Thirty-seven patients who were clinically suspected of having vertebral osteomyelitis were prospectively evaluated with magnetic resonance (MR), radiography, and radionuclide studies. These findings were correlated with the final clinical, microbiologic, or histologic diagnoses. Based on the results of these latter studies, 23 patients were believed to have osteomyelitis. MR examinations consisted of at least a sagittal image (TE = 30 msec, TR = 0.5 sec) and an image obtained at TE = 120 msec, TR = 2-3 sec. All patients underwent radiographic and MR examinations, 36 underwent technetium 99m-HDP bone scanning, and 20 patients underwent gallium 67 scanning. Nineteen patients underwent both bone and gallium scanning. The imaging studies were reviewed independently by investigators blinded to the final diagnoses. MR had a sensitivity of 96%, specificity of 92%, and accuracy of 94%. Combined gallium and bone scan studies (19 cases) had a sensitivity of 90%, specificity of 100%, and accuracy of 94%. Bone scans alone had a sensitivity of 90%, specificity of 78%, and accuracy of 86%. Plain radiographs had a sensitivity of 82%, specificity of 57%, and accuracy of 73%. The MR appearance of vertebral osteomyelitis in this study was characteristic, and MR was as accurate and sensitive as radionuclide scanning in the detection of osteomyelitis.

Sixty-five patients were examined with magnetic resonance imaging (MR) to determine what combination of operator-selectable controls would result in a thorough examination of the intervertebral disks. There were 20 normal subjects, 8 with degenerative lumbar disk disease, 27 with both degeneration and herniation, 5 with stenosis of the spinal canal, and 5 with disk space infection. T2 was significantly longer in the normal nucleus pulposus than in the degenerated disk. Based on plots of in vivo signal intensity vs. repetition time (TR) for various echo times (TE), a sagittal 30-msec. TE and a 0.25-sec. TR were used for anatomical delineation and rapid localization, while sagittal and/or axial 120-msec. TE/3-sec. TR images were used to evaluate the cerebrospinal fluid and disk. Comparison with radiographs, high-resolution CT scans, and myelograms showed that MR was the most sensitive for identification of degeneration and disk space infection, separating the normal nucleus pulposus from the annulus and degenerated disk. Herniation, stenosis of the canal, and scarring can be identified as accurately with MR as with CT or myelography.

Physiological calcification of the globus pallidus was visualized by computed tomography in 32 patients. The frequency of visualization increased with increasing age. Patients under the age of 40 with calcification of the globus pallidus should be evaluated for disorders associated with pathological calcification of the basal ganglia. Patients of any age with calcification in the lenticular nucleus and elsewhere in the basal ganglia, dentate nucleus, or multiple areas of the cortex should also be evaluated for these disorders.

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Conventional angiography and intravenous digital subtraction angiography (DSA) were used to examine the common carotid artery bifurcations in 100 patients with clinically suspected arteriosclerotic disease. In 60% of the patients, the quality of the DSA examination was good or excellent bilaterally; in 23%, the quality was good or excellent on one side; in the remaining 17%, both bifurcations were poorly visualized. There was excellent correlation of conventional and digital angiograms when the carotid bifurcations were well visualized with DSA (sensitivity 95%, specificity 99%, accuracy 97%). When the carotid bifurcations were not well visualized with DSA, there was a substantial chance for misinterpretation of the study (sensitivity 54%, specificity 70%, accuracy 64%). Digital subtraction angiography is a safe, rapid procedure that can be performed on an outpatient basis and can accurately evaluate the carotid bifurcation in approximately 70% of the arteries examined.