Magnetic resonance imaging and spectroscopy of pressure ulcers

In the previous chapters of this book, we have seen that pressure ulcers (decubitus ulcers) are extremely common in patients who are bed or chair bound, e.g. during hospitalization or because of spinal cord injuries. The ulcers can range from mild coloration of the skin to deep non-healing wounds, which extend into organs or bone. This complex pathology and aetiology of pressure ulcers makes a clinical evaluation by physical examination alone very difficult, if not impossible. Therefore, there is a great need for diagnostic methods to evaluate the depth and extent of pressure ulcers. With their ability to measure structural, functional and metabolic parameters in healthy and diseased tissue, magnetic resonance imaging (MRI) and spectroscopy (MRS) offer a variety of fast and non-invasive tools that can be used not only for diagnosis and suitable planning of treatment, but also for a better understanding of the mechanisms underlying the formation of pressure ulcers. In this chapter the current MR literature on pressure ulcers is discussed and new techniques that can be used in research and clinical diagnosis are proposed. The outline of the chapter is as follows. First the present role of MR techniques in pressure ulcer research is reviewed. Subsequently, a brief description of the basic principles of MR is given, followed by an explanation of a number of MR modalities and their (possible) applications in relation to the investigation of pressure ulcers. We conclude with a summary and perspective.