Is there a need for contrast-enhanced T1-weighted MRI of the spine after inconspicuous short tau inversion recovery imaging?

To assess the use of contrast-enhanced T1-weighted images in comparison with short tau inversion recovery (STIR) images for the detection of vertebral bone marrow abnormalities. A total of 201 vertebral magnetic resonance (MR) examinations were included in a prospective trial. Examinations were performed on a 0.5-T MR scanner. The examination protocol included STIR, T2-weighted turbo spin-echo and T1-weighted spin-echo images before and after administration of gadopentetate dimeglumine. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of STIR images were calculated. In the case of abnormal STIR images the additional information from contrast-enhanced images was evaluated using Fisher's exact test. The value of the combined evaluation of STIR and contrast-enhanced T1-weighted images was compared with that of the combined assessment of T2-weighted and contrast-enhanced T1-weighted images. The PPV and the NPV of STIR images for detection of vertebral bone marrow abnormalities were 99.3 and 95.9%. In the case of normal STIR images no relevant additional information was found with contrast-enhanced T1-weighted images, while in the case of abnormal STIR images significant supplementary information was obtained. There was no difference in the diagnostic value when comparing combined assessment of STIR and contrast-enhanced T1-weighted images with combined evaluation of T2-weighted and contrast-enhanced T1-weighted images. Normal STIR images allow contrast-enhanced T1-weighted images for detection of bone marrow abnormalities to be omitted, whereas further imaging is needed in case of abnormal STIR images.