AbstractThe purpose of our study was to use magnetic resonance imaging (MRI) to determine deep changes in soft tissues and bones underlying decubitus ulcers which occur in spinal cord injury (SCI) patients. By diagnosing these deep changes adjacent to decubitus ulcers, MRI can facilitate proper clinical management and prevent contraindicated surgery. MRI evaluation was performed on 37 male SCI patients for a total of 44 diagnostic studies. The studies were evaluated by the following criteria: 1) the presence of an adjacent fluid collection, 2) bone involvement raising the possibility of osteomyelitis and 3) heterotopic bone formation. Results demonstrated 11 patients (29.7 percent) with fluid collection in the deep soft tissues underlying the decubitus ulcer and eight patients (21.6 percent) with abnormal adjacent bone marrow signal. Four patients (10.8 percent) had heterotopic bone formation near the ulcer. We conclude that MRI is helpful in determining the depth and extent of soft tissue involvement underlying decubitus ulcers including underlying fluid collections, heterotopic bone formation and evidence of adjacent bone marrow edema. This is beneficial in planning proper therapy. (J Spinal Cord Med1996; 19:5–8.)