Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul 08308, South Korea.
Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul 08308, South Korea.
Acad Radiol. 2019 Nov;26(11):e317-e323. doi: 10.1016/j.acra.2019.01.001. Epub 2019 Jan 17.
To assess the diagnostic power of MR imaging features for post-traumatic osteomyelitis (PTOM) of the extremities with metal implants using a 3.0-T machine with conventional metal-artifact reducing (MAR) protocols.
Between December 2012 and September 2016, 261 consecutive patients underwent MRI for clinical suspicion of PTOM in the appendicular skeleton at our hospital. A total of 72 enrolled patients with metal implants were divided into two groups, one with surgical, histologic, or microbiologic proven to be PTOM, and the other proven not to be PTOM. Their MR images were reviewed by two musculoskeletal radiologists who qualitatively analyzed various findings regarding PTOM, and concluded diagnosis of PTOM or without PTOM for each patient. All MR images were obtained using conventional MAR protocols.
The sensitivity, specificity, positive and negative predictive values, and accuracy of MR diagnosis by two observers were 55%/38%, 81%/93%, 67%/40%, 73%/78%, and 71%/71%, respectively. Among the findings, T1 low signal intensity, medullary location, confluent pattern, typical features (concurrence of T1 low signal intensity, medullary, and confluent patterns), heterogeneous or no enhancement, and cortical destruction were statistically significant by univariate analysis (p<0.05). Among these features, only medullary involvement was significant by multivariate analysis (p = 0.007). Medullary involvement and no enhancement pattern were significant by step-wise discrimination analysis. Interobserver correlation was moderate with a weighted kappa value of 0.512 (confidence interval: 0.3-0.723).
The overall accuracy for diagnosis of PTOM of the extremities using 3.0-T MRI with conventional metal-artifact reduction parameters was 71%. The strongest diagnostic MR imaging feature was medullary involvement of T1 low signal intensity. PTOM of the extremities can be accurately diagnosed with a 3.0-T MR machine using conventional MAR protocols.
使用配备常规金属伪影抑制（MAR）协议的 3.0T 磁共振成像（MRI）设备评估四肢外伤性骨髓炎（PTOM）的 MRI 特征的诊断效能。
2012 年 12 月至 2016 年 9 月期间，我院对 261 例怀疑患有四肢外伤性骨髓炎的患者进行了 MRI 检查。72 例患者（共 72 处病变）纳入本研究，这些患者均存在金属植入物，分为两组：手术、组织学或微生物学证实的 PTOM 组，和未证实为 PTOM 的组。两位肌肉骨骼放射科医生对所有患者的 MRI 图像进行了定性分析，以评估各种与 PTOM 相关的发现，并得出每位患者是否患有 PTOM 的诊断。所有 MRI 图像均采用常规 MAR 协议获取。
两位观察者的 MRI 诊断 PTOM 的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为 55%/38%、81%/93%、67%/40%、73%/78%和 71%/71%。在各种发现中，T1 低信号强度、骨髓内位置、融合模式、典型特征（T1 低信号强度、骨髓内和融合模式同时存在）、不均匀或无强化以及皮质破坏在单变量分析中具有统计学意义（p<0.05）。多变量分析仅显示骨髓受累有统计学意义（p=0.007）。逐步判别分析显示骨髓受累和无强化模式具有统计学意义。观察者间的相关性为中度，加权 κ 值为 0.512（置信区间：0.3-0.723）。
使用配备常规 MAR 参数的 3.0T MRI 对四肢外伤性骨髓炎进行诊断的准确率为 71%。最强的 MRI 诊断特征是 T1 低信号强度骨髓受累。使用常规 MAR 协议，3.0T MRI 可准确诊断四肢外伤性骨髓炎。
