Imaging
Decubitus Ulcers
- Preliminary Diagnosis: Decubitus Ulcers
-
I. What imaging technique is first-line for this diagnosis?
- II. Describe the advantages and disadvantages of this technique for diagnosing decubitus ulcers.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosing decubitus ulcers.
- VI. What are the contraindications for the alternative imaging techniques?
Preliminary Diagnosis: Decubitus Ulcers
I. What imaging technique is first-line for this diagnosis?
MRI
II. Describe the advantages and disadvantages of this technique for diagnosing decubitus ulcers.
Advantages
Can rule out complications of decubitus ulcers, such as osteomyelitis, fluid collections, abscesses, and sinus tract
Does not require use of ionizing radiation and may be performed in pregnant patients
Disadvantages
Expensive
Requires a significant amount of patient cooperation due to long imaging times
III. What are the contraindications for the first-line imaging technique?
Contraindicated in patients with non-MR compatible metallic hardware or foreign bodies
IV. What alternative imaging techniques are available?
Plain radiograph
Nuclear medicine
Computed tomography
Ultrasound
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing decubitus ulcers.
Plain radiograph
Advantages
Relatively quick imaging procedure that requires minimal patient cooperation
Inexpensive
Recommended as the initial imaging technique to evaluate osteomyelitis associated with decubitus ulcers; radiography and MRI are complementary, and both are indicated
Disadvantages
Exposure to ionizing radiation
May be normal in early osteomyelitis
Nuclear medicine
Advantages
Can be used if MRI is contraindicated
The 3-phase bone scan has a high sensitivity for osteomyelitis
An alternative nuclear imaging technique is the 111In-labeled white blood cell scan
Disadvantages
Weak anatomic analysis
Relatively expensive
Radiation risks due to administered radionuclide
3-phase bone scan loses specificity in the setting of recent trauma or surgery, as either of these will mimic osteomyelitis
111In-labeled white blood cell scan has a poor image resolution and often fails to distinguish whether the infection is in bone, soft tissue, or both
Computed tomography
Advantages
May be useful in patients who have a contraindication to MRI
Disadvantages
Exposure to ionizing radiation
Ultrasound
Advantages
Noninvasive
Inexpensive
Does not use ionizing radiation
Can assess associated soft tissue abnormalities, such as cellulitis, soft tissue abscesses, and acute septic arthritis
Disadvantages
Operator dependent
A patient with acute tenderness at the site of suspected infection may not be able to tolerate the ultrasonic probe touching the surface
Limited bone evaluation
VI. What are the contraindications for the alternative imaging techniques?
Plain radiograph
Pregnancy is a relative contraindication. The small risk must be weighed against the benefit.
Nuclear medicine
Contraindicated in pregnant women and those who are breastfeeding
Computed tomography
Contraindicated in pregnant women, especially during the first two trimesters
Ultrasound
No contraindications
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