Algorithms vie for diagnostic role in prostate cancer

The conventional radiographs and urgent short tau inversion recovery (STIR) magnetic resonance image (MRI) examinations of 27 consecutive patients with occult bony injuries were prospectively analysed over a 12 month period. A STIR MRI study was undertaken where the plain films were normal (n = 15) or inconclusive (n = 12) and where the patients' clinical setting was highly suggestive of an underlying bony injury. In six patients, MRI only revealed soft-tissue injuries or joint effusions and did not demonstrate any bony injury but in the remainder fractures or bone contusions were shown to be present. The MRI studies were performed on a 0.2 Tesla lower field strength unit and the examinations were expeditiously performed, inexpensive, and done on a priority basis between electively booked patients. Radio-isotope studies were not available and hence were not included in the study protocol. Apart from demonstrating the value of STIR MRI (without additional T1-weighted sequences in most patients), the purpose of this study was to highlight the alteration in management in 18/27 patients (66%) and the significant alteration in management in six of these patients.