and inflammatory conditions of the musculoskeletal system are a group of disorders commonly seen by emergency room physicians and radiologists. Many of these entities can either be limb- or life-threatening. Magnetic resonance imaging is currently the best imaging modality to evaluate these conditions. In this review, the characteristic imaging findings of cellulitis, abscess formation, necrotizing fasciitis, pyomyositis, diabetic ischemic infarction, acute and exertional compartment syndromes, and rhabdomyolysis will be emphasized as well as imaging factors that can help to differentiate these disorders.

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References

  1. Fayad LM, Carrino JA, Fishman EK (2007) Musculoskeletal infection: role of CT in the emergency department. Radiographics 27:1723–1736. doi:10.1148/rg.276075033

    Article  PubMed  Google Scholar 

  2. McHenry CR, Piotrowski JJ, Petrinic D et al (1995) Determinants of mortality for necrotizing soft-tissue infections. Ann Surg 221:558–565. doi:10.1097/00000658-199505000-00013

    Article  PubMed  CAS  Google Scholar 

  3. Revelon G, Rahmouni A, Jazaerli N et al (1999) Acute swelling of the limbs: magnetic resonance pictorial review of fascial and muscle signal changes. Eur J Radiol 30:11–21. doi:10.1016/S0720-048X(98)00119-3

    Article  PubMed  CAS  Google Scholar 

  4. Rahmouni A, Chosidow O, Mathieu D et al (1994) MR imaging in acute infectious cellulitis. Radiology 192:493–496

    PubMed  CAS  Google Scholar 

  5. Beltran J (1995) MR imaging of soft-tissue infection. Magn Reson Imaging Clin N Am 3:743–751

    PubMed  CAS  Google Scholar 

  6. Struk DW, Munk L, Lee MJ, Ho SG, Worsley DF (2001) Imaging of soft tissue infections. Radiol Clin North Am 39:277–303. doi:10.1016/S0033-8389(05)70278-5

    Article  PubMed  CAS  Google Scholar 

  7. Christian S, Kraas J, Conway WF (2007) Musculoskeletal infections. Semin Roentgenol 42:92–101. doi:10.1053/j.ro.2006.08.011

    Article  PubMed  Google Scholar 

  8. Bivjii AA, Paiement GD, Steinbach LS (2002) Musculoskeletal manifestations of human immunodeficiency virus infection. J Am Acad Orthop Surg 10:312–320

    Google Scholar 

  9. Beltran J, McGhee RB, Shaffer PB, Freedy RM, McCalla MS (1987) Infections of the musculoskeletal system: high-field strength MR imaging. Radiology 164:449–454

    PubMed  CAS  Google Scholar 

  10. Horton LK, Jacobson JA, Powell A et al (2001) Sonography and radiography of soft-tissue foreign bodies. AJR Am J Roentgenol 175:1155–1159

    Google Scholar 

  11. Peterson JJ, Bancroft LW, Kransdorf MJ (2002) Wooden foreign bodies: imaging appearance. AJR Am J Roentgenol 178:557–562

    PubMed  Google Scholar 

  12. Bureau NJ, Chhem RK, Cardinal E (1999) Musculoskeletal infections: US manifestations. Radiographics 19:1585–1592

    PubMed  CAS  Google Scholar 

  13. Paydar KZ, Hansen SL, Charlebois ED, Harris HW, Young DM (2006) Inappropriate antibiotic use in soft tissue infections. Arch Surg 141:850–856. doi:10.1001/archsurg.141.9.850

    Article  PubMed  Google Scholar 

  14. Frazee BW, Lynn J, Charlebois ED, Lambert L, Lowery D, Perdreau-Remington F (2005) High prevalence of methicillin-resistant Staphylococcus aureus in emergency department skin and soft tissue infections. Ann Emerg Med 45:311–320. doi:10.1016/j.annemergmed.2004.10.011

