11 October 2004 (online)
Musculoskeletal infections have been a long interest of ours. Because of the diversity of the disease conditions, this is one of the more fascinating areas of research and clinical practice. With the increased mobility of populations and in particular with the current rapid increase in the incidence of type II diabetes in western societies, these issues will become even more of a burden to the medical system.
One of the more fascinating intellectual developments in medicine in the past 15 years has been that many diseases that were formerly thought to be of metabolic or inflammatory etiology have consequently been found to be infectious diseases. These include such diverse conditions as peptic ulceration, type I diabetes, cervical cancer, Reiter’s syndrome, and reactive arthritis. It is our belief that in the musculoskeletal system we are merely scratching the surface regarding infections and will soon discover that many disorders that were formerly thought to be noninfectious end up having an infectious etiology. Therefore, the timing of this issue is apt.
In this issue of Seminars in Musculoskeletal Radiology we take pride in having the opening article by Drs. Gil and Morrison on imaging of diabetic foot infection. David and I take tremendous pride in having a role in the training of both of these exceptionally capable individuals. Dr. Bohndorf then continues with an article on imaging in posttraumatic osteomyelitis, an increasingly important entity and one we believe is currently underemphasized in most radiology residency training. There are two articles on techniques in this issue: one on scintigraphy, which in recent years has unfortunately been somewhat underemphasized in the evaluation of musculoskeletal infections, and the second on magnetic resonance (MR) imaging of spinal infection, currently the state of the art in most developed nations. In addition, there is an important article on parasitic and fungal diseases of bone and joints. The issue ends with two articles that evaluate infections in younger populations: one on chronic recurrent multifocal osteomyelitis and one on imaging of pediatric osteomyelitis.
This is an exceptionally thorough issue of Seminars. Dr. Bohndorf and collaborators have done an outstanding job in reviewing infections of the musculoskeletal system. This family of diseases is close to my heart because it was my first, and continues to be one of my stronger, personal areas of research interest. It is fascinating to compare how different the state of the art is in understanding the musculoskeletal aspects of these diseases when looking back a decade ago. At that time MR was just beginning to be used in diabetic infections and in spinal infections. Chronic multifocal osteomyelitis was considered to be a disorder of unknown origin. Posttraumatic osteomyelitis was considered to be predominantly an orthopedic concern with little imaging requirements. At that time the study of scintigraphic techniques was just blossoming with the increase in utilization of labeled white blood cell scans. Ten years from now it is possible that the picture may look very different, and I think we should strive to understand further the infectious etiology of many diseases in the musculoskeletal system that are currently thought to be of disparate etiologies. We look forward to that time but continue to enjoy the exceptional evolution of our subspecialty in the evaluation of infection over time.
We hope the readers will enjoy this issue as much as we have. Our sincerest thanks to Dr. Bohndorf and his esteemed contributors who have made our journal the finest and most contemporary in its field.