Labiste Chase C, McElroy Evan, Subhawong Ty K, Banks James S
Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA.
Department of Radiology, Miller School of Medicine, University of Miami, Coral Gables, FL, USA.
Skeletal Radiol. 2022 Jun;51(6):1285-1296. doi: 10.1007/s00256-021-03915-4. Epub 2021 Oct 13.
Osteomyelitis is an infection of the bone marrow. MRI with gadolinium-based contrast is frequently performed for cases of suspected osteomyelitis. The objective of this systematic review is to examine the diagnostic accuracy of contrast-enhanced vs non-contrast-enhanced MRI for osteomyelitis in the appendicular skeleton.
We conducted a systematic review of MRI in the diagnosis of osteomyelitis by searching MEDLINE and EMBASE from January 2000 to March 2020. There were 21 studies that met the inclusion criteria for the systematic review for a total of 1095 patients. Analytic methods were based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Evidence was evaluated using the STARD criteria for evaluation of completeness and transparency of reporting.
For diagnosing osteomyelitis in the appendicular skeleton, MRI with gadolinium-based contrast has 89% sensitivity (95% CI, 86-92%), 79% specificity (95% CI, 75-83%), and 90% overall diagnostic accuracy ([SE] = 0.03). For diagnosing osteomyelitis in the appendicular skeleton, MRI without gadolinium-based contrast has a 92% sensitivity (95% CI, 87-96%), 89% specificity (95% CI, 84-93%), and 96% overall diagnostic accuracy ([SE] = 0.03). The median score of included studies was 85% utilizing the STARD criteria with excellent interobserver agreement of 83.4%. Limitations included small sample size of studies, with retrospective designs.
No evidence was found to suggest an added diagnostic value of gadolinium contrast for the diagnosis of osteomyelitis in the appendicular skeleton. For routine cases of suspected non-spinal osteomyelitis, non-contrast MRI of the area of interest is the next most appropriate study after radiographs.
骨髓炎是骨髓的一种感染。对于疑似骨髓炎的病例，常进行基于钆对比剂的磁共振成像（MRI）检查。本系统评价的目的是检验对比增强MRI与非对比增强MRI对四肢骨骼骨髓炎的诊断准确性。
我们通过检索2000年1月至2020年3月的MEDLINE和EMBASE数据库，对MRI诊断骨髓炎进行了系统评价。有21项研究符合该系统评价的纳入标准，共纳入1095例患者。分析方法基于系统评价和Meta分析的首选报告项目。使用STARD标准评估报告的完整性和透明度来评价证据。
对于诊断四肢骨骼骨髓炎，基于钆对比剂的MRI敏感性为89%（95%CI，86-92%），特异性为79%（95%CI，75-83%），总体诊断准确性为90%（[SE]=0.03）。对于诊断四肢骨骼骨髓炎，非基于钆对比剂的MRI敏感性为92%（95%CI，87-96%），特异性为89%（95%CI，84-93%），总体诊断准确性为96%（[SE]=0.03）。纳入研究的中位数评分在使用STARD标准时为85%，观察者间一致性良好，为83.4%。局限性包括研究样本量小，且为回顾性设计。
未发现证据表明钆对比剂对四肢骨骼骨髓炎的诊断有额外的诊断价值。对于疑似非脊柱骨髓炎的常规病例，在进行X线检查后，对感兴趣区域进行非对比MRI检查是次优的检查方法。