    Article  PubMed  Google Scholar 

  15. Ma LD, McCarthy EF, Bluemke DA et al (1998) Differentiation of benign from malignant musculoskeletal lesions using MR imaging: pitfalls in MR evaluation of lesions with a cystic appearance. AJR Am J Roentgenol 170:1251–1258

    PubMed  CAS  Google Scholar 

  16. Gozal D, Ziser A, Shupak A, Ariel A, Melamed Y (1986) Necrotizing fasciitis. Arch Surg 121:233–235

    PubMed  CAS  Google Scholar 

  17. Anaya DA, Dellinger EP (2007) Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis 44:705–710. doi:10.1086/511638

    Article  PubMed  CAS  Google Scholar 

  18. Voros D, Pissiotis C, Georgantas D, Katsaragakis S, Antoniou S, Papdimitriou J (1993) Role of early and extensive surgery in the treatment of severe necrotizing soft tissue infection. Br J Surg 80:1190–1191. doi:10.1002/bjs.1800800943

    Article  PubMed  CAS  Google Scholar 

  19. Endorf FW, Supple KG, Gamelli RL (2005) The evolving characteristics and care of necrotizing soft-tissue infections. Burns 31:269–273. doi:10.1016/j.burns.2004.11.008

    Article  PubMed  Google Scholar 

  20. Schmid MR, Kossman T, Duewell S (1998) Differentiation of necrotizing fasciitis and cellulitis using MR imaging. AJR Am J Roentgenol 170:615–620

    PubMed  CAS  Google Scholar 

  21. Loh NN, Chen IY, Cheung LP, Li KC (1997) Deep fascial hyperintensity in soft-tissue abnormalities as revealed by T2-weighted MR imaging. AJR Am J Roentgenol 168:1301–1304

    PubMed  CAS  Google Scholar 

  22. Brothers TE, Tagge DU, Stutley JE, Conway F, Del Schutte H, Byrne TK Jr (1998) Magnetic resonance imaging differentiates between necrotizing and non-necrotizing fasciitis of the lower extremity. J Am Coll Surg 187:416–421. doi:10.1016/S1072-7515(98)00192-6

    Article  PubMed  CAS  Google Scholar 

  23. Fugitt JB, Puckett ML, Quigley MM, Kerr SM (2004) Necrotizing fasciitis. Radiographics 24:1472–1476. doi:10.1148/rg.245035169

    Article  PubMed  Google Scholar 

  24. Bickels J, Ben-Sira L, Kessler A, Wientroub S (2002) Primary pyomyositis. J Bone Joint Surg 84A:2277–2286

    Google Scholar 

  25. Restrepo CS, Lemos DF, Gordillo H et al (2004) Imaging findings in musculoskeletal complications of AIDS. Radiographics 24:1029–1049. doi:10.1148/rg.244035151

    Article  PubMed  Google Scholar 

  26. Soler R, Rodriguez E, Aguilera C, Fernandez R (2000) Magnetic resonance imaging of pyomyositis in 43 cases. Eur J Radiol 35:59–64. doi:10.1016/S0720-048X(99)00108-4

    Article  PubMed  CAS  Google Scholar 

  27. Gordon BA, Martinez S, Collins AJ (1995) Pyomyositis: characteristics at CT and MR imaging. Radiology 197:279–286

    PubMed  CAS  Google Scholar 

  28. Nunez-Hoyo M, Gardner CL, Motta AO, Ashmead JW (1993) Skeletal muscle infarction in diabetes: MR findings. J Comput Assist Tomogr 17:986–988

    Article  PubMed  CAS  Google Scholar 

  29. Jelinek JS, Murphey MD, Aboulafia AJ, Dussault RG, Kaplan PA, Snearly WN (1999) Muscle infarction in patients with diabetes mellitus: MR imaging findings. Radiology 211:241–247

    PubMed  CAS  Google Scholar 

  30. Yildirim Donmez F, Feldman F (2008) Muscle compromise in diabetes. Acta Radiol 49:673–679. doi:10.1080/02841850802105269

    Article  PubMed  CAS  Google Scholar 

  31. Kattapuram TM, Suri R, Rosol MS, Rosenberg AE, Kattapuram SV (2005) Idiopathic and diabetic skeletal muscle necrosis: evaluation by magnetic resonance imaging. Skeletal Radiol 34:203–209. doi:10.1007/s00256-004-0881-8

    Article  PubMed  Google Scholar 

  32. Chason DP, Fleckenstein JL, Burns DK, Rojas G (1996) Diabetic muscle infarction: radiologic evaluation. Skeletal Radiol 25:127–132. doi:10.1007/s002560050048

    Article  PubMed  CAS  Google Scholar 

  33. Grigoriadis E, Fam AG, Starok M, Ang LC (2000) Skeletal muscle infarction in diabetes mellitus. J Rheumatol 27:1063–1068

    PubMed  CAS  Google Scholar 

  34. Heppenstall RB, Scott R, Sapega A et al (1986) A comparative study of the tolerance of skeletal muscle to ischemia: tourniquet application compared with acute compartment syndrome. J Bone Joint Surg 68A:820–828

    Google Scholar 

  35. Tiwari A, Haq AI, Myint F, Hamilton G (2002) Acute compartment syndromes. Br J Surg 89:397–412. doi:10.1046/j.0007-1323.2002.02063.x

    Article  PubMed  CAS  Google Scholar 

  36. Konstantakos EK, Dalstrom DJ, Nelles ME, Laughlin RT, Prayson MJ (2007) Diagnosis and management of extremity compartment syndromes: an orthopaedic perspective. Am Surg 73:1199–1209

    PubMed  Google Scholar 

  37. Rominger MB, Lukosch CJ, Bachmann GF (2004) MR imaging of compartment syndrome of the lower leg: a case control study. Eur Radiol 14:1432–1439. doi:10.1007/s00330-004-2305-5

    Article  PubMed  CAS  Google Scholar 

  38. Schepsis AA, Martini D, Corbett M (1993) Surgical management of exertional compartment syndrome of the lower leg: long-term followup. Am J Sports Med 21:811–817. doi:10.1177/036354659302100609

    Article  PubMed  CAS  Google Scholar 

  39. Eskelin MKK, Lotjonen J, Mantysaari MJ (1998) Chronic exertional compartment syndrome: MR imaging at 0.1 T compared with tissue pressure measurement. Radiology 206:333–337

    PubMed  CAS  Google Scholar 

  40. Verleisdonk EJMM, van Gils A, van der Werken C (2001) The diagnostic value of MRI scans for the diagnosis of chronic exertional compartment syndrome of the lower leg. Skeletal Radiol 30:321–325. doi:10.1007/s002560100361

    Article  PubMed  CAS  Google Scholar 

  41. Shintani S, Shiigai T (1993) Repeat MRI in acute rhabdomyolysis: correlation with clinicopathological findings. J Comput Assist Tomogr 17:786–791. doi:10.1097/00004728-199309000-00023

    Article  PubMed  CAS  Google Scholar 

  42. Lu CH, Tsang YM, Yu CW, Wu MZ, Hsu CY, Shih TT (2007) Rhabdomyolysis: magnetic resonance imaging and computed tomography findings. J Comput Assist Tomogr 31:368–374. doi:10.1097/01.rct.0000250115.10457.e9

    Article  PubMed  Google Scholar 

  43. Moratalla MB, Braun P, Fornas GM (2008) Importance of MRI in the diagnosis and treatment of rhabdomyolysis. Eur J Radiol 65:311–315. doi:10.1016/j.ejrad.2007.03.033

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. The Ohio State University, Columbus, USA

    Joseph S. Yu & Paula Habib

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  1. Joseph S. Yu
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  2. Paula Habib
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Correspondence to Joseph S. Yu.

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Yu, J.S., Habib, P. MR imaging of urgent inflammatory and infectious conditions affecting the soft tissues of the musculoskeletal system. Emerg Radiol 16, 267–276 (2009). https://doi.org/10.1007/s10140-008-0786-2

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  • DOI: https://doi.org/10.1007/s10140-008-0786-2

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